Dengue hemorrhagic fever is a disease caused by Aedes mosquitoes, which are a concern for everyone, especially during the rainy season when water collects and mosquitoes are more common. If bitten by an infected mosquito, you could contract this severe and potentially fatal illness. Let’s explore what symptoms to watch for and at what stage the condition becomes dangerous.
Interesting Facts About Dengue Hemorrhagic Fever
Dengue hemorrhagic fever (DHF) is a severe form of dengue fever caused by the dengue virus(DF), which is transmitted by Aedes mosquitoes. Although it is most common during the rainy season, cases can occur year-round. Each year, a significant number of infections are reported.
Dengue hemorrhagic fever is caused by the dengue virus, which has four serotypes: DEN-1, DEN-2, DEN-3, and DEN-4. These viruses are transmitted by Aedes mosquitoes. Once a person has been infected with one serotype, they gain lifelong immunity to that specific serotype but only temporary immunity to the other serotypes, which lasts about 3 to 12 months.
Dengue hemorrhagic fever is not spread directly from person to person. Instead, it is transmitted by female Aedes mosquitoes, which act as carriers. When a mosquito bites someone who is in the fever stage—when the virus is present in high levels in the bloodstream—the virus enters the mosquito’s digestive system, multiplies, and then moves to its salivary glands. The mosquito can then pass the virus to another person through its bite.
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Fever typically spikes for 2-7 days and can reach up to 40°C. 
Loss of appetite, headaches, body aches, and flushed face.
Thrombocytopenia (low platelet count): In cases of low platelet counts, small red spots may appear on the skin due to bleeding under the skin, which is the origin of the name "dengue hemorrhagic fever."
There may be abdominal pain due to liver enlargement, often tender under the right costal margin.
*Most patients experience mild symptoms and recover on their own, but a small percentage may develop severe symptoms, such as significant bleeding, particularly in the gastrointestinal tract, or fluid leakage from blood vessels, leading to low blood pressure, shock, and unconsciousness.
During this phase, patients experience a sudden high fever lasting 2-7 days, which can reach up to 40°C Unlike a common cold, there is usually no runny nose or cough. If the fever becomes too high, seizures may occur. Other symptoms include severe headaches, eye pain, loss of appetite, nausea, and vomiting.
Some patients may have a red throat or flushed face. Small red spots may appear on the arms, legs, armpits, or torso due to bleeding under the skin. In some cases, nosebleeds, abdominal pain, or black stool may occur. Liver enlargement may cause pain under the right costal margin.
It is recommended to seek medical attention during the febrile phase to closely monitor the condition. 
During the critical phase, plasma leakage occurs in all patients, leading to shock in some cases. This phase typically happens just before or at the same time as a rapid drop in fever.
Patients in shock may exhibit restlessness, excessive sweating, and cold hands and feet. Their pulse may be weak and rapid, but most remain conscious and able to communicate. They may also feel extreme thirst. If shock is treated promptly, most patients recover quickly. However, if shock persists, there can be severe internal bleeding, especially in the gastrointestinal tract.
If left untreated, shock can lead to death within 12-24 hours. Immediate and proper treatment is crucial for survival.
The recovery phase occurs relatively quickly, within 24-48 hours after the fever subsides. During this time, a rash may appear, characterized by white spots on a red background, often causing itchiness. This rash typically lasts for 2-4 days.
Patients may experience increased urination, and in some cases, a slow pulse may be detected. They begin to regain their appetite and can drink and eat more.
Patients who have passed the critical stage will show signs of improvement, such as a decrease in fever, increased alertness, and overall better mental clarity. 
Dengue fever is characterized by a sudden high fever, which may be accompanied by nosebleeds and small red spots on the body, indicating internal bleeding. In contrast, the common cold typically presents with a high fever that persists, along with respiratory symptoms such as coughing and a runny nose.
It's important to closely monitor patients after their fever subsides, as there is a risk of shock or severe bleeding, which can be life-threatening.
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Stay Hydrated Drink plenty of fluids or oral rehydration solutions. To ensure adequate hydration, check the color of your urine. It should be light yellow. Dark yellow or tea-colored urine indicates dehydration.
Fever Management Use paracetamol (acetaminophen) as prescribed by your doctor. Do not exceed the recommended dose to avoid the risk of liver damage.
Avoid Aspirin Aspirin should be avoided as it can increase the risk of bleeding.
Seek Medical Attention Contact a healthcare provider immediately if you experience symptoms such as vomiting blood, black stools, excessive vomiting, persistent dehydration despite drinking fluids, or cold extremities. These may indicate severe conditions like low blood pressure and shock. Extremities
Contagion Dengue fever is not spread through casual contact or shared food.
Bathing During Fever Use warm water for bathing or sponge baths to prevent excessive heat loss and shivering. Avoid cold water, which can lead to a rapid loss of body heat.
Dengue fever is managed symptomatically and with supportive care, as there is currently no specific antiviral treatment. Early detection and close monitoring can significantly reduce the risk of death. Here are the recommended care guidelines:
Fever Management Use paracetamol to reduce fever. Avoid aspirin, as it can cause abnormal bleeding and gastric irritation.
Fluid Replacement Ensure adequate hydration since patients often experience dehydration due to high fever and vomiting. For those who can tolerate oral intake, frequently drink oral rehydration solutions. If severe dehydration, bleeding, vomiting, or bloody stools occur, hospitalization may be necessary.
Close Monitorin Regularly check the patient's condition. Look for signs of abdominal pain, reduced urine output, restlessness, and cold extremities, especially as the fever subsides.
Dengue Fever is a serious illness that can be severe and even fatal if not diagnosed and treated promptly. Currently, treatment is symptomatic and supportive, with close monitoring of the patient's condition.
As there is no specific antiviral medication available for dengue fever, vaccination is the only preventive measure currently available.
Therefore, if anyone shows symptoms, especially children and individuals with pre-existing conditions, it is crucial to seek medical attention immediately for timely treatment.
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Composer: Supansa Niewbopha, MD
Last edited : 17/09/2024
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