symptoms

Dengue / Dengue Hemorrhagic Fever / Dengue Shock Syndrome

 

Symptoms & Signs

Classic dengue fever is characterized by fever:

 Sudden and abrupt onset

May go up to 39.5-41.4°C

Lasts for about 1-7 days, then fades away for 1-2 days
It soon recurs with secondary rashes which is usually not as severe as before

Headaches:

Fever is usually accompanied by headache in front portion of head or behind the eyes

Muscular (Myalgia) or bone pain:

Occurs after onset of fever

Affects legs, joints, and lumbar spine

Usually the pain gets severe after its onset

The pain may last for several weeks even after the fever has subsided

Pain is usually absent in DHF/DSS

Other symptoms: 

Nausea and vomiting

Loss of appetite

Increased sensation to touch

Change in taste sensation

Symptoms maybe milder in children than in adults

The acute phase of illness can last for 1 week followed by a 1 to 2 week period of recovery period that is characterized by weakness, malaise and loss of appetite.

Rash - red and white patchy rashes: The illness is clinically indistinguishable from Influenza, Measles or Rubella.

Dengue Hemorrhagic Fever / Dengue Shock Syndrome

Initial stages of the disease resembles symptoms of dengue fever. However fever subsidies after 2 to 7 days followed by signs and symptoms of

Restlessness

Signs of circulatory failure

Bleeding or hemorrhagic manifestations including:

Skin bleeds that appear as blotchy red patches called - Petechiae

Bleeding from Nose or Epistaxis

Bleeding from Stomach - appearing as blood in the vomit


Bleeding from gums

Decrease in the blood platelet count (Thrombocytopenia)

Leakage of plasma from vascular compartment leading to increased blood concentration and manifestations of shock.

These symptoms when not treated may lead to Dengue Shock Syndrome, which when not treated immediately may lead to profound shock and eventually death.

Warning signs of Dengue Shock Syndrome are

Severe abdominal pain,                                                             

Vomiting,

Change in temperature,                                                                                

Mental irritability  

Symptoms

                                                         Dengue (pronounced DENG-gay) can affect anybody but it is more brutal in individuals with weak immune systems. The symptoms of dengue fever occur in stages and are as follows:

1. In the initial phase the patients suffer from coldness, headache, pain in the eyes while moving them around and backache in the lower part of body.
2. Sore aching in the legs and joints are also exhibited by patient in the early stages of infection.
3. Then the temperature of the person goes up rapidly as high as 104 F (40 C).
4. Redness occurs in the eyes followed by a pale pink rash over whole face and then it fades away.
5. The above symptoms continue for two to four days followed by a sudden fall in body temperature with prolific sweating.
6. This leads to a phase with average temperature and a feeling of comfort that continues for about a day.

7. A second brisk climb in temperature follows. Specific rashes develop together with the fever and extend from the boundaries to cover up the whole body apart from face 

 So the typical patient at any stage of infection exhibits following symptoms:

High fever and at least two of the following:

• Severe headache
• Acute eye pain (behind eyes)
• Pain in joints
• Intense muscle pain
• Rash
• Mild bleeding symptom
• Low count of white blood cells
• Mechanism of Dengue Action:
  The mechanism of dengue action is segregated into three phases named as: febrile, critical, and recovery phase.
  
  Febrile Phase:
  This is the initial phase which involves high fever, usually above 40 C and is accompanied with general pain and headache. It lasts for about two to seven days. In this phase, a rash arises throughout the body along with approximately 50–80% of other symptoms.The rash starts in the first or second day along with the fever which is itself biphasic in nature, breaks and then returns for one or two days.
  
  Critical Phase:
  If the patient’s immune system is weak and cannot combat with this infection then it enters into a critical phase in which high fever progresses to its peak and lasts from one to two days. In this phase there may be large fluid buildup in the chest and abdomen because of intense capillary permeability and leakage. This results in lessening of fluid and blood from the circulation which ultimately reduces supply of blood to vital organs of the body. In this phase, organ dysfunction and serious bleeding may take place from the gastrointestinal tract.
  
  Recovery Phase:
  The recovery phase proceeds after critical phase in which resorption of the seeped out fluid into the bloodstream occurs.This phase generally lasts two to three days. The recovery is often signaled, but there may possibly be intense itching and low blood pressure. This phase may involve damage to brain because of fluid overload which can result in reduced level of consciousness.
  
  Diagnosis
  Dengue fever becomes hard to spot because its signs tend to overlap with many other viral diseases. The first factor which indicates the presence of dengue fever is the low white blood cell count, which leads to low platelets count. In most of the cases the victims of dengue fever are usually diagnosed on the basis of fever plus two of the following symptoms: headache, vomiting, rash, pains in whole body, low white blood cell count, eye pain, severe muscle aches, positive tourniquet test, or any of the other symptoms associated with dengue fever

Epidemic of Dengue Virus across the World:

The global prevalence of dengue fever (DF) has grown dramatically in recent decades; DF is now endemic to more than100 countries. During the past decade, DHF epidemics have occurred in China, Sri Lanka, India, the Maldives, Bangladesh, and Pakistan

Expansion of Epidemic Dengue Viral Infection

In Pakistan, an outbreak of DHF was first reported in Karachi in 1994. From September through December 2005, at least 3 major hospitals in Karachi had a sudden increase in the number of patients with signs consistent with that of Dengue Viral Infections.

Today the Epidemic of Dengue Viral Infections has spread severely throughout the country. According to Dr. Javed Akram, the Head of Jinnah Hospital Lahore and chairman of dengue expert committee: Until date, officially more than 3,500 people have been infected and over a dozen have died from the recent dengue virus in Pakistan outbreaks

“These are the official figures but I think the number of unreported dengue patients is more than 500, 000.