Dengue hemorrhagic fever : Symptoms & Signs, Diagnosis & Tests

Symptoms & Signs

Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state.

Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding.

Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.

Early symptoms include:

  • Decreased appetite
  • Fever
  • Headache
  • Joint aches
  • Malaise
  • Muscle aches
  • Vomiting

Acute phase symptoms include:

  • Restlessness followed by:
    • Ecchymosis
    • Generalized rash
    • Petechiae
    • Worsening of earlier symptoms
  • Shock-like state
    • Cold, clammy extremities
    • Sweatiness (diaphoretic)

Diagnosis & Tests

A physical examination may reveal:

  • Enlarged liver (hepatomegaly)
  • Low blood pressure
  • Rash
  • Red eyes
  • Red throat
  • Swollen glands
  • Weak, rapid pulse

Tests may include:

  • Arterial blood gases
  • Coagulation studies
  • Electrolytes
  • Hematocrit
  • Liver enzymes
  • Platelet count
  • Serologic studies (demonstrate antibodies to Dengue viruses)
  • Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen)
  • Tourniquet test (causes petechiae to form below the tourniquet)
  • X-ray of the chest (may demonstrate pleural effusion)


Review Date : 11/11/2008
Reviewed By : Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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