Overview
Dengue hemorrhagic fever (DHF) is a severe form of dengue infection characterized by increased vascular permeability, leading to plasma leakage, hemorrhagic manifestations, and potentially life-threatening complications such as dengue shock syndrome and disseminated intravascular coagulation (DIC). 1Diagnosis
Clinical Presentation: High fever, hemorrhagic manifestations, thrombocytopenia, and evidence of plasma leakage (e.g., pleural effusion, ascites).
Laboratory Tests:
- Low platelet count (<150,000/μL).
- Increased hematocrit or hemoconcentration.
- Presence of dengue-specific antibodies or viral RNA in blood.
Grading: WHO classification includes grades I-IV based on severity, with grade III and IV indicating DHF and dengue shock syndrome, respectively.Management
First-Line Treatments:
- Supportive Care: Fluid replacement to manage hypovolemic shock and correct electrolyte imbalances.
- Monitoring: Close observation for signs of shock, organ failure, and DIC.
Adjunctive Treatments:
- Corticosteroids: Pulse methylprednisolone may be considered in severe cases with multiorgan involvement. 1
- Intravenous Immunoglobulin (IVIG): High-dose IVIG has shown efficacy in managing severe complications like hemophagocytic syndrome. 1Special Populations
Adult Cases: Hemophagocytic syndrome can complicate adult DHF, necessitating early diagnosis and aggressive treatment with pulse methylprednisolone and IVIG. 1Key Recommendations
Early Recognition and Supportive Care: Prompt identification and management of fluid balance and hemodynamic stability are crucial in DHF management. (Evidence: Moderate) 1
Consider Corticosteroids and IVIG for Severe Complications: In cases with severe multiorgan involvement, such as hemophagocytic syndrome, pulse methylprednisolone and high-dose IVIG may improve outcomes. (Evidence: Weak) 1
Close Monitoring for DIC and Organ Failure: Regular monitoring for signs of disseminated intravascular coagulation and organ dysfunction is essential in guiding treatment adjustments. (Evidence: Expert opinion) 1References
1 Srichaikul T, Punyagupta S, Kanchanapoom T, Chanokovat C, Likittanasombat K, Leelasiri A. Hemophagocytic syndrome in Dengue hemorrhagic fever with severe multiorgan complications. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2008. link