What is the disease progression of severe dengue (dengue hemorrhagic fever)?

Updated: May 03, 2019
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Severe dengue typically begins with the initial manifestations of dengue fever. The acute febrile illness (temperatures ≤40°C), like that of dengue fever, lasts approximately 2-7 days. However, in persons with severe dengue, the fever reappears, giving a biphasic or saddleback fever curve.

Along with biphasic fever, patients with severe dengue have progressive thrombocytopenia, increasing hematocrit (20% absolute rise from baseline) and low albumin (signs of hemoconcentration preceding shock), more obvious hemorrhagic manifestations (>50% of patients have a positive tourniquet test), and progressive effusions (pleural or peritoneal). Lymphocytosis, often with atypical lymphocytes, commonly develops before defervescence or the onset of shock. Transaminase levels may be mildly elevated or present in the several thousands associated with hepatomegaly in those patients with acute hepatitis. Low fibrinogen and elevated fibrin split products are signs of disseminated intravascular coagulation. Severe metabolic acidosis and circulatory failure can occur.

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