From the Guidelines
Dengue hemorrhagic syndrome is a severe form of dengue fever characterized by bleeding complications, plasma leakage, and potential shock, defined as an acute febrile illness with minor or major bleeding phenomena, thrombocytopenia, and evidence of plasma leakage documented by hemoconcentration or other objective evidence of increased capillary permeability 1.
Key Characteristics
- Bleeding complications
- Plasma leakage
- Potential shock
- Thrombocytopenia (less than or equal to 100,000/mm3)
- Evidence of plasma leakage documented by hemoconcentration (hematocrit increased by greater than or equal to 20%) or other objective evidence of increased capillary permeability
Treatment and Management
- Supportive care with intravenous fluids to prevent shock
- Careful monitoring of vital signs and blood parameters
- Management of bleeding complications
- No specific antiviral medication for dengue
- Patients with suspected dengue hemorrhagic syndrome require immediate medical attention and often hospitalization for close monitoring
- Prevention involves avoiding mosquito bites through repellents, protective clothing, and eliminating mosquito breeding sites
Critical Phase
- Typically occurs after the fever subsides (days 3-7 of illness)
- Life-threatening if not properly managed
- Requires close monitoring and supportive care to prevent complications and improve outcomes 1.
From the Research
Definition of Dengue Haemorrhagic Syndrome
- Dengue haemorrhagic fever (DHF) is a viral haemorrhagic disease characterized by bleeding and plasma leakage 2.
- It is a severe form of dengue infection, which occurs mostly during a secondary dengue virus infection 2.
- The characteristic feature of DHF is the transient period of plasma leakage and a haemorrhagic tendency 2.
Clinical Manifestations
- DHF can progress to fulminant liver failure with a high fatality rate 3.
- Clinical manifestations of fatal DHF include massive gastrointestinal bleeding, dengue shock syndrome, concurrent bacteremia, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage 4.
- Warning signs of severe dengue include hypothermia, leukocytosis, and bandemia 4.
Pathogenesis
- The pathogenesis of DHF is complex and involves a interaction between the virus, host immune response, and endothelial cells 2.
- Serotype cross-reactive antibodies and mediators from serotype cross-reactive Dengue-specific T cells have been implicated in the pathogenesis of DHF 2.
- Angiogenic factors and the role of dengue virus on endothelial cell transcription and functions have also been studied in the context of DHF 2.
Management
- Management of DHF is predominantly supportive and includes methods to judiciously resolve shock and control bleeding while preventing fluid overload 5.
- Treatment is supportive, and outcomes can be optimized by early recognition and cautious titrated fluid replacement, especially in resource-limited environments 5.
- The use of N-acetyl cysteine and activated recombinant factor VII has been reported to be effective in the management of fulminant liver failure and massive bleeding associated with DHF 3.