Dengue hemorrhagic fever is a more severe form of the viral illness.

Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. 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 (dengue shock syndrome). Cyanotic(bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding. The mortality (death) rate with DHF is significant. With proper treatment, the World Health Organization estimates a 2.5% mortality rate. However, without proper treatment, the mortality rate rises to 20%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.

Prevention: The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious. The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective. To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever, except living in or traveling to an area where the

mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas. There is currently no vaccination available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2015.

Dengue hemorrhagic fever (DHF) - symptoms during onset may be mild, but gradually worsen after a number of days. DHF can result in death if not treated in time. Mild dengue fever symptoms may occur in DHF, as well as the ones listed below:

Bleeding from your mouth/gums Nosebleeds Clammy skin Considerably damaged lymph and blood vessels Internal bleeding, which can result in black vomit and feces (stools) Lower number of platelets in blood - these are the cells that help clot your blood Sensitive stomach Small blood spots under your skin Weak pulse

What are the Causes of Dengue?

There are four Dengue viruses (DENV) that cause Dengue fever, all of which are spread by a species of mosquito known as the Aedes aegypti mosquito, and more rarely by the Aedes albopictus mosquito. Aedes aegypti originated in Africa, but nowadays is found in all the tropical areas around the world and prospers in and close to areas of human population. The high risk regions for catching dengue fever are Central America, South America, the Caribbean and tropical Asia; more specifically - northern Argentina, northern Australia, the entirety of Bangladesh, Barbados, Bolivia, Brazil, Cambodia, Costa Rica, Dominican Republic, Guatemala, Guyana, Honduras, India, Indonesia, Jamaica, Laos, Malaysia, Mexico, Micronesia, Pakistan, Panama, Paraguay, Philippines, Puerto Rico, Samoa, Singapore, Sri Lanka, Suriname, Taiwan, Thailand, Trinidad, Venezuela and Vietnam, and increasingly in southern China. The virus is transmitted from an infected mosquito to human. The process begins when a person who is infected with the Dengue virus is bitten by a mosquito, the virus is then passed on when someone else is then bitten by the infected mosquito. If you have suffered from dengue fever previously it is still possible to contract it again, because of the number of different types of viruses that cause the fever. If you were infected again and became ill, there is a greater risk of developing a harsher form of the disease, such as dengue hemorrhagic

fever (particularly in children). This is unusual because, normally, previous exposure to a virus causes the body to carry antibodies that allow the body to fight off the virus more easily the second time.

Symptoms
Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state. Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding. Shock may cause death. If the patient survives, recovery begins after a one-day crisis period. Early symptoms include: Decreased appetite Fever Headache Joint aches Malaise Muscle aches Vomiting

Acute phase symptoms include: Restlessness followed by: Ecchymosis Generalized rash Petechiae Worsening of earlier symptoms

Shock-like state Cold, clammy extremities Sweatiness (diaphoretic)

Signs and tests

A physical examination may reveal: Enlarged liver (hepatomegaly) Low blood pressure Rash Red eyes

Red throat Swollen glands Weak, rapid pulse

Tests may include: Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengueantigen) Tourniquet test (causes petechiae to form below the tourniquet) X-ray of the chest (may demonstrate pleural effusion)

Treatment
Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms. A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment

Prevention
There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection.

Because dengue is a virus there is no specific treatment or cure, however there are things the patient or the doctor can do to help, depending on the severity of the disease. For milder forms of dengue the treatment methods are:

Prevent dehydration - high fever and vomiting can dehydrate the body. Make sure you drink clean (ideally bottled) water rather than tap water. Rehydration salts can also help replace fluids and minerals. Painkillers - this can help lower fever and ease pain. As some NSAIDs (non-steroidal antiinflammatory drugs), such as aspirin or ibuprofen can increase the risk of internal bleeding, patients are advised to use Tylenol (paracetamol) instead. The following treatment options are designed for the more severe forms of dengue fever:

Intravenous fluid supplementation (IV drip) - in some harsher cases of dengue the patient is unable to take fluids orally (via the mouth) and will need to receive an IV drip. Bloood transfusion - a blood transfusion may be recommended for patients with severedehydration. Hospital care - it is important that you be treated by medical professionals, this way you can be properly monitored (e.g. fluid levels, blood pressure) in case your symptoms worsen. If the patient is cared for by physicians and nurses experienced with the effects and complications of hemorrhagic fever, lives can be saved.

Prevention of dengue fever

At present there is no dengue vaccine; one is currently in development. Even so, developing a vaccine to protect against four closely related viruses that can cause the disease will not be easy. The best method of prevention is to avoid being bitten by mosquitoes. If you live or travel to an area where dengue exists, there a number of ways to avoid being bitten:

Clothing - your chances of being bitten are significantly reduced if you expose as little skin as possible. When in an area with mosquitoes, be sure to wear long trousers/pants, long sleeved shirts, and socks. For further protection, tuck your pant legs into your shoes or socks. Wear a hat. Mosquito repellants - be sure to use one with at least 10% concentration of DEET, you will need a higher concentration the longer you need the protection, avoid using DEET on young children. Use mosquito traps and nets - studies have shown that the risk of being bitten by mosquitoes is considerably reduced if you use a mosquito net when you go to sleep. Untreated nets are significantly less effective because the mosquito can bite the host through the net if the person is

standing next to it. Also, even tiny holes in the netting are usually enough for the mosquito to find a way in. Nets that have been treated with insecticide are much more protective. Not only does the insecticide kill the mosquito and other insects, it is also a repellent - fewer mosquitoes are likely to enter the room(s). Smell - Avoid wearing heavily scented soaps and perfumes. Windows - use structural barriers, such as window screens or netting. Camping - if you are camping, treat clothes, shoes and camping gear with permethrin. There are clothes which have been treated with permethrin. Certain times of day - try to avoid being outside at dawn, dusk and early evening. Stagnant water - the Aedes mosquito prefers to breed in clean, stagnant water. It is important to frequently check and remove stagnant water in your home/premises.
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Turn pails (buckets) and watering cans over; store them under shelter so water cannot accumulate in them. Remove the water from plant pot plates. To remove mosquito eggs, clean and scrub them thoroughly. Ideally, do not use plant pot plates. Loosen soil from potted plants. This will prevent puddles from developing on the surface of hard soil. Make sure scupper drains are not blocked; do not place potted plants and other objects over the scupper drains. Gully traps that are rarely used should be covered; replace gully traps with non-perforated ones, and install anti-mosquito valves. Do not place receptacles under or on top of any air-conditioning unit. Flower vases - change the water every other day. When you do so, scrub the inside of the vase thoroughly and rinse it out. Leaves - make sure leaves are not blocking anything which may result in the accumulation of puddles or stagnant water.