What are the signs and symptoms of dengue?
After being bitten by a mosquito carrying the virus, the incubation period
ranges from three to 15 (usually five to eight) days before the signs and
symptoms of dengue appear. Dengue starts with chills, headache, pain upon
moving the eyes, and low backache. Painful aching in the legs and joints
occurs during the first hours of illness. The temperature rises quickly as
high as 104° F (40° C), with relative low heart rate (bradycardia) and low
blood pressure (hypotension). The eyes become reddened. A flushing or pale
pink rash comes over the face and then disappears. The glands (lymph nodes)
in the neck and groin are often swollen.
Fever and other signs of dengue last for two to four days, followed by rapid
drop in temperature (defervescence) with profuse sweating. This precedes a
period with normal temperature and a sense of well-being that lasts about a
day. A second rapid rise in temperature follows. A characteristic rash
appears along with the fever and spreads from the extremities to cover the
entire body except the face. The palms and soles may be bright red and
swollen.
How is dengue fever treated?
Because dengue is caused by a virus, there is no specific medicine or
antibiotic to treat it. For typical dengue, the treatment is purely
concerned with relief of the symptoms (symptomatic). Rest and fluid intake
for adequate hydration is important. Aspirin and nonsteroidal anti-
inflammatory drugs should be avoided. Acetaminophen (Tylenol) and codeine
may be given for severe headache and for the joint and muscle pain
(myalgia).
What is the outcome with typical dengue?
Typical dengue does not result in death. It is fatal in less than 1% of
cases. The acute phase of the illness with fever and myalgias lasts about
one to two weeks. Convalescence is accompanied by a feeling of weakness
(asthenia), and full recovery often takes several weeks.
What is dengue hemorrhagic fever?
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect
children under 10. It causes abdominal pain, hemorrhage (bleeding), and
circulatory collapse (shock). DHF is also called Philippine, Thai, or
Southeast Asian hemorrhagic fever and dengue shock syndrome.
DHF starts abruptly with high continuous fever and headache. There are
respiratory and intestinal symptoms with sore throat, cough, nausea,
vomiting, and abdominal pain. Shock occurs two to six days after the start
of symptoms with sudden collapse, cool, clammy extremities (the trunk is
often warm), weak pulse, and blueness around the mouth (circumoral
cyanosis).
In DHF, there is bleeding with easy bruising, blood spots in the skin
(petechiae), spitting up blood (hematemesis), blood in the stool (melena),
bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and
inflammation of the heart (myocarditis) may be present.
Patients with DHF must be monitored closely for the first few days since
shock may occur or recur precipitously. Cyanotic (bluish) patients are given
oxygen. Vascular collapse (shock) requires immediate fluid replacement.
Blood transfusions may be needed to control bleeding.
The mortality, or death rate, with DHF is significant. It ranges from 6%-
30%. Most deaths occur in children. Infants under a year of age are
especially at risk of dying from DHF.
