About Dengue Hemorrhagic Fever
Dengue hemorrhagic fever (DHF) is a severe form of dengue fever, which is a common mosquito-borne illness. The definition of DHF includes the presence of at least the first two of the following four clinical manifestations:
- Sudden onset acute fever lasting for 2 to 7 days
- Spontaneous bleeding (unexpected bleeding) manifestations or a positive tourniquet test (tiny red spots on the skin after a blood pressure test)
- Enlarged liver (hepatomegaly).
- Circulatory failure (inability of the heart or blood vessels to deliver enough blood to meet the body’s needs), along with low platelet count (thrombocytopenia) and an increased hematocrit level
Suspected DHF cases are further assessed and classified as probable or confirmed cases. A probable case means the person has positive blood test results for dengue or has been in contact with others who have confirmed DHF. A confirmed case is diagnosed through laboratory tests, such as DENV isolation (growing the virus in a lab from a sample) or detecting its antigens (proteins from the virus) or RNA (genetic material) in the blood.
It's important to note that DHF can progress into a more serious condition known as severe dengue, which may have life-threatening complications.
Dengue hemorrhagic fever is caused by various disease cause factors, including:
- Vascular damage: DHF causes blood vessels to become more permeable, meaning they allow plasma (the liquid part of the blood) to leak into surrounding tissues, which can lead to bleeding. Infected cells release inflammatory proteins, called cytokines, which activate the cells lining the blood vessels (endothelial cells). This process also involves adhesion molecules, which help immune cells stick to blood vessel walls, contributing to inflammation.
- Excessive cytokine response: As the disease progresses, infected cells produce inflammatory cytokines such as TNF-alpha, IL-6, and IL-10. These proteins make blood vessels for leaky, allowing fluids to escape into surrounding tissue.
Risk factors for DHF include:
- Dengue virus exposure: Once you contract one type of dengue virus, you develop immunity to that specific virus but remain susceptible to other types. Repeated exposure to different types of the dengue virus increases the risk of developing severe DHF.
- Mosquito exposure: Being bitten by infected mosquitoes is the most common cause of dengue virus transmission. Taking preventive measures, such as using mosquito repellents and eliminating breeding sites, can reduce the risk of mosquito bites.
- Geographic location: Living in areas with a high prevalence of dengue mosquitoes increases the risk of DHF. Different regions may have varying levels of risk due to mosquito populations and environmental factors. According to the Centers for Disease Control and Prevention, these areas include the Americas (Central and South America), Africa, the Middle East, Asia (Souteast Asia), and Pacific Islands.
Remember, it's important to consult with your healthcare professional for personalized advice on managing your risk factors or symptoms related to DHF.
Early symptoms of dengue hemorrhagic fever include:
- Mild to high fever
- Headaches
- Nausea
- Vomiting
- Muscle, bone, or joint pain
- Rashes on the skin
- Pain with eye movements
As DHF progresses, additional symptoms may occur, such as:
- Restlessness
- Acute fever
- Severe abdominal pain
- Bleeding or bruising under the skin
- Cold or clammy skin
- Nosebleeds
- Steep decrease in blood pressure (shock)
It's important to note that these symptoms can vary from person to person. If you experience any of these symptoms, especially if they worsen or become severe, it's crucial to seek medical attention immediately. DHF can be a serious condition, and early diagnosis and treatment are essential for a better outcome. Remember to consult your healthcare professional for personalized advice and guidance.
To diagnose dengue hemorrhagic fever, doctors may perform the following examinations, tests, and procedures:
- Physical exam: The healthcare provider will check for signs like dehydration, abdominal tenderness, or an enlarged liver. They may also assess mental alertness to identify potential complications.
- Blood pressure check: The doctor will measure your blood pressure to assess any abnormalities.
- Skin, eye, and gland examination: The healthcare provider will examine your skin for rashes or small red spots (petechiae), the eyes for redness or irritation, and the glands for swelling, which may indicate inflammation or infection related to DHF.
- Blood tests: These tests help determine the type of dengue virus and its severity. They may include a complete blood count (CBC), coagulation (blood clotting) studies, and testing for dengue-specific antigens or antibodies.
- Chest X-ray: This imaging study may be performed to assess lung involvement or complications.
Additional examinations, tests, and procedures may be recommended:
- Repeat blood tests: Regular monitoring of blood counts and clotting ability (coagulation parameters) helps track how the disease is progressing and identify any complications.
- Imaging studies: Depending on the symptoms and suspected complications, additional imaging studies such as MRI (magnetic resonance imaging) scan or ultrasound may be performed to assess organ involvement.
It's important to note that these are general guidelines, and the specific tests and procedures may vary depending on individual circumstances. Always consult with your healthcare provider for an accurate diagnosis and appropriate management.
The goals of treatment for dengue hemorrhagic fever are to manage symptoms and prevent the infection from worsening. Close monitoring of blood pressure, body response, platelet count, hematocrit, and urine output throughout treatment is crucial.
Here are the different types of treatments and therapies recommended:
- Medications: Pain relief medications such as acetaminophen can help reduce fever and manage pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen are not suitable as they can increase the risk of internal bleeding.
- Therapies: Electrolyte therapy helps maintain proper electrolyte balance in the body. Oxygen therapy provides additional oxygen to improve breathing. Skilled nursing observation ensures close monitoring of your condition.
- Therapeutic procedures: Blood transfusions may be necessary in severe cases to replace lost blood or platelets. IV (intravenous) fluid supplementation helps with hydration, but excessive IV fluids can lead to fluid leakage.
- Self-care and health behavior changes:
- Resting and staying hydrated are important for recovery. Drinking water can prevent dehydration.
- Preventative measures: Mosquito repellents and permethrin treated clothing.
These treatments aim to control symptoms, prevent complications like dengue shock syndrome, and support the body's natural healing process. It's important to consult with your healthcare professional for personalized advice on medication dosing and potential side effects.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.