Dengue fever history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Dengue virus infection has a wide spectrum of clinical manifestations, ranging from asymptomic infection, to symptoms of non-severe disease (such as flu-like symptoms, fever, retro-orbital headache, fatigue, arthralgia, myalgia, nausea, vomiting, or lymphadenopathy), and to severe complications including signs of plasma leakage (such as pleural effusion, hemoconcentration, or hypoproteinemia), hemorrhagic tendencies (such as petechiae, ecchymoses, purpura, easy bruising at venipuncture sites, mucosal bleeding, gastrointestinal bleeding, hematemesis. or melena), and organ failure associated with shock.[1]
History and Symptoms
After an incubation period of 4–10 days, the illness begins abruptly and is followed by the three phases — febrile phase, critical phase, and recovery phase.
Febrile Phase
The febrile phase of the disease is marked by the sudden onset of fever, along with a severe retro-orbital headache, myalgias (muscle pains) and arthralgias (joint pains). Indeed, the joint pains can be so bad that this has given rise to the name break-bone fever or bonecrusher disease. The dengue fever rash characteristically consists of bright red petechia and usually appears first on the lower limbs and the chest - in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting or diarrhea. Patients with Dengue fever may also have a case of swollen lymph nodes. There can be nose and mouth bleeding, which is to be distinguished from Dengue hemorrhagic fever in which there is more severe bleeding such as gastrointestinal (GI) bleeding.
Some cases develop much milder symptoms which can, when no rash is present, be misdiagnosed as influenza or other viral infection. Thus travelers from tropical areas may inadvertently pass on dengue in their home countries, having not been properly diagnosed at the height of their illness. Patients with dengue can only pass on the infection through mosquitoes or blood products while they are still febrile.
The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the fever (the so-called "biphasic pattern"). Clinically, the platelet count will drop until the patient's temperature is normal.
Critical Phase
During the critical phase of the disease, some patients develop hypotension, ascites, pleural effusions, and GI bleeding.
Recovery Phase
During the recovery phase, there can be altered mental status, seizures, itching and bradycardia.
Dengue Hemorrhagic Fever
A small proportion of patients develop Dengue Hemorrhagic Fever (DHF). In this scenario, they not only develop higher fever, but also hemorrhagic complications such as GI bleeding, and thrombocytopenia.
Dengue Shock Syndrome
A small proportion of patients can develop Dengue shock syndrome (DSS) which has a high mortality rate.
Referemces
- ↑ Thong, Meow-Keong (1998). "Dengue shock syndrome and acute respiratory distress syndrome". The Lancet. 352 (9141): 1712. doi:10.1016/S0140-6736(05)61496-1. ISSN 0140-6736.