This is How Severe Dengue Symptoms Can Get

Dengue is a mosquito-borne disease that has affected many in the Philippines over the years. In fact, there were nearly 80,000 cases from January to late November last year. ^[1]

While there is no cure for dengue, one of the best ways to prevent the worsening of the disease is through early detection. By knowing the warning signs, you will be able to intervene and treat the milder symptoms, and know when you need to seek professional help.

Mild dengue fever

If you or someone you know contracts dengue, the symptoms can appear up to seven (7) days after first getting infected. These symptoms are usually confused with those of the flu or other infections, like malaria or typhus fever. ^[2]

The mild symptoms are as follows:

• Rashes

• Aches and pains

• Sudden, high fever

• Nausea and vomiting

While most cases of dengue can go away within a week or so, there is still the possibility of the symptoms becoming severe in the first two days of having the disease, and without treatment, these could be fatal. 

Severe dengue 

Dengue can become more severe if a person already contracted the disease before. Studies found that when a person previously had dengue, the antibodies produced during the first infection could pose a greater risk for when the person contracts the disease again. This is because instead of neutralizing the virus, the antibodies recognize the virus and bind to it, helping it spread. ^[6]

When the disease becomes more severe, a number of additional symptoms can occur, such as ^[7]:

• Cold or clammy skin

• Belly pain and tenderness

• Circulatory collapse, or shock

• Bleeding from the nose or gums

• Vomiting blood or blood in the stool

Aside from these, however, there have also been cases with uncommon and more severe manifestations:

Neurological complications

Studies have shown that dengue can cause major damages to the brain, such as encephalitis or the inflammation of the brain, and stroke. Even the peripheral nervous system can get affected by the disease, as found in patients that got dengue myositis, which is the inflammation of muscles used to move your body. There have also been many reports of these cases in children. ^[8]

Gastrointestinal complications

In addition to abdominal pains, there are other more severe manifestations that occur in one’s digestive system, such as gastrointestinal bleeding, jaundice, and hepatomegaly, which is the condition of having an enlarged liver. ^[9]

Cardiac complications

Research also found that it’s possible for dengue patients to experience rhythm abnormalities in the heart, like sinus tachycardia (a heart rate greater than 100 beats/min in adults) and even third-degree heart block, which puts patients at risk for cardiac death. ^[10] These are likely due to the fluid accumulation that occurs when a person has dengue hemorrhagic fever (DHF), which is a severe form of dengue. ^[11]

Treatment for severe cases of dengue usually involves intravenous supplementation, or IV drip, to replenish the person’s fluids in case they can’t take them from the mouth, and even blood transfusion for lost blood.

Because there is no cure for dengue itself, it is best to take every precaution and ensure that you protect yourself and your family from the risks that come with this disease. Keep your house clean, remove stagnant water from areas in your home, use insect repellent, and cover up when going out. By taking action now, you can prevent contracting dengue later on.

---

References:

1. Dengue Situation Update Number 610. World Health Organization. [Internet] 2020 [cited 2021 January 13] Available from: https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/dengue/dengue-20201217.pdf?sfvrsn=fc80101d_45

2. Gulati, S., Maheshwari, A. Dengue fever-like illnesses: how different are they from each other? Scandinavian Journal of Infectious Diseases. [Internet] 2012 [cited 2021 January 13] Available from: https://pubmed.ncbi.nlm.nih.gov/22506663/

3. Dengue Fever. John Hopkins Medicine. [Internet] [cited 2021 January 13] Available from: https://www.hopkinsallchildrens.org/patients-families/health-library/healthdocnew/dengue-fever

4. Shiel, W. Medical Definition of Dengue hemorrhagic fever (DHF). MedicineNet. [Internet] [cited 2021 January 13] Available from: https://www.medicinenet.com/dengue_hemorrhagic_fever_dhf/definition.htm

5. Dengue and Dengue Hemorrhagic Fever. Centers for Disease Control and Prevention. [Internet] [cited 2021 January 13] Available from: https://www.cdc.gov/dengue/resources/denguedhf-information-for-health-care-practitioners_2009.pdf

6. Katzelnick, L., Gresh, L., Halloran, M., Mercado, J., Kuan, G., Gordon A., et al. Antibody-dependent enhancement of severe dengue disease in humans. Science. [Internet] 2017 [cited 2021 January 14] Available from: https://science.sciencemag.org/content/358/6365/929

7. Symptoms and Treatment (Dengue). Centers for Disease Control and Prevention. [Internet] [cited 2021 January 13] Available from: https://www.cdc.gov/dengue/symptoms/index.html

8. Li, G., Ning, Z., Liu, Y., Li, H. Neurological Manifestations of Dengue Infection. [Internet] 2017 [cited 2021 January 15] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660970/

9. Prashanthm, V., Manasa, G. Study of gastrointestinal manifestations in Dengue fever. [Internet] 2019 [cited 2021 January 15] Available from: https://www.ijmedicine.com/index.php/ijam/article/view/1924

10. Umakanth, M., Suganthan, N. Unusual Manifestations of Dengue Fever: A Review on Expanded Dengue Syndrome. Cureus. [Internet] 2020 [cited 2021 January 15] Available from: https://www.cureus.com/articles/40499-unusual-manifestations-of-dengue-fever-a-review-on-expanded-dengue-syndrome#references

11. Sheetal, S., Jacob, E. A Study on the Cardiac Manifestations of Dengue. The Journal of the Association of Physicians of India. [Internet] 2016 [cited 2021 January 15] Available from: https://pubmed.ncbi.nlm.nih.gov/27735146/#:~:text=Among%20severe%20dengue%2C%20fluid%20accumulation,sinus%20bradycardia%20was%20the%20commonest.