The Dangers of Severe Dengue

Dengue is a viral disease that is transmitted by mosquitoes infected with flavivirus¹. It is spread by the Aedes mosquito specifically Aedes aegypti and Aedes albopictus¹. This virus is known as DENV and has 4 serotypes (DENV-1, DENV-2, DENV-3 and DENV-4)². 

According to WHO statistics, Malaysia is one of the countries with the highest number of dengue cases in the world with more than 100,000 cases a year³. According to Ministry of Health Malaysia statistics, the total number of cases from 2nd January 2022 to 25th September 2022 is 41,5164 cases, compared to 26,3655 cases in 2021. This represents a 36% increase in dengue cases in a year⁵.

Speaking of dengue, dengue haemorrhagic fever is a popular term and sounds like a very debilitating illness. So, what is it? Let’s find out. 

What is Dengue Haemorrhagic Fever?

Dengue Hemorrhagic Fever (DHF) is defined by the criteria listed below²:

•  Fever or a recent fever lasting 2-7 days
•  Any type of hemorrhagic manifestation
•  Thrombocytopenia (platelet count greater than 100,000/mm3) 
•  Indications of increased vascular permeability
  

Previously, WHO classified dengue as dengue fever and dengue haemorrhagic fever¹. However, dengue has been reclassified according to severity, namely dengue and severe dengue¹. Severe dengue happens when there is organ damage, severe bleeding or severe plasma leak¹. This will cause shock or an accumulation of fluid with breathing problems⁵.

Severe dengue happens to a small number of patients that have been infected with dengue⁶. Treatment and close monitoring are needed for this group of patients.

Know The Symptoms of Severe Dengue

Symptoms of dengue fever begin with a sudden rise in temperature accompanied by facial flushing and other symptoms that resemble dengue fever, such as anorexia, vomiting, headache, and muscle or joint pain⁶. In many cases, the liver is enlarged¹. A liver that is larger than normal is called hepatomegaly and is usually able to be palpated. 

Symptoms and signs of severe dengue are listed as below^1,3:

• Bleeding from mouth/gums/nose
• Internal bleeding
• Abdominal pain
• Small spots of blood under your skin
• Weak pulse
• Convulsions
• Vomiting blood
• High fever
• Organ failure
  

It is important to detect the early warning signs of severe dengue to avoid complications such as death⁶.

Are You At Risk of Severe Dengue?

Severe dengue fever occurs more often in children less than 15 years old in hyperendemic areas but adult cases are also increasing⁷. According to the WHO, the previous infection with DENV increases an individual's risk of developing severe dengue fever³.

People at high risk for severe dengue fever are listed below⁷:

• Babies and the elderly
• Obese individuals
• Pregnant ladies
• Patients with peptic ulcer disease
• Women who experience abnormal menstruation or vaginal bleeding
• Patients with hemolytic diseases such as glucose-6-phosphatase dehydrogenase (G6PD) deficiency, thalassemia and other haemoglobinopathies
• Patients with congenital heart disease
• Individuals with chronic diseases such as diabetes mellitus, hypertension, asthma, ischemic heart disease, chronic kidney failure, liver cirrhosis
• Patients receiving steroid or NSAID treatment, etc.
  

1 in 20 patients with dengue disease will develop into severe dengue disease⁶. The important risks of severe dengue fever are internal bleeding, organ failure and death¹.

How is Severe Dengue Fever Treated?

Before treatment, testing is important for the diagnosis of dengue. You need to go to the hospital for a physical examination and a medical history taken by the doctor. If dengue is suspected, the doctor will order several laboratory confirmation tests to confirm the diagnosis in the clinic or hospital¹. After the diagnosis, the doctor will prepare a treatment plan.

The diagnosis of dengue is usually made based on a criteria defined by a combination of ≥2 findings of signs and symptoms in a febrile person who traveled to or lives in dengue endemic areas⁶. The signs and symptoms include⁶:

• Nausea
• Vomiting
• Rash
• Pain
• Positive tourniquet test
• Leukopenia
• The following warning signs: abdominal pain or tenderness, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, restlessness and liver enlargement.
  

The presence of warning signs may predict severe dengue in patients⁶.

The diagnosis of severe dengue is defined by dengue with any of the following symptoms⁶:

• Severe plasma leakage leading to shock (dengue hemorrhagic)
• Fluid accumulation with respiratory distress
• Severe bleeding
• Severe organ damage
• Consciousness is impaired
• Heart issues
  
  

Patients with severe dengue usually require treatment in a hospital or a health facility as the disease is dangerous and can be fatal. The supportive treatment for severe dengue may potentially be in the form of if clinically required¹:

1. Intravenous fluids if dehydrated or bleeding is not severe
2. Blood transfusion if platelets are low
3. Blood pressure monitoring.
   

Paracetamol can also be taken to relieve pain1. If the condition worsens, intensive care may be required. Patients are also advised to avoid blood thinners such as Aspirin with the consent of their doctor¹.

At this point of time, there is no special treatment for dengue⁷. However, we can work together to prevent dengue with the measures listed below⁸.

• Make sure there is no breeding ground for mosquitoes
• Dispose of containers that can hold water
• Make sure the water tank, rain catchment container is closed
• Make sure flower pots and containers are emptied of water at least once a week
• Make sure the roof drain is always flowing
• Rear fish in the fish pond to reduce larvae
• Use insect spray to kill mosquitoes
• Take measures to protect yourself to avoid mosquito bites such as
• Make sure windows and doors are always closed
• Apply mosquito repellent on limbs exposed to mosquito bites
• Wear bright colored shirts with long sleeves and long pants when leaving the house
• Install mosquito nets and electric mosquito repellents in closed areas
  
  

​

References

1. Kementerian Kesihatan Malaysia. CPG - Dengue 3rd edition | https://tinyurl.com/tazp2ca5 | Accessed on 22th September 2022.

2. Centers for Disease Control and Prevention. Dengue and Dengue Hemorrhagic Fever | https://tinyurl.com/43ux56av | Accessed on 22th September 2022.

3. World Health Organization (WHO). Fact Sheet: Dengue and Severe Dengue | https://tinyurl.com/3s9ryfhp | Accessed on 26th September 2022.

4. Kementerian Kesihatan Malaysia. iDengue Untuk Komuniti | https://tinyurl.com/4d5pf3pj | Accessed on 26th September 2022.

5. Malaysian Space Agency (MYSA). Kes Mingguan Demam Denggi Malaysia

Tahun 2021, 2020 & Median 5 tahun (2016-2020) | https://idengue.mysa.gov.my/pdf/statistik.pdf | Accessed on 27th October 2022.   

6. Centers for Disease Control and Prevention. Clinical Presentation - Dengue | https://tinyurl.com/4xa94uvh | Accessed on 22th September 2022.

7. World Health Organization. Regional Office for South-East Asia. (‎2011)‎. Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and expanded edition. WHO Regional Office for South-East Asia.

https://tinyurl.com/3jwst4ad | Accessed on 22th September 2022.

8. Bahagian Pendidikan Kesihatan Kementerian Kesihatan Malaysia. Info Sihat - Demam Denggi | https://tinyurl.com/ys9bz5ej | Accessed on 23th September 2022.

This article is brought to you by Takeda Malaysia Sdn. Bhd. 200901025887 (868989-K)

Disclaimer: This information is available to public for information purposes only; it should not be used for diagnosing or treating a health problem or disease. It is not intended to substitute consultation with a healthcare provider. Please consult your healthcare provider for advice

C-ANPROM/MY/DENV/0098 NOV 2022