|Dengue Fever (DF)|
|Dengue Haemorrhagic Fever (DHF)|
Figure 1: Dengue fever symptoms. A: Hospital with dengue patients, B: Dengue fever rash, C: Patient with dengue hemorrhagic fever
Video 1. Dengue epidemic in Asia. Example of clinical dengue fever symptoms
Recognition of Dengue fever
- Sudden onset of high fever
- Severe headache (mostly in the forehead)
- Pain behind the eyes which worsens with eye movement
- Body aches and joint pains
- Nausea or vomiting
Figure 2: Typical dengue fever symptoms, patients with dengue fever rash
Dengue virus infections are sometimes confused with chikungunya viral infection, because both diseases can present with high temperatures and myalgias (muscle pain) in people living in or returning from tropical areas (see table 1). Although these diseases share similar clinical features, prominent and prolonged joint pains are more consistent with chikungunya, whereas haemorrhage is more common in cases of dengue virus infection.
Table 1. Comparison of the Clinical Features of Dengue Fever and Chikungunya Fever|
Symbols indicate the percentage of patients exhibiting each feature: +++, 70%–100% of patients; ++, 40%–69%; +, 10%–39%; +/-, <10%; -, 0%. Adapted from CID 2009; 49:942
In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock. The Dengue Shock Syndrome (DSS) is characterized by bleeding that may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding (see figure 4). Shock may cause death within 12 to 24 hours. Patients can recover following appropriate medical treatment.
The progress towards DHF or DSS occur after 3-5 days of fever (see figure 3). At this time, fever has often come down. This may mislead many of us to believe that the patient is heading towards recovery. In fact, this is the most dangerous period that requires high vigilance from care-givers.
Figure 3. Generalized time course of the events associated with DF, DHF and DSS. The incubation period before the development of signs of infection generally ranges from 4 to 7 days.
Recognition of Dengue Haemorrhagic Fever (DHF)
- Symptoms similar to dengue fever plus, any one of the following:
- Severe and continuous pain in abdomen
- Bleeding from the nose, mouth and gums or skin bruising
- Frequent vomiting with or without blood
- Black stools, like coal tar
- Excessive thirst (dry mouth)
- Pale, cold skin
- Restlessness, or sleepiness
Dengue shock syndrome is defined as dengue hemorrhagic fever plus:
- Weak rapid pulse
- Narrow pulse pressure (less than 20 mm Hg)
- Cold, clammy skin and restlessness.
Figure 4: Patients with dengue hemorrhagic fever