Causes Four different dengue viruses are known to cause dengue hemorrhagic fever.

Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunity to a different dengue virus type plays an important role in this severe disease. Worldwide, more than 1 million cases of dengue fever occur every year. ! small number of these develop into dengue hemorrhagic fever. "ost infections in the #nited $tates are brought in from other countries. %t is possible, but uncommon, for a traveler who has returned to the #nited $tates to pass the infection to someone who has not traveled. &isk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 1', female, or Caucasian. (ack to )op$ymptoms *arly symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. )hese symptoms are followed by a shock +like state. (leeding may appear as tiny spots of blood on the skin ,petechiae- and larger patches of blood under the skin ,ecchymoses-. "inor in.uries may cause bleeding. $hock may cause death. %f the patient survives, recovery begins after a one+day crisis period. *arly symptoms include/ Decreased appetite Fever 0eadache 1oint aches "alaise "uscle aches 2omiting !cute phase symptoms include/ &estlessness followed by/ *cchymosis 3enerali4ed rash

Petechiae Worsening of earlier symptoms $hock+like state Cold, clammy e5tremities $weatiness ,diaphoretic-