Dengue shock syndrome

Alternative names

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

Definition

Dengue hemorrhagic fever is a severe, potentially fatal infection that occurs when someone with immunity to one type of Dengue virus is infected by a different type. It is spread by certain mosquitoes (Aedes aegypti) which bite primarily during the day. See also Dengue fever.

Causes, incidence, and risk factors

Four different dengue viruses have been implicated in both dengue fever and dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when the patient contracts a different dengue virus after previous infection(s) by another type. Prior immunity to a different dengue virus type is important in the production of this severe disease.

Worldwide, more than 100 million cases of dengue fever occur every year. A small percent of these develop into dengue hemorrhagic fever. Most cases in the U.S. are brought in from other countries. It is possible for a traveler who has returned to the United States to pass the infection to someone who has not traveled.

Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior 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 may appear as pinpoint spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Bleeding may occur from minor injuries.

Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.

Early symptoms include the following:

• Fever
  
• Headache
  
• Muscle aches
  
• Joint aches
  
• Malaise
  
• Decreased appetite
  
• Vomiting
  

Acute phase symptoms include the following:

• Shock-like state
  o Sweaty (diaphoretic)
  o Cold, clammy extremities
  
• Restlessness followed by:
  o Worsening of earlier symptoms
  o Petechiae
  o Ecchymosis
  o Generalized rash