A91 Dengue hemorrhagic fever

Name of the Condition

• Dengue hemorrhagic fever

Summary

Dengue hemorrhagic fever is a severe form of dengue virus infection characterized by plasma leakage, bleeding manifestations, and potential organ impairment. It typically follows a primary dengue infection and is distinguished by increased vascular permeability, which can lead to hypovolemic shock. The condition requires prompt recognition and supportive care to manage complications.

Causes

Dengue hemorrhagic fever is caused by infection with one of the four dengue virus serotypes (DENV-1, DENV-2, DENV-3, or DENV-4). The severe form often occurs in individuals with prior dengue exposure, as secondary infections with a different serotype can trigger an exaggerated immune response. The virus is transmitted through the bite of infected Aedes mosquitoes, primarily Aedes aegypti.

Risk Factors

• Prior infection with a different dengue virus serotype
• Living in or traveling to dengue-endemic regions
• Lack of mosquito control measures
• Young age (particularly children under 15 years)
• Female gender (in some studies)

Symptoms

• Sudden high fever
• Severe abdominal pain
• Persistent vomiting
• Bleeding gums or nose
• Fatigue, restlessness, or lethargy
• Skin hemorrhages (e.g., petechiae, purpura)
• Fluid accumulation (e.g., pleural effusion, ascites)
• Hypotension or shock

Diagnosis

Diagnosis is based on clinical presentation, including fever, hemorrhagic signs, and thrombocytopenia (platelet count <100,000/mm³) or hemoconcentration (hematocrit ≥20% above baseline). Laboratory confirmation involves detecting dengue virus or antibodies in blood samples. Differential diagnosis excludes other hemorrhagic fevers, sepsis, or malaria.

Treatment Options

• Supportive Care: Intravenous fluid resuscitation to correct hypovolemia and prevent shock.
• Monitoring: Close observation of vital signs, hematocrit, and platelet levels.
• Blood Products: Transfusion of platelets or plasma if severe bleeding occurs.
• Avoidance of Aspirin: Use of acetaminophen for fever/pain (aspirin/NSAIDs may worsen bleeding).

Prognosis and Follow-Up

With timely treatment, mortality rates are low (1–5%). Recovery may take weeks, with fatigue and weakness common. Follow-up includes monitoring for post-dengue complications, such as prolonged thrombocytopenia or organ dysfunction. Severe cases may require intensive care.

Complications

• Dengue shock syndrome (severe hypotension)
• Severe bleeding (e.g., gastrointestinal, cerebral)
• Multi-organ failure (liver, kidney, or respiratory)
• Secondary infections (e.g., pneumonia)

Lifestyle & Prevention

• Eliminate mosquito breeding sites (e.g., standing water).
• Use insect repellent and wear protective clothing.
• Install window screens or use bed nets.
• Seek early medical care for fever in endemic areas.

When to Seek Professional Help

• High fever with severe abdominal pain or vomiting.
• Bleeding from gums, nose, or skin.
• Signs of shock (e.g., cold extremities, weak pulse).
• Rapid drop in platelet count or rising hematocrit.

Tips for Medical Coders

Document the presence of hemorrhagic manifestations (e.g., petechiae, bleeding) and plasma leakage (e.g., hemoconcentration, pleural effusion) to support the diagnosis. Include details on prior dengue exposure if available, as this may influence coding specificity. Ensure laboratory results (e.g., platelet count, hematocrit) are recorded to confirm severity.