Different Classification of Dengue. How Can You Recognize Their Symptoms?

There are four types of dengue viruses (DENV1-4) that have been identified^1,2. Dengue is caused by any one of these four types of viruses. All four types have been circulating globally and affects people of all ages¹. 

Malaysia is a country where dengue is hyperendemic3. Hyperendemicity is defined as a situation where there are persistent, high levels of dengue occurrence⁴. Every four to five years, dengue outbreaks in Malaysia tend to soar higher⁵.The year 2019 saw the highest dengue cases in our country with 131,101 of cases reported⁶.

Dengue virus is transmitted by Aedes mosquitoes, which bite mainly during the day usually early in the morning and in the evening before dusk¹. The virus circulates in the blood of an infected person(incubated) for about 4-10 days before that person starts to show symptoms of dengue1. It is possible to be infected 4 times over the course of your lifetime. A second infection caused by a different virus type can increase your risk of severe dengue¹.

While most dengue infections are asymptomatic, symptomatic dengue is classified into 2 main types, which are dengue (with and without warning signs) and severe dengue¹. It is important to look out for warning signs even if you only have mild dengue as it may potentially escalate to a severe dengue.

Dengue

What is dengue? Dengue is a mosquito borne viral disease caused by any of the four types of dengue virus¹.

The incubation period for dengue is 4-10 days, with most people experiencing symptoms for 2-7 days after that¹.

Symptoms of dengue include^1,2:

- Fever (high temperature usually up to 40 °C)

- Headache

- Pain behind the eyes

- Muscle and joint pain

- Nausea and vomiting

- Swollen glands

- Rash 

Dengue With Warning Signs

What are the warning signs of dengue?

3-7 days after the onset of dengue, some patients may deteriorate1. If you or your family member have dengue, you will need to pay attention when the body temperature drops below 38 °C and is accompanied by one of the following symptoms^1,7:

• Severe stomach ache

• Persistent vomiting

• Rapid breathing

• Bleeding gums

• Blood vomiting

• Fatigue

• Restlessness

• Excessive sleepiness

Severe Dengue

WHO previously classified dengue into dengue fever and dengue haemorrhagic fever⁸. However, the classification was revised due to several reasons⁸:

1. The symptoms can overlap during febrile phase of the infection and difficult to differentiate
2. Dengue with shock can happened without fulfilling all criteria of Dengue Haemorrhagic Fever (DHF)
3. Patient can get organ impairment without shock⁴. The initial classification doesn’t address the whole spectrum of dengue 

As mentioned above, WHO now has classified dengue into its level of severity which helps in the management of the patient⁸.Severe dengue can be fatal due to plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ dysfunction¹.

Dengue Haemorrhagic fever

Dengue hemorrhagic fever (DHF) is one of the common term that you may have heard when talking about dengue. So, what is it?

Dengue haemorrhagic fever previously diagnosed with 4 major criteria which are⁹:

• High fever

• Bleeding (haemorrhage)

• Enlarged liver (hepatomegaly)

• Circulatory failure (in severe cases)

One with dengue fever may presented with these symptoms 3-5 days after the fever starts which may indicate DHF⁹. 

• Bleeding

• Difficulty breathing (pleural effusion)

• Restless

• Vomiting

• Abdominal pain

• Sudden temperature drop

​

Dengue Shock Syndrome

Dengue shock syndrome (DSS) or shock can happen in dengue patient as the result of severe plasma leakage^8,10.

Shock is characterised by¹⁰:

​

• Pulse is fast but weak

• Low blood pressure (hypotension)

• Reduced perfusion (delay capillary refill time)

• Cold and clammy skin

• Restlessness

​

Summary of Dengue Classification

References^1,8

What To Do If You Suspect You Have Dengue?

If you think you may have dengue, it is important to seek medical attention immediately. There is no specific cure for the disease¹, but with early diagnosis and treatment most patients can recover even from severe dengue¹. Delay of treatment may lead to shock or organ failure which increases the risk of fatality¹⁰.

Treatment of dengue typically involves rest, plenty of fluids, and pain relief^11,12. In some cases, hospitalization may be necessary¹³. 

For severe dengue, medical care provided by physicians and nurses familiar with the disease's symptoms and progression can save lives, lowering mortality rates to less than 1% in the majority of countries¹.

References

1. World Health Organisation. Dengue and Severe Dengue | https://tinyurl.com/46vwdxu7 | Accessed on September 23, 2022

2. Kaur. J. Demam Denggi. Portal | https://tinyurl.com/2kj8u8bx | Accessed on September 23, 2022

3. Rathakrishnan A, Klekamp B, Wang SM, Komarasamy TV, Natkunam SK, Sathar J, et al. (2014) Clinical and Immunological Markers of Dengue Progression in a Study Cohort from a Hyperendemic Area in Malaysia. PLoS ONE 9(3): e92021 | https://tinyurl.com/yck86uwh | Accessed on September 23, 2022

4. Centers for Disease Control and Prevention (CDC). Lesson 1: Introduction to Epidemiology | https://tinyurl.com/wtnp8djx | Accessed on September 23, 2022

5. 'Malaysia catat Kes demam Denggi Terendah Sejak Sedekad Lalu'. (2022, January 31) Berita Harian | https://tinyurl.com/4wc5pzmk | Accessed September 15, 2022

6. CodeBlue. (2020, January 6). Malaysia reports 130,000 dengue cases in 2019, highest since 2015 | https://tinyurl.com/26365jyk | Accessed on September 23, 2022 

7. Tanda-tanda amaran bagi jangkitan denggi yang teruk. World Health Organisation - Western Pacific Region. | https://tinyurl.com/5ayww5mr | Accessed on September 23, 2022

8. Ministry of Health Malaysia. 2015. Clinical Practice Guideline - Management of Dengue Infection In Adults (Third Edition) | https://tinyurl.com/yc7a2xwv | Accessed on September 23, 2022
9. Wang, W.-H., Urbina, A. N., Chang, M. R., Assavalapsakul, W., Lu, P.-L., Chen, Y.-H., & Wang, S.-F. (2020, March 26). Dengue hemorrhagic fever – a systemic literature review of current perspectives on pathogenesis, prevention and Control. Journal of Microbiology, Immunology and Infection | https://tinyurl.com/2p83nntx | Accessed on September 28, 2022 

10. World Health Organization. (1970, January 1). Comprehensive guideline for prevention and control of Dengue and dengue haemorrhagic fever. revised and expanded edition | https://tinyurl.com/4k8pvttr | Accessed on September 23, 2022

11. MIMS. Supportive Therapy | MIMS Malaysia | https://tinyurl.com/23p2arr7 | Accessed on September 23, 2022

12. MIMS. Dengue Treatment | MIMS Malaysia | https://tinyurl.com/3pavak3p | Accessed on September 23, 2022

13. MIMS. Dengue Diagnosis | MIMS Malaysia | https://tinyurl.com/4vuckzze | Accessed on September 23, 2022

C-ANPROM/MY/DENV/0088 OCT 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