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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Dengue hemorrhagic fever

Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever; Thai hemorrhagic fever; Singapore hemorrhagic fever

Last reviewed: November 10, 2012.

Dengue hemorrhagic fever is a severe, potentially deadly infection spread by mosquitos, mainly the species Aedes aegypti.

Causes

Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person is bitten by a mosquito that is infected with the virus.

There are more than 100 million new cases of dengue fever every year throughout the world. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from an earlier infection and being younger than 12, female, or Caucasian.

Symptoms

Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever. But after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock-like state.

Bleeding appears as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries can cause bleeding.

Shock can lead to death. If the patient survives, recovery begins after a one-day crisis period.

Early symptoms include:

  • Decreased appetite
  • Headache
  • Joint or muscle aches
  • Vomiting

Acute phase symptoms include:

  • Restlessness followed by:
    • Ecchymosis
    • Generalized rash
    • Worsening of earlier symptoms
  • Shock-like state

Exams and Tests

A physical examination may reveal:

Tests may include:

Treatment

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

Outlook (Prognosis)

With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.

Possible Complications

When to Contact a Medical Professional

See your health care provider right away if you have symptoms of dengue fever and have been in an area where dengue fever occurs, and especially if you have had dengue fever before.

Prevention

There is no vaccine to prevent dengue fever. Use personal protection such as full-coverage clothing, mosquito nets, mosquito repellent containing DEET. If possible, travel during times of the day when mosquitos are not so active. Mosquito abatement (control) programs can also reduce the risk of infection.

References

  1. Haile-Mariam T, Polis MA. Viral illnesses. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 128.
  2. Lupi O. Mosquito-borne hemorrhagic fevers. Dermatologic Clinics. 2011;29:33-38. [PubMed: 21095525]
  3. Vaughn DW, Barrett A, Solomon T. Flaviviruses (Yellow Fever, Dengue, Dengue Hemorrhagic Fever, Japanese Encephalitis, West Nile Encephalitis, St. Louis Encephalitis, Tick-Borne Encephalitis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 153. 

Review Date: 11/10/2012.

Reviewed by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Corticosteroids for treating dengue infection in children and adultsCorticosteroids for treating dengue infection in children and adults
    Dengue is a disease caused by a virus transmitted by mosquitoes, occurring in many resource‐limited countries, and children are often most severely affected. Most infected patients will recover with mild symptoms, but a few progress to severe dengue and may die. There is no specific treatment for dengue, but some clinicians provide corticosteroids at an early stage to prevent progression to severe dengue disease; and some treat patients with dengue‐related shock with corticosteroids to improve survival. It is important to summarise the effects of corticosteroids in dengue.
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Figures

  • Mosquito, adult feeding on the skin.
    Mosquito, adult.
    Mosquito, egg raft.
    Mosquito, larvae.
    Mosquito, pupa.
    Antibodies.

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