Is Dengue Fever a Life-Threatening Disease?

Dengue fever is common in countries such as Malaysia. Reasons being is because the environment and climate itself being the perfect medium for the mosquitoes responsible for dengue infection, to breed and live. Dengue cases often spike during the rainy season or after a big flood in the state. You may have already known that the dengue virus is transmitted by the Aedes mosquito but do you know that only the infected female mosquito is able to cause dengue infection in humans? A mosquito is said to be infected when it bites a human with dengue virus circulating in the human body. The infected mosquito then bites humans and spreads the dengue virus. The question now is, is dengue fever a life-threatening disease?

          In short, yes it can be but it is not definitely. Dengue itself is a self-limiting disease, which means it is a disease that can go away on its own. The mortality rate is less than 1{d6b3193afd8499af2f28ac17c1a3778c4e6c8819d5d73c7dc9806223890cfc76} but the number can get lower when it is detected early and treated well. This shows that it is rare for a person with dengue fever to die from dengue infection itself. Thus, dengue fever is not a definite life-threatening disease.

          However, dengue fever is certainly a life-threatening disease when it becomes a severe dengue infection. Severe dengue infection can be either dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). A person diagnosed with either of this is certainly at high risk for experiencing a life-threatening phase. DSS and DHF may seem to be the same thing but it is in fact in contrast. DHF is the continuation of dengue fever which includes signs of severe abdominal pain, marked change in temperature from fever to low temperature (hypothermia), signs of bleeding such as bleeding gums or nose and changes in alertness such as confusion. According to the World Health Organization (WHO), DHF is defined when it fulfils any of the four criteria as stated below:

  • Fever that lasts for 2 to 7 days or recent history of such fever.
  • Any signs of bleeding or known as hemorrhagic manifestation such as mild or positive tourniquet test, skin changes (purpura, ecchymoses), bleeding gums, vomiting blood (hematemesis) and presence of blood in stool (melena).
  • Low number of platelets in the body which is below 100 000/mm3 (thrombocytopenia).
  • Sign of increased vascular permeability such as presence of fluid in the chest activities (pleural effusion) or in the abdomen (ascites).

On the other hand, DSS is defined as any case that meets the four criteria for DHF, such as mentioned above, and with evidence of circulatory failure. Circulatory failure is characterised by rapid, weak and narrow pulse or hypotension (low blood pressure) and cold clammy skin. Mortality rate in DSS can be 10{d6b3193afd8499af2f28ac17c1a3778c4e6c8819d5d73c7dc9806223890cfc76} or higher but this number is significantly reduced to 1{d6b3193afd8499af2f28ac17c1a3778c4e6c8819d5d73c7dc9806223890cfc76} when it is detected early and treated well.

Either DSS or DHF, both are part of the severe dengue form. The risk for severe dengue is high in the elderly and young children. The risk is also high for those with chronic medical conditions such as diabetes. Severe dengue is more susceptible for those already have been infected by dengue infection before. You probably wonder, why would a person with dengue infection before, be susceptible for severe dengue? You probably thought that shouldn’t a person who already got infected will have antibodies that could fight infection in the future? This is not the case with dengue infection. When a person is infected by the different serotypes of dengue virus from the previous infections, the body will face cross-reaction immunity. In general, dengue virus has four serotypes, DENV-1, DENV-2, DENV-3 and DENV-4. Hence, a person may be infected by one of the serotypes and recover. When a person recovers, he or she will have immunity but the immunity only works against that one specific serotype. Thus, when a person is infected with the other serotypes, the immunity in fact turns out to be cross-reacting immunity and this itself leads to high risk for severe dengue.

          Since there are no specific treatments for dengue fever, either mild or severe form, treatment provided aims to support patients and to prevent further complications. Typically, fluid replacement therapy is emphasised through intravenous fluid to maintain good hydration level and to support the patient’s circulatory system. Common prescribed medications include paracetamol to ease pain and fever.

          The best way to prevent dengue fever from reaching the severe form is to treat it when it is still in early stage. Dengue fever is initially marked by high-grade fever of more than 2 to 7 days and other symptoms such as headaches especially with pain behind the eyes (retro-orbital headaches), joint pain (arthralgia), muscle pain (myalgia) and skin rash. Any person that shows symptoms of dengue fever should get checked by a doctor immediately. This is important as symptoms may seem to go away around the 3rd to 7th day and it can be mistaken as the person deemed to be healed from dengue fever. Unfortunately, this is the stage where the critical phase occurs. Critical phase is the phase where most patients may develop severe dengue. Critical phase lasts from 24 to 48 hours. By making sure the critical phase itself is at least experienced in a hospital setting, healthcare professionals can make close observation and prompt treatment should there be any possibility of severe dengue.

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In essence, dengue fever can be life-threatening but it is rare. It is best to get medical advice if a person shows any symptoms of dengue fever. It is also important for patients to follow all treatment plans provided by the doctor such as hospitalisation for the first 24 hours in case of a suspected severe dengue case.

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