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Potentially life-threatening emergency
Dengue hemorrhagic fever
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Potentially life-threatening emergency

Dengue hemorrhagic fever

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Contributors: Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Dengue hemorrhagic fever (DHF) is a life threatening illness that is caused by dengue virus, an RNA-containing flavivirus. It is transmitted to humans by the bite of a mosquito, principally Aedes aegypti. The hemorrhagic form is believed to be more likely to occur during secondary infections with the dengue virus, especially if the secondary infection involves a different serotype.

The disease is widespread in Southeast Asia and the western Pacific, and more recently in Cuba, Central America, the Caribbean, and South America. Dengue affects an estimated 50 million people annually, with DHF affecting approximately 500 000 people. The disease is most common in children under 15 years of age. A vaccine is under development. Transmission of dengue virus via allogeneic blood cell transplantation has been documented.

DHF typically begins with the abrupt onset of high fever (40°C-41°C [104°F-105.8°F]), facial flushing, circumoral cyanosis, and headache. Sore throat, anorexia, weakness, abdominal pain, nausea, and vomiting are common. This febrile phase lasts for 2-7 days and may be accompanied by a maculopapular rash. Many cases are accompanied by petechiae and nonpalpable purpura on the extremities, trunk, and face. Bleeding from the nose, gums, and gastrointestinal (GI) tract may be noted. Moderate cases will resolve after the fever subsides. However, after a few febrile days, the critical stage of plasma leakage may occur following a rapid drop in temperature. Circulatory failure accompanied by diaphoresis with cool extremities and shock may herald dengue shock syndrome (DSS). Death rates of up to 20% are reported and usually occur within 24 hours of DSS.

Patients with sickle cell disease or trait may be at increased risk of death from dengue.

In October 2013, discovery of a new dengue virus serotype, dengue 5, was announced; it is thought to be phylogenetically distinct from the other 4 types.

Related topic: Dengue Fever

Codes

ICD10CM:
A91 – Dengue hemorrhagic fever

SNOMEDCT:
20927009 – Dengue hemorrhagic fever

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

In the absence of hemorrhagic findings, all other tropical fevers and worldwide causes of fever with or without rash must be ruled out.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 08/30/2016
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Potentially life-threatening emergency
Dengue hemorrhagic fever
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Dengue hemorrhagic fever : Abdominal pain, Fever, Headache, Nausea/vomiting, Patient appears systemically ill - toxic, Ecchymosis, Conjunctival injection
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