Dengue Hemorrhagic Fever
Disease Details
Family Health Simplified
- Description
- Dengue hemorrhagic fever is a severe form of dengue fever characterized by bleeding, blood plasma leakage, and dangerously low platelet levels.
- Type
- Dengue hemorrhagic fever is an infectious disease caused by the dengue virus. It is not genetically transmitted. Instead, it is spread to humans through the bite of an infected Aedes mosquito, primarily Aedes aegypti. The disease is vector-borne rather than inherited through genetic transmission.
- Signs And Symptoms
- Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as an uncomplicated fever. Others have more severe illness (5%), and in a small proportion it is life-threatening. The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days.The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash. If this progresses to severe dengue the symptoms are severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness.
- Prognosis
- Most people with dengue recover without any ongoing problems. The risk of death among those with severe dengue is 0.8% to 2.5%, and with adequate treatment this is less than 1%. However, those who develop significantly low blood pressure may have a fatality rate of up to 26%. The risk of death among children less than five years old is four times greater than among those over the age of 10. Elderly people are also at higher risk of a poor outcome.
- Onset
- Dengue Hemorrhagic Fever typically has an abrupt onset, starting with a sudden high fever.
- Prevalence
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Dengue Hemorrhagic Fever (DHF) is a severe form of dengue fever caused by the dengue virus, which is transmitted by Aedes mosquitoes. The prevalence of DHF can vary widely depending on geographic location, climate, and the presence of the mosquito vectors.
- **Geography:** DHF is most commonly found in tropical and subtropical regions, including parts of Southeast Asia, the Western Pacific, the Caribbean, Central and South America, and Africa.
- **Seasonality:** The incidence typically peaks during and after the rainy seasons when mosquito populations are highest.
- **Global Burden:** The World Health Organization estimates that about 390 million dengue infections occur every year globally, with a significant proportion developing into severe forms such as DHF. However, exact data on the prevalence of DHF alone are variable and less frequently reported.
DHF is considered a public health concern due to the potential for outbreaks and severe complications, including shock and organ failure. - Epidemiology
- As of March 2023, Dengue is endemic in more than 100 countries with cases reported in every continent with the exception of Antarctica. The Americas, Southeast Asia and the Western Pacific regions are the most seriously affected. It is difficult to estimate the full extent of the disease, as many cases are mild and not correctly diagnosed. WHO currently estimates that 3.9 billion people are at risk of dengue infection. In 2013, it was estimated that 390 million dengue infections occur every year, with 500,000 of these developing severe symptoms and 25,000 deaths.Generally, areas where dengue is endemic have only one serotype of the virus in circulation. The disease is said to be hyperendemic in areas where more than one serotype is circulating; this increases the risk of severe disease on a second or subsequent infection.Infections are most commonly acquired in urban environments where the virus is primarily transmitted by the mosquito species Aedes aegypti. This species has adapted to the urban environment, is generally found close to human habitation, prefers humans as its host, and takes advantage of small bodies of standing water (such as tanks and buckets) in which to breed. In rural settings the virus is transmitted to humans by A. aegypti and other related mosquitoes such as Aedes albopictus. Both these species have expanding ranges.Dengue has increased in incidence in recent decades, with WHO recording a ten fold increase between 2010 and 2019 (from 500,000 to 5 million recorded cases). This increase is tied closely to the increasing range of Aedes mosquitoes, which is attributed to a combination of urbanization, population growth, and an increasingly warm climate. In endemic areas, dengue infections peak when rainfall is optimal for mosquito breeding.The disease infects all races, sexes, and ages equally. In endemic areas, the infection is most commonly seen in children who then acquire a lifelong partial immunity.
- Intractability
- Dengue hemorrhagic fever (DHF) is not considered intractable in most cases. With timely and appropriate medical intervention, the condition can often be managed effectively. Treatment typically focuses on supportive care, including fluid replacement and monitoring for complications. However, severe cases can still be life-threatening, and prevention through mosquito control and vaccination in endemic areas is crucial.
- Disease Severity
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Dengue hemorrhagic fever (DHF) is a severe form of dengue fever. It can cause significant morbidity and mortality if not managed appropriately.
- **Disease Severity:** It is characterized by increased vascular permeability, thrombocytopenia (low platelet count), and hemorrhagic manifestations. Severe cases can lead to dengue shock syndrome (DSS), which is potentially life-threatening.
- **Nan:** This term is not applicable in the context of dengue hemorrhagic fever. If you meant to ask about something specific or if it's an abbreviation, please clarify. - Healthcare Professionals
- Disease Ontology ID - DOID:12206
- Pathophysiology
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Dengue hemorrhagic fever (DHF) is a severe form of dengue infection. The pathophysiology involves several key processes:
1. **Immune Response**: Prior infection with a different dengue virus serotype can lead to antibody-dependent enhancement (ADE), where non-neutralizing antibodies facilitate viral entry into host cells, exacerbating the infection.
2. **Increased Vascular Permeability**: DHF is characterized by plasma leakage due to increased capillary permeability, leading to hemoconcentration, pleural effusion, and ascites.
3. **Coagulopathy**: There is a disturbance in the blood coagulation process, manifesting as thrombocytopenia (low platelet count) and bleeding tendencies, including petechiae, bruising, and mucosal hemorrhages.
4. **Cytokine Storm**: An overwhelming release of cytokines and inflammatory mediators occurs, resulting in endothelial cell dysfunction and further contributing to vascular leakage.
These combined factors can progress to dengue shock syndrome (DSS), a life-threatening condition with profound hypotension and multi-organ failure. - Carrier Status
- Dengue Hemorrhagic Fever (DHF) is not associated with a carrier status in the typical sense. It is a severe form of dengue fever caused by the dengue virus, which is transmitted to humans primarily through the bite of infected Aedes mosquitoes, particularly Aedes aegypti. There is no chronic carrier state for the dengue virus in humans; individuals either recover from the infection or, in some cases, suffer severe complications. The virus can only be temporarily present in an infected person's bloodstream, during which time mosquitoes can pick up the virus and subsequently infect other individuals.
- Mechanism
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Dengue hemorrhagic fever (DHF) is a severe form of dengue fever caused by the dengue virus, which is transmitted by Aedes mosquitoes. The primary molecular mechanisms involved in DHF include:
1. **Antibody-Dependent Enhancement (ADE):**
- Previous infection with one serotype of the virus can enhance infection with another serotype. Non-neutralizing antibodies from the first infection bind to the virus during a subsequent infection and facilitate its entry into monocytes, macrophages, and dendritic cells via Fc receptors.
2. **Cytokine Storm:**
- Infected immune cells release excessive amounts of pro-inflammatory cytokines and chemokines, such as TNF-α, IL-6, and IFN-γ. This "cytokine storm" can lead to increased vascular permeability, plasma leakage, and coagulopathy, key features of DHF.
3. **Endothelial Cell Dysfunction:**
- The virus and the excessive immune response disrupt the endothelial barrier integrity, leading to plasma leakage into tissues, hemorrhage, and hypovolemic shock.
4. **Complement Activation:**
- Activation of the complement system contributes to inflammation and tissue damage. Components like C3a and C5a can promote vascular permeability and chemotaxis, exacerbating the disease.
5. **Platelet Dysfunction and Hemostatic Changes:**
- Thrombocytopenia (low platelet count) and impaired platelet function are common, contributing to bleeding tendencies. The interaction between the virus and platelets, and the immune response, can lead to increased destruction of platelets and dysregulated hemostasis.
These mechanisms collectively lead to the severe manifestations seen in dengue hemorrhagic fever, including capillary leakage, bleeding, and organ impairment. - Treatment
- As of March 2024, there is no specific antiviral treatment available for dengue fever.Most cases of dengue fever have mild symptoms, and recovery takes place in a few days. No treatment is required for these cases. Acetaminophen (Paracetamol, Tylenol) may be used to relieve mild fever or pain. Other common pain relievers, including aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) should be avoided as they can increase the risk of bleeding complications.For moderate illness, those who can drink, are passing urine, have no warning signs and are otherwise reasonably healthy can be monitored carefully at home. Supportive care with analgesics, fluid replacement, and bed rest are recommended.Severe dengue is a life-threatening emergency, requiring hospitalization and potentially intensive care. Warning signs include dehydration, decreasing platelets and increasing hematocrit. Treatment modes include intravenous fluids, and transfusion with platelets or plasma.
- Compassionate Use Treatment
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For dengue hemorrhagic fever, compassionate use and off-label or experimental treatments may include:
1. **Intravenous Immunoglobulin (IVIG):** Though not commonly used, IVIG may be administered in severe cases to modulate the immune response.
2. **Corticosteroids:** There has been interest in using corticosteroids to reduce inflammation and capillary leakage, but evidence supporting their efficacy is limited and not yet conclusive.
3. **Antiviral Agents:** Experimental antiviral drugs are under investigation to directly combat the dengue virus, though none are currently approved specifically for this purpose.
4. **Monoclonal Antibodies:** Development of monoclonal antibodies targeting the dengue virus is ongoing, with some in early-stage clinical trials.
These treatments are considered experimental and should be used with caution, ideally within the context of a clinical trial or under compassionate use protocols with careful monitoring. - Lifestyle Recommendations
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For dengue hemorrhagic fever, consider the following lifestyle recommendations to manage and prevent the disease:
1. **Avoid Mosquito Bites:**
- Use insect repellent containing DEET, picaridin, or oil of lemon eucalyptus.
- Wear long sleeves, long pants, and socks to reduce skin exposure.
- Sleep under mosquito nets, especially in areas where dengue is common.
2. **Eliminate Mosquito Breeding Sites:**
- Remove standing water where mosquitoes breed, such as in flower pots, buckets, and old tires.
- Ensure proper disposal of garbage and maintain cleanliness around living areas.
3. **Stay Hydrated:**
- Drink plenty of fluids to prevent dehydration, especially if fever and vomiting are present.
4. **Rest:**
- Get adequate rest to help the body fight the infection and recover.
5. **Seek Medical Attention:**
- Monitor symptoms closely and seek prompt medical attention if signs of severe dengue (such as persistent vomiting, abdominal pain, or bleeding) are present.
6. **Nutritional Support:**
- Maintain a balanced diet to support the immune system.
- Include foods rich in vitamins and minerals to boost overall health.
Remember, there is currently no specific antiviral treatment for dengue. Preventive measures and supportive care are crucial. - Medication
- Dengue hemorrhagic fever (DHF) does not have a specific antiviral medication for treatment. Management primarily involves supportive care, which includes maintaining fluid balance, managing bleeding complications, and careful monitoring of vital signs. In severe cases, hospitalization is often required to provide intravenous fluids and electrolytes, blood transfusions, and other supportive measures. Analgesics such as acetaminophen can be used to reduce pain and fever, but nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin should be avoided due to increased bleeding risk.
- Repurposable Drugs
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Currently, there are no specific antiviral drugs approved for dengue hemorrhagic fever (DHF). However, some repurposable drugs have been investigated for their potential use against dengue virus, including:
1. **Chloroquine** - Initially used for malaria, it has shown some in vitro activity against dengue virus.
2. **Statins** - Generally prescribed for lowering cholesterol, statins like lovastatin have been studied for their anti-inflammatory properties and potential to reduce vascular leakage in dengue.
3. **Baloxavir marboxil** - An influenza drug being considered for its broad-spectrum antiviral properties.
Always consult with healthcare professionals before considering any medication for off-label use. - Metabolites
- In the case of dengue hemorrhagic fever (DHF), specific metabolites and their pathways are still being studied. However, some observed alterations in metabolites include changes in amino acids, lipids, and carbohydrate metabolism. For instance, increases in certain amino acids such as glutamate have been recorded, along with alterations in lipid profiles, notably elevated levels of lysophospholipids. Further research is ongoing to fully elucidate the metabolic changes associated with DHF, which could potentially aid in diagnosis and therapeutic strategies.
- Nutraceuticals
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For dengue hemorrhagic fever, there is currently no specific nutraceutical that has been conclusively proven to treat or prevent the condition effectively. Management primarily focuses on supportive care, including proper hydration, pain relief, and close monitoring of vital signs.
"NAN" is not typically related to dengue hemorrhagic fever. If you meant "nanotechnology," its application in dengue fever is still under research. Some studies are investigating the potential of nanotechnology for improved diagnostic methods and targeted drug delivery, but these are not yet part of standard treatment protocols. - Peptides
- Dengue Hemorrhagic Fever (DHF) involves severe symptoms such as plasma leakage, bleeding, and low platelet count. Researchers have been exploring the use of peptides and nanoparticles for diagnostic, therapeutic, and preventive purposes. Peptides can target the dengue virus specifically, potentially inhibiting its ability to replicate. Nanoparticles, on the other hand, can be employed to deliver drugs directly to infected cells or used in diagnostic assays to detect the virus more accurately and quickly. Both approaches are part of innovative strategies aiming to improve outcomes for patients with DHF.