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Symptoms, Causes, and Treatment

Dengue Hemorrhagic Fever (DHF)

Definition

What is dengue hemorrhagic fever (DHF)?

Dengue hemorrhagic fever (DHF) or what is called dengue hemorrhagic fever (DHF) is a contagious disease caused by the dengue virus that is carried by mosquito Aedes aegypti or Aedes albopictus. This disease is caused by one of the four types of dengue virus.

Dengue fever used to be called a disease “break-bone“. This is because the symptoms sometimes cause joint and muscle pain which makes the bones feel cracked.

Dengue fever that is mild will cause fever and other flu-like symptoms. However, this disease can develop into dengue hemorrhagic fever with a more serious severity. Without proper treatment, DHF can lead to dengue shock syndrome with a serious risk of bleeding.

How common is this condition?

Millions of cases of dengue fever infection occur every year around the world. This condition can happen to anyone regardless of status, gender, and age.

Dengue fever most commonly occurs during and after the rainy season, in tropical and subtropical areas, such as:

  • Africa
  • Southeast Asia and China
  • India
  • the middle East
  • Caribbean, Central America and South America
  • Australia, South Pacific and Central Pacific

According to information from WHO, Dengue cases worldwide have increased rapidly in recent decades. It is estimated that there are about 50-100 million cases each year, and about half of the world’s human population is at risk of developing this disease.

Signs and symptoms

What are the signs and symptoms of dengue fever?

The signs and symptoms of dengue fever may vary from patient to patient, depending on the severity and phase of dengue fever that has been passed.

According to the site Mayo ClinicThe symptoms will appear within 4-10 days after you have been bitten by a mosquito Aedes the first time.

The following are common signs and symptoms of dengue fever:

  • Fever up to 40 degrees Celsius
  • Headache
  • Pain in muscles, bones and joints
  • Nausea and vomiting
  • Pain behind the eye
  • Swollen lymph nodes
  • Skin rash

The above symptoms will usually improve within one week. However, there is also the possibility that the symptoms will get worse and pose a life threatening risk. This condition is called severe dengue fever and dengue shock syndrome.

Dengue fever usually occurs in children and adults who have a second dengue infection. This type of disease is often fatal, especially in children and young adults.

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

When should I see a doctor?

If you have any signs or symptoms above or any other questions, please consult your doctor. Always consult a doctor to treat your health condition.

After the mosquito bites, the virus it carries will then enter and flow in your blood. The dengue virus will first be in the incubation stage until it finally causes symptoms in 3 stages. Dengue phase often referred to as the “Horse Saddle Cycle”.

Here are the phases of dengue you need to know:

  • Fever phase: appears high fever that lasts for 2-7, accompanied by other symptoms such as muscle aches and headaches.
  • Critical phase: after 1 week, the fever will go down. However, DHF patients are at risk of experiencing severe bleeding in this phase. This condition usually requires intensive care.
  • Healing phase: after the critical phase, the patient will experience fever again. However, this phase is a period of healing for DHF in which the platelets slowly rise again.
  • Immediately consult a doctor if you experience additional symptoms after the fever drops. This means, chances are you are starting to enter a critical phase. Here are the symptoms you need to watch out for:
  • Severe stomach pain
  • Continuous vomiting
  • Bleeding in the gums
  • Nosebleed
  • Blood in urine and feces
  • Bruises that appear without cause
  • Difficulty breathing
  • The body feels very tired
  • Each patient’s body may experience different symptoms. To get the most suitable treatment for your health condition, don’t hesitate to check with the nearest doctor or health service.

Cause

What causes dengue hemorrhagic fever?

Causes of dengue hemorrhagic fever is a dengue virus that is spread by mosquito bites Aedes aegypti or Aedes albopictus. Usually the ankles and neck are common body parts for mosquito bites.

There are 4 dengue viruses, namely DEN-1, DEN-2, DEN-3 and DEN-4 viruses. After the virus-carrying mosquito bites, the virus will enter and flow in human blood and then infect nearby skin cells called keratinocytes.

The dengue virus also infects and multiplies in Langerhans cells, specialized immune cells that are present in the skin layer. Langerhans cells normally work to limit the persistent spread of infection.

However, the cells that have been infected with the virus then go to the lymph nodes and infect more healthy cells. The spread of the dengue virus produces viremia, which is a high level of the virus in the bloodstream.

To overcome this, the immune system will produce special antibodies that neutralize dengue virus particles, while the backup immune system is activated to help antibodies and white blood cells fight the virus. The immune response also includes cytotoxic T-cells (lymphocytes), which recognize and kill infected cells.

This process then gives rise to the various symptoms of dengue fever as described above.

A mosquito that carries the dengue virus can continue to infect other people as long as it is alive. There is a possibility that all members of the family can be infected with the dengue virus from the same mosquito within 2-3 days.

Once you recover, your immunity will be built up but only for strains certain. There are 4 types of dengue virus, which means you may be infected again but by a different strain than before.

Risk factors

What increases my risk of getting this disease?

There are many risk factors for getting dengue fever or dengue, namely:

  • Living or traveling to areas with tropical climates
  • Being in the tropics and subtropics increases the risk of getting dengue fever. Areas at high risk are Southeast Asia, the western Pacific Islands, Latin America and the Caribbean.
  • Have a history of dengue fever
  • If you have had dengue fever before, you have a higher chance of experiencing more serious symptoms if you get infected again.

Complications

What complications can occur from this disease?

If not handled properly, fatal complications of dengue fever can occur. One of them is dengue or shock syndrome dengue shock syndrome (DSS).

DSS not only causes the usual symptoms of dengue fever, but is also accompanied by shock symptoms such as:

  • Hypotension (blood pressure drops)
  • Difficulty breathing
  • Pulse weakens
  • Cold sweats
  • The pupils are dilated

This condition cannot be cured just by being left alone. The reason is, DSS can cause organ failure, which may lead to death.

Diagnosis and treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How do doctors diagnose this disease?

Diagnosing dengue fever may be difficult, because the signs and symptoms are difficult to distinguish from other diseases such as malaria, leptospirosis, and typhoid. Some laboratory tests can detect evidence of the dengue virus, but the test results usually take some time to make an immediate treatment decision.

The doctor will also check some of the symptoms you feel. Especially if you experience symptoms after traveling to areas where cases of dengue virus are common.

The patient should also provide the doctor with details of your trip. For example, when you have traveled from which area, how long you have been there, and other things concerning the signs of dengue fever.

If it is two weeks or more since it is found that you have been bitten by a mosquito, it is unlikely that you will be diagnosed with the dengue virus. For a definite diagnosis, a dengue fever blood test will also be needed. This will check for actual viruses or antibodies produced by your immune system in response to infection.

How to treat dengue fever?

There is no specific treatment for the disease, most patients will usually recover within 2 weeks. However, it is important to treat symptoms appropriately to avoid complications.

Doctors usually recommend the following treatment options for dengue:

1. Fever-lowering drugs

Paracetamol is a pain reliever drug that can relieve pain and reduce fever. Avoid pain relievers that can increase bleeding complications, such as aspirin, ibuprofen and naproxen sodium.

For more serious cases, dengue fever can cause shock or shock hemorrhagic fever which requires more medical attention.

2. Get plenty of rest in bed

People who are experiencing dengue fever are advised to rest. With rest, the patient will recover faster. Rest can help restore body tissue that is damaged when exposed to this condition.

The doctor will give the patient some medicine to quickly become drowsy so that he can rest completely.

3. Drink lots of fluids

Treatment in the hospital using an IV will help meet the fluids needs of DHF patients. Even so, not always a dengue patient has to be hospitalized in the hospital. As long as you follow the guidelines, you can treat DHF patients at home.

Doctors will advise patients to be hospitalized or outpatient at home to consume lots of fluids. Not only mineral water or infusions, fluids can be from food with soup, fruit, or juices.

DHF patients must consume fluids to reduce fever and prevent dehydration. Symptoms of dengue fever due to the dengue virus are characterized by muscle cramps and headaches due to dehydration can also be treated by drinking plenty of fluids.

Prevention

What are the lifestyle changes to prevent dengue fever?

You can avoid dengue hemorrhagic fever by making a few changes in your daily life. The following are lifestyle changes that can help you prevent dengue:

  • Wear closed clothes when traveling, especially in the afternoons
  • Wear mosquito repellent
  • Take 3M steps (drain water reservoirs, bury, and recycle used goods) to eradicate mosquito nests
  • Spray your environment with fogging gas

If you have any questions, consult your doctor for the best solution to your problem.

Hello Health Group and Hello Sehat do not provide medical advice, diagnosis or treatment. Please check our editorial policy page for more detailed information.

Dengue and severe dengue – WHO. (2020). Retrieved November 26, 2021, from https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

What is Dengue Fever? – Break Dengue. (2018). Retrieved November 26, 2021, from https://www.breakdengue.org/dengue-fever/

Dengue fever – Mayo Clinic. (2020). Retrieved November 26, 2021, from https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-20353078

Dengue Testing – CDC. (2019). Retrieved November 26, 2021, from https://www.cdc.gov/dengue/healthcare-providers/testing/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdengue%2Fclinicallab%2Fclinical.html

Dengue – NHS. (2019). Retrieved November 26, 2021, from https://www.nhs.uk/conditions/dengue/

Hasan, S., Jamdar, SF, Alalowi, M., & Al Ageel Al Beaiji, SM (2016). Dengue virus: A global human threat: A review of the literature. Journal of International Society of Preventive & Community Dentistry, 6(1), 1–6. https://doi.org/10.4103/2231-0762.175416