Dengue hemorrhagic fever

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitos.

Incidence
Dengue Haemorrhagic Fever was first recognized in the 1950s during dengue epidemics in the
Philippines and Thailand.
The Philippines ranks 4th in the list of Association of Southeast Asian Nations (ASEAN) membercountries tormented by dengue
The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion
people over 40% of the world's population are now at risk from dengue. WHO currently estimates
there may be 50100 million dengue infections worldwide every year.

Causative Agent
The causative agent of denfue hemorrhagic fever (DHF) is dengue virus, of which there are 4 serotypes:
DENV-1, DENV-2, DENV-3 and DENV-4.
One of the characteristics of this virus is that it is a positive-sense, single stranded RNA virus. Once an
individual contracts one of the serotypes of dengue fever, he or she has lifelong immunity for that
serotype but not for the others.

Vector
Dengue is spread by the female Aedes aegypti mosquito that primarily lives in the tropical and
subtropical regions of the world. The virus is found within the salivary glands of the female mosquito
and can be passed from adult to egg, which allows it to survive from season to season.

Mode of Transmission
The virus is transmitted to humans through the bites of infected female mosquitoes. After virus
incubation for 410 days, an infected mosquito is capable of transmitting the virus for the rest of its life.
Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for
uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit the
infection (for 45 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.

Sesceptible
Who Is at High Risk for Dengue Hemorrhagic Fever?
Living in or traveling to Southeast Asia, South and Central America, Sub-Saharan Africa, and parts of the
Caribbean can increase your risk of contracting the dengue virus.
These patients are also at higher risk:
-infants and small children
-the elderly

-those with compromised immune systems

Incubation Period
The incubation period ranges from 812 days and then, the person infected can then transmit DENV for
the rest of their approximately 1-month lifespan.

Laboratory/Diagnostic
Physical examination may reveal:
Enlarged liver (hepatomegaly)
Low blood pressure
Rash
Red eyes
Red throat
Swollen glands
Weak, rapid pulse
Tests may include:
Arterial blood gases
Blood tests (find signs of the virus in the blood)
Coagulation studies
Electrolytes
Hematocrit
Liver enzymes
Platelet count
Serum studies from samples taken during acute illness and convalescence (increase in titer to
Dengue antigen)
Tourniquet test (causes petechiae to form below the tourniquet)
X-ray of the chest (may demonstrate pleural effusion)

Dengue Case Classification

1. Dengue without Warning Signs
Fever and two of the following:
Nausea, vomiting
Rash
Aches and pains
Leukopenia
Positive tourniquet test
2. Dengue with Warning Signs
Dengue as defined above with any of the following:
Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation (ascites, pleural effusion)
Mucosal bleeding
Lethargy, restlessness
Liver enlargement >2 cm

Laboratory: increase in HCT concurrent with rapid decrease in platelet count

**requires strict observation and medical intervention
3. Severe Dengue
Dengue with at least one of the following criteria:
Severe Plasma Leakage leading to:
Shock (DSS)
Fluid accumulation with respiratory distress

Severe Bleeding as evaluated by clinician

Severe organ involvement

Liver: AST or ALT 1000
CNS: impaired consciousness
Failure of heart and other organs

Phases of Illness
DHF may appear as a relatively benign infection at first but can quickly develop into life-threatening
illness as fever abates. DHF can usually be distinguished from DF as it progresses through its three
predictable pathophysiological phases:
Febrile phase: Viremia-driven high fevers
Critical/plasma leak phase: Sudden onset of varying degrees of plasma leak into the pleural and
abdominal cavities
Convalescence or reabsorption phase: Sudden arrest of plasma leak with concomitant reabsorption of
extravasated plasma and fluids

Management
Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the
only management is to treat the symptoms.

A transfusion of fresh blood or platelets can correct bleeding problems

Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances
Oxygen therapy may be needed to treat abnormally low blood oxygen
Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
Supportive care in an intensive care unit/environment