Dengue Hemorrhagic Fever

By : dr. Dyah Agustina Lestari



Dengue fever is a disease caused by a family of viruses transmitted by mosquitoes. Infection with one serotype of DENV (DENV-1, -2, -3, and -4) provides immunity to that serotype for life, but provides no long-term immunity to other serotypes. Thus, a person can be infected as many as four times, once with each serotype. Dengue viruses are transmitted from person to person by Aedes mosquitoes (most often Aedes aegypti) in the domestic environment.

Epidemics have occurred periodically in the Western Hemisphere for more than 200 years. In the past 30 years, dengue transmission and the frequency of dengue epidemics have increased greatly in most tropical countries in the American region.                                  

What are the signs and symptoms?

In mild dengue fever symptoms can appear up to 7 days after being bitten by the mosquito that carries the virus.They include aching muscles and joints, body rash that can disappear and then reappear, high fever, intense headache, pain behind the eyes, vomiting and feeling nauseous. Symptoms usually disappear after a week, and mild dengue rarely involves serious or fatal complications.

The next level after dengue fever is Dengue hemorrhagic fever. At first, symptoms of DHF may be mild, but they gradually worsen within a few days. As well as mild dengue symptoms, there may be signs of internal bleeding. A person with Dengue hemorrhagic fever may experience like bleeding from the mouth, gums, or nose, clammy skin, damage to lymph and blood vessels, internal bleeding, which can lead to black vomit and feces, Or stools, a lower number of platelets  ( on full blood cell test) in the blood, sensitive stomach, small blood spots under the skin, weak pulse. Without prompt treatment, DHF can be fatal.                              

The last stage of sign and symptoms this dengue virus is Dengue shock syndrome.

DSS is a severe form of dengue. It can be fatal.Apart from symptoms of mild dengue fever, the person may experience : intense stomach pain, disorientation, sudden hypotension, or a fast drop in blood pressure, heavy bleeding, regular vomiting, blood vessels leaking fluid. Without treatment, this can result in death.

Diagnose Process

DHF can diagnosed  criteria included with history, sign or symptoms, and the criteria diagnosis DHF from World Health Organization (WHO) is:

  1. Fever or recent history of fever lasting 2–7 days.
  2. Any hemorrhagic manifestation.
  3. Trombocytopenia (platelet count of <100,000/mm3).
  4. Evidence of increased vascular permeability.

Or maybe with rapid diagnostic test :

  1. NS1Ag test during the febrile phase (first five days of fever): sensitivity 60–70%, specificity >99%.
  2. PCR – good sensitivity and specificity but expensive and not available in most places.
  3. ELISA- IgM, IgG test – not suitable for early diagnosis because the antibody significantly rises after day 5 of fever

Treatment of DHF

Best treatment for dengue fever is preventing dehydration. A high fever and vomiting can dehydrate the body. The person should drink clean water. Rehydration salts can also help replace fluids and minerals. Painkillers, such as Tylenol or paracetamol. These can help lower fever and ease pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are not advised, as they can increase the risk of internal bleeding.

More severe forms of dengue fever may need intravenous (IV) fluid supplementation, or drip, if the person cannot take fluids by mouth. Blood transfusion, for patients with severe dehydration

Hospitalization will allow the individual to be properly monitored, in case symptoms get worse.

Prevention of DHF

No vaccine can protect against dengue fever. Only avoiding mosquito bites can prevent it. Anyone who lives in or travels to an at-risk area can use a number of ways to avoid being bitten. Reduce the amount of skin exposed by wearing long pants, long-sleeved shirts, and socks, tucking pant legs into shoes or socks, and wearing a hat. Use a repellent with at least 10 percent concentration of diethyltoluamide (DEET), or a higher concentration for longer lengths of exposure. Avoid using DEET on young children. Nets treated with insecticide are more effective, otherwise the mosquito can bite through the net if the person is standing next to it.

The insecticide will kill mosquitoes and other insects, and it will repel insects from entering the room. Door and window screens: Structural barriers, such as screens or netting, can keep mosquitos out. Avoid scents: Heavily scented soaps and perfumes may attract mosquitos. Camping gear: Treat clothes, shoes, and camping gear with permethrin, or purchase clothes that have been pretreated. And also try to avoid being outside at dawn, dusk, and early evening. Reminding about the Aedes mosquito breeds in clean, stagnant water. Checking for and removing stagnant water can help reduce the risk.