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* The febrile phase is characterized by an abrupt onset of high [[fever]] which usually lasts 2–7 days, with a smaller peak at the trailing end of the fever (the so-called ''biphasic pattern''). Accompanying symptoms include [[facial flushing]], [[erythema|skin erythema]], generalized body aches, [[myalgia]], [[arthralgia]], retro-orbital [[eye pain]], [[photophobia]], [[rubella|rubeliform]] [[exanthem]] and [[headache]]. The joint aches can be so intense that this has given rise to the name ''[[breakbone fever]]'' or ''[[bonecrusher disease]]''. Some patients may have [[sore throat]], [[inflammation|injected]] [[pharynx]] or [[conjunctiva]], [[lymphadenopathy|swollen lymph nodes]], [[anorexia]], [[nausea]], or [[vomiting]]. | * The febrile phase is characterized by an abrupt onset of high [[fever]] which usually lasts 2–7 days, with a smaller peak at the trailing end of the fever (the so-called ''biphasic pattern''). Accompanying symptoms include [[facial flushing]], [[erythema|skin erythema]], generalized body aches, [[myalgia]], [[arthralgia]], retro-orbital [[eye pain]], [[photophobia]], [[rubella|rubeliform]] [[exanthem]] and [[headache]]. The joint aches can be so intense that this has given rise to the name ''[[breakbone fever]]'' or ''[[bonecrusher disease]]''. Some patients may have [[sore throat]], [[inflammation|injected]] [[pharynx]] or [[conjunctiva]], [[lymphadenopathy|swollen lymph nodes]], [[anorexia]], [[nausea]], or [[vomiting]]. | ||
* Mild hemorrhagic manifestations such as [[petechiae]] and [[mucosal]] membrane [[bleeding]] (e.g. of the [[nose]] and [[gums]]) may be seen. [[bruising|Easy bruising]] and [[bleeding]] at [[venipuncture|venipuncture sites]] is present in some cases. The petechiael rash usually appears first on the lower limbs and the chest and may spread to other parts of the body in some patients. Massive [[vaginal bleeding]] in women of childbearing age and [[gastrointestinal bleeding]] occur less commonly in this phase.<ref name="KalayanaroojVaughn1997">{{cite journal|last1=Kalayanarooj|first1=S.|last2=Vaughn|first2=D. W.|last3=Nimmannitya|first3=S.|last4=Green|first4=S.|last5=Suntayakorn|first5=S.|last6=Kunentrasai|first6=N.|last7=Viramitrachai|first7=W.|last8=Ratanachu‐eke|first8=S.|last9=Kiatpolpoj|first9=S.|last10=Innis|first10=B. L.|last11=Rothman|first11=A. L.|last12=Nisalak|first12=A.|last13=Ennis|first13=F. A.|title=Early Clinical and Laboratory Indicators of Acute Dengue Illness|journal=The Journal of Infectious Diseases|volume=176|issue=2|year=1997|pages=313–321|issn=0022-1899|doi=10.1086/514047}}</ref> A positive tourniquet test in the febrile phase indicates an increased probability of dengue.<ref name="KalayanaroojVaughn1997">{{cite journal|last1=Kalayanarooj|first1=S.|last2=Vaughn|first2=D. W.|last3=Nimmannitya|first3=S.|last4=Green|first4=S.|last5=Suntayakorn|first5=S.|last6=Kunentrasai|first6=N.|last7=Viramitrachai|first7=W.|last8=Ratanachu‐eke|first8=S.|last9=Kiatpolpoj|first9=S.|last10=Innis|first10=B. L.|last11=Rothman|first11=A. L.|last12=Nisalak|first12=A.|last13=Ennis|first13=F. A.|title=Early Clinical and Laboratory Indicators of Acute Dengue Illness|journal=The Journal of Infectious Diseases|volume=176|issue=2|year=1997|pages=313–321|issn=0022-1899|doi=10.1086/514047}}</ref><ref name="MayxayPhetsouvanh2011">{{cite journal|last1=Mayxay|first1=Mayfong|last2=Phetsouvanh|first2=Rattanaphone|last3=Moore|first3=Catrin E|last4=Chansamouth|first4=Vilada|last5=Vongsouvath|first5=Manivanh|last6=Sisouphone|first6=Syho|last7=Vongphachanh|first7=Pankham|last8=Thaojaikong|first8=Thaksinaporn|last9=Thongpaseuth|first9=Soulignasack|last10=Phongmany|first10=Simmaly|last11=Keolouangkhot|first11=Valy|last12=Strobel|first12=Michel|last13=Newton|first13=Paul N.|title=Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adults|journal=Tropical Medicine & International Health|volume=16|issue=1|year=2011|pages=127–133|issn=13602276|doi=10.1111/j.1365-3156.2010.02641.x}}</ref> | * Mild hemorrhagic manifestations such as [[petechiae]] and [[mucosal]] membrane [[bleeding]] (e.g. of the [[nose]] and [[gums]]) may be seen. [[bruising|Easy bruising]] and [[bleeding]] at [[venipuncture|venipuncture sites]] is present in some cases. The petechiael rash usually appears first on the lower limbs and the chest and may spread to other parts of the body in some patients. Massive [[vaginal bleeding]] in women of childbearing age and [[gastrointestinal bleeding]] occur less commonly in this phase.<ref name="KalayanaroojVaughn1997">{{cite journal|last1=Kalayanarooj|first1=S.|last2=Vaughn|first2=D. W.|last3=Nimmannitya|first3=S.|last4=Green|first4=S.|last5=Suntayakorn|first5=S.|last6=Kunentrasai|first6=N.|last7=Viramitrachai|first7=W.|last8=Ratanachu‐eke|first8=S.|last9=Kiatpolpoj|first9=S.|last10=Innis|first10=B. L.|last11=Rothman|first11=A. L.|last12=Nisalak|first12=A.|last13=Ennis|first13=F. A.|title=Early Clinical and Laboratory Indicators of Acute Dengue Illness|journal=The Journal of Infectious Diseases|volume=176|issue=2|year=1997|pages=313–321|issn=0022-1899|doi=10.1086/514047}}</ref> A positive tourniquet test in the febrile phase indicates an increased probability of dengue.<ref name="KalayanaroojVaughn1997">{{cite journal|last1=Kalayanarooj|first1=S.|last2=Vaughn|first2=D. W.|last3=Nimmannitya|first3=S.|last4=Green|first4=S.|last5=Suntayakorn|first5=S.|last6=Kunentrasai|first6=N.|last7=Viramitrachai|first7=W.|last8=Ratanachu‐eke|first8=S.|last9=Kiatpolpoj|first9=S.|last10=Innis|first10=B. L.|last11=Rothman|first11=A. L.|last12=Nisalak|first12=A.|last13=Ennis|first13=F. A.|title=Early Clinical and Laboratory Indicators of Acute Dengue Illness|journal=The Journal of Infectious Diseases|volume=176|issue=2|year=1997|pages=313–321|issn=0022-1899|doi=10.1086/514047}}</ref><ref name="MayxayPhetsouvanh2011">{{cite journal|last1=Mayxay|first1=Mayfong|last2=Phetsouvanh|first2=Rattanaphone|last3=Moore|first3=Catrin E|last4=Chansamouth|first4=Vilada|last5=Vongsouvath|first5=Manivanh|last6=Sisouphone|first6=Syho|last7=Vongphachanh|first7=Pankham|last8=Thaojaikong|first8=Thaksinaporn|last9=Thongpaseuth|first9=Soulignasack|last10=Phongmany|first10=Simmaly|last11=Keolouangkhot|first11=Valy|last12=Strobel|first12=Michel|last13=Newton|first13=Paul N.|title=Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adults|journal=Tropical Medicine & International Health|volume=16|issue=1|year=2011|pages=127–133|issn=13602276|doi=10.1111/j.1365-3156.2010.02641.x}}</ref> | ||
* These clinical features do not predict the severity of dengue fever. Therefore, it is crucial to monitor for warning signs and other clinical parameters (see table below) in order to recognize progression to the critical phase. | |||
{| class=wikitable style="font-size: 85%; margin: 0 20px;" | |||
! colspan=2 | Warning signs requiring strict observation and medical intervention | |||
|- | |||
| valign=top style="width: 200px;" | | |||
* Abdominal pain or tenderness | |||
* Persistent vomiting | |||
* Clinical fluid accumulation | |||
* Mucosal bleed | |||
| valign=top style="width: 200px;" | | |||
* Lethargy, restlessness | |||
* Liver enlargment >2 cm | |||
* Increase in hematocrit concurrent with rapid decrease in platelet count | |||
|} | |||
* The earliest abnormality in the full blood count is a progressive decrease in [[white cell]] count, which should alert the physician to a high probability of dengue. The [[platelet]] count usually begins to drop when the temperature returns to normal. | * The earliest abnormality in the full blood count is a progressive decrease in [[white cell]] count, which should alert the physician to a high probability of dengue. The [[platelet]] count usually begins to drop when the temperature returns to normal. | ||
Revision as of 16:57, 10 June 2014
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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.
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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.[2]
Febrile Phase
- The febrile phase is characterized by an abrupt onset of high fever which usually lasts 2–7 days, with a smaller peak at the trailing end of the fever (the so-called biphasic pattern). Accompanying symptoms include facial flushing, skin erythema, generalized body aches, myalgia, arthralgia, retro-orbital eye pain, photophobia, rubeliform exanthem and headache. The joint aches can be so intense that this has given rise to the name breakbone fever or bonecrusher disease. Some patients may have sore throat, injected pharynx or conjunctiva, swollen lymph nodes, anorexia, nausea, or vomiting.
- Mild hemorrhagic manifestations such as petechiae and mucosal membrane bleeding (e.g. of the nose and gums) may be seen. Easy bruising and bleeding at venipuncture sites is present in some cases. The petechiael rash usually appears first on the lower limbs and the chest and may spread to other parts of the body in some patients. Massive vaginal bleeding in women of childbearing age and gastrointestinal bleeding occur less commonly in this phase.[3] A positive tourniquet test in the febrile phase indicates an increased probability of dengue.[3][4]
- These clinical features do not predict the severity of dengue fever. Therefore, it is crucial to monitor for warning signs and other clinical parameters (see table below) in order to recognize progression to the critical phase.
| Warning signs requiring strict observation and medical intervention | |
|---|---|
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- The earliest abnormality in the full blood count is a progressive decrease in white cell count, which should alert the physician to a high probability of dengue. The platelet count usually begins to drop when the temperature returns to normal.
- When no rash is present, mild symptoms of dengue fever may be misdiagnosed as influenza or other viral infection. Travelers from endemic 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.
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
- ↑ "Dengue haemorrhagic fever: diagnosis, treatment, prevention and control" (PDF).
- ↑ 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.
- ↑ 3.0 3.1 Kalayanarooj, S.; Vaughn, D. W.; Nimmannitya, S.; Green, S.; Suntayakorn, S.; Kunentrasai, N.; Viramitrachai, W.; Ratanachu‐eke, S.; Kiatpolpoj, S.; Innis, B. L.; Rothman, A. L.; Nisalak, A.; Ennis, F. A. (1997). "Early Clinical and Laboratory Indicators of Acute Dengue Illness". The Journal of Infectious Diseases. 176 (2): 313–321. doi:10.1086/514047. ISSN 0022-1899.
- ↑ Mayxay, Mayfong; Phetsouvanh, Rattanaphone; Moore, Catrin E; Chansamouth, Vilada; Vongsouvath, Manivanh; Sisouphone, Syho; Vongphachanh, Pankham; Thaojaikong, Thaksinaporn; Thongpaseuth, Soulignasack; Phongmany, Simmaly; Keolouangkhot, Valy; Strobel, Michel; Newton, Paul N. (2011). "Predictive diagnostic value of the tourniquet test for the diagnosis of dengue infection in adults". Tropical Medicine & International Health. 16 (1): 127–133. doi:10.1111/j.1365-3156.2010.02641.x. ISSN 1360-2276.