Dengue Hemorrhagic Fever (DHF)

A 15-year-old girl presents with 5 days of fever, which suddenly resolved, followed by severe abdominal pain, persistent vomiting, and gum bleeding. She appears lethargic, with cold extremities and a weak pulse. Her blood pressure is 90/60 mmHg, and pulse is 110 bpm. A tourniquet test is positive (petechiae after BP cuff inflation).

Differential Diagnosis:

• Dengue Hemorrhagic Fever (DHF)
• Leptospirosis
• Meningococcal sepsis
• Yellow fever

Investigations:

• Dengue IgM and IgG → Positive (suggesting secondary dengue infection).
• Hematocrit → Increased (50%) (suggestive of plasma leakage).
• Platelets → Very low (25,000/µL).
• Coagulation panel → Prolonged PT and APTT (DIC-like picture).

Management (Dengue Shock Syndrome - DSS):

• Urgent IV fluid resuscitation:
  • Crystalloids (Ringer’s lactate or normal saline) bolus.
  • Titrate fluids based on hematocrit trends.
• Monitor for signs of worsening shock (tachycardia, cold extremities, prolonged capillary refill).
• Blood transfusion only if significant hemorrhage.
• Intensive care monitoring for respiratory distress or worsening shock.

Key Learning Points:

• Dengue Hemorrhagic Fever (DHF) is characterized by plasma leakage, thrombocytopenia, and hemorrhagic manifestations.
• Sudden defervescence with worsening symptoms is a red flag for severe disease.
• Early aggressive IV fluid management is lifesaving in DSS.

 

We need sufficient water resuscitation and in addition to this symptomatic treatment, such as acetaminophen, steroids in some critical conditions as well as the administration of fresh plasma or platelets by axheresis in conditions that warrant it.

 

We need sufficient water resuscitation and symptomatic treatment, such as paracetamol, steroids in some critical conditions, as well as the administration of fresh plasma or platelets by axpheresis in conditions that merit it.