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Dengue Hemorrhagic Fever

Dengue virus is an infectious disease spread by mosquitoes. This specific virus is the cause of dengue hemorrhagic fever (DHF), a virus that has been reported in numerous countries around the world, with the first reported case in the kingdom in 1958.

Today, the annual number of people infected by the virus extends from tens to hundreds of thousands. The disease is most common during the rainy season, from around May to September. DHF can be found in people at any age and gender. However mostly seen in people aged 5-9 years old, followed by those aged 10-14, 0-4 and 15 years of age respectively. However, the disease has not been shown to affect people differently based on gender.

Dengue hemorrhagic fever does pose a major problem for the public health system due to mosquitoes being the carriers of the dengue virus. There are numerous species of mosquitoes, but only Aedes aegypti species can transmit dengue virus as they hunt during the daytime, lay their eggs in clean, stagnant water sources and are capable of carrying the disease for the duration of their 1- to 2-month lifespan.

The key symptoms of dengue hemorrhagic fever occur 5-8 days after the virus has entered the body. Symptoms include:

  1. Consistently high fever for 2-7 days
  2. Frequent bleeding from various points on the skin’s surface
  3. Hepatomegaly, meaning the liver is large enough to be felt when the area is touched, with any contact causing pain.
  4. Risk of circulatory function failure and possibility of shock

Symptoms of dengue hemorrhagic fever

People with acute DHF usually have an acute high fever, face redness, headaches and an aching body, followed by skin bleeding (petechiae) from various points, including the arms and legs. They may also lose their appetite, vomit, feel nauseous, develop stomach pain. They don’t want to drink any fluids and generally feel down, depressed and don’t want to speak with anyone.

Some patients may also suffer from nosebleeds, pass black stools or vomit blood. People with DHF do not usually present any symptoms of a common cold, including coughing. The most dangerous time is the period when the fever begins to decrease after around 2-7 days. Only 2-3 % of patients develop shock which can lead to death if they suffer a severe shock or receive late treatment.

Other symptoms include cold hands and feet, discomfort, as well as an increased or decreased pulse rate. In cases where there is a severe drop in blood pressure, shock or death are both possible. Nevertheless, treatment for dengue hemorrhagic fever can be effective where the disease is diagnosed early enough.

Severity of dengue hemorrhagic  fever

The levels of severity for this condition can be categorized into the following four stages:

Grade 1: High fever with no signs of bleeding. At this stage, treatment in the form of drinking plenty of water and frequently dabbing the patient with a damp cloth to alleviate their fever can be effective.

Grade 2: If patients are still able to eat and drink as usual, this stage may not necessitate admission to a hospital. However, if they are unable to eat or drink, they should be brought to hospital to be diagnosed and monitored.

Grade 3: If the patient’s pulse is weak, but has rapid pulse rate and they are also suffering from cold hands and feet, pale complexion and severe discomfort, it is a sign of a drop in blood pressure. The patient should be brought in to see a doctor and have vital signs examined immediately.

Grade 4: In cases where there is a serious drop in blood pressure, meaning it is difficult to even take a reading or the patient is suffering from shock, the patient should be brought to hospital immediately.

Some patients may only present grade 1 or 2 symptoms which might not require a stay in hospital. However, some patients have severe grade 3 or 4 symptoms and need to be admitted to hospital for immediate attention.

Diagnosing dengue hemorrhagic fever

When attending a consultation, the doctor will first inquire about the patient’s medical history before carrying out a full body examination and detailed blood test.

Prevention

  • Avoid mosquito bites
  • Limit the amount of potential mosquito breeding grounds, such as pools of stagnant, clean water
  • Vaccine against dengue hemorrhagic fever is under research

Treatment

  • Drink plenty of water and frequently dab the patient with a damp cloth.
  • Take paracetamol (Aspirin or ibuprofen should not be taken since they can increase the risk of bleeding).
  • Patients who seek medical attention early enough can decrease the risk of bleeding, shock and other medical complications.

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Clinical professor Sanay Chearskul, M.D. Summary: Pediatrics Pediatrics