Dengue hemorrhagic fever in children can prove to be fatal. However, it’s important to know that early treatment can save a child’s life.

Dengue hemorrhagic fever and dengue shock syndrome are caused by any one of four dengue viruses. The dengue viruses are members of the Flavivirus genus, which are spread by mosquitoes. According to the World Health Organization, the transmission of dengue has increased predominantly in all tropical countries, as warm climates create mosquito-friendly habitats.

• Symptoms of dengue
• diagnosis
• treatment

Symptoms of dengue, which appear in 3 phases:

• Acute Fever Stage: At this phase, no specific symptoms are present. Children get a high fever (for about 5-6 days) with aching, nausea, and vomiting. During rainy season, if a child has a high fever for over several days, parents should consider the possibility that they have contracted dengue and seek immediate medical attention. Parents should not attempt to treat their child on their own. Avoid using aspirin and ibuprofen, which may irritate the stomach lining, cause stomach bleeding, and thinning of the blood, resulting in dengue shock syndrome.
• Critical Stage (3 critical days of possible shock syndrome): After several days with a fever, the child will be weak with body aches, abdominal pain, abdominal bloating, and a loss of appetite, along with redness in the face, palms, and soles. At this stage, the child’s pulse and blood pressure should be monitored regularly. Their water intake and urine output should be checked several times a day. Some children may have abdominal bloating, restlessness, cold hands and feet, and a decreased temperature, which can mislead parents into believing that their child is heading towards recovery. However, they may go into shock within a few hours.
• Recovery Phase: The body temperature drops, without the child going into shock syndrome. The child will have a higher number of platelets, have a stable pulse rate, have stable blood pressure, and pass more water. During the recovery, blood flow increases to all tissues in the body, and the organs begin to function normally. It takes about 48-72 hours for the patients to get back to normal. At this phase, the child will regain their appetite and energy, with less abdominal pain and bloating. There will also be redness and itchy rashes on their palms and soles (without skin peeling).

In terms of diagnosis, the doctor will first evaluate the symptoms and perform a complete blood count (CBC) with hematocrit (Hct) in order to determine the number of red blood cells, white blood cells, and platelets. The doctor will then perform liver function tests (AST and ALT) to evaluate the severity of the disease. An elevated red blood cell count and low platelet count (below one hundred thousand per cubic millimeter) along with a fast pulse, low blood pressure, restlessness, fatigue, and low urine output indicates that the patient may be at risk of going into shock (within a few hours). The patient will then be transferred to an ICU (Intensive Care Unit) for close monitoring. The patient will also be given fluids, intravenously, and their lost electrolytes will be replaced – which is essential for preventing hypovolemic shock. The critical stage may last for 48-72 hours.

Some female adolescents with dengue infection have excessive menstrual bleeding; therefore, it is important to let the doctor know if the patient’s period is due or has already started. If required, the doctor may use hormones to delay the menstrual cycle until after the critical stage. Children with a bleeding disorder or blood cancer should be closely monitored, as the critical stage can be lethal for them.

There is no specific treatment for dengue hemorrhagic fever. The only current method of preventing dengue virus transmission is to effectively combat the mosquitoes – but this is no easy task. Parents may eliminate mosquitoes around their residence by getting rid of stagnant water containers where the mosquitoes breed, using appropriate netting to avoid mosquito bites, and using insect spray.

Whether such precautions have been taken or not, if a child’s high fever persists for several days during the dengue season, the parents should take their child to the hospital for early medical attention, in order to minimize the chances of shock syndrome and risk of death.

By Dr. Prasong Pruksananonda, Pediatrician, Pediatric Infectious Disease, Children’s (Pediatrics) Center, Bumrungrad Hospital

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