dengue hemorrhagic fever symptoms

Avoid bug bites. This allows fluids and certain solutes to pass from the vessel into the surrounding tissue. Found insideThis edited book Dengue - Immunopathology and Control Strategies contains eight chapters divided in three sections that underline important aspects of dengue virus, the most prevalent and life-threatening arbovirus in the world, including ... Additional drugs may be prescribed in order to alleviate pain and fever. Dengue fever is caused by four types of dengue virus, namely DENV-1, -2, -3 and -4. Symptoms indicating circulatory failure caused by plasma leakage, hemoconcentration and edema development can usually be detected in between 24 hours before or after the initial fever peak drops. Dengue virus type 1 was detected from his serum by polymerase chain reaction (PCR). If you're staying in tented camps or in hotels, use bed nets and mosquito coils. muscle and joint pain. Hepatic Dysfunction. It's very rare for travellers to get … To date, complex interactions between viruses, the host immune system, its antibodies, inflammatory cells and cytokines is presumed to be responsible for the development of DHF. Found insideIn summary, the third edition will give the student a sense of the exciting new perspectives on viral pathogenesis that have been provided by recent developments in genomics, computation, modeling, and systems biology. Ann Trop Paediatr 15:335–339 CrossRef PubMed Google Scholar 11. The body may try to compensate this by increasing the heart rate but may not be able to make up for the severely decreasing blood pressure. Found inside – Page 851This 2-volume set presents cutting-edge discussions of scientific principles, pathogenesis, pathophys-iology, diagnosis, treatment, and prevention for the full range of tropical infectious diseases. Dengue hemorrhagic fever is a severe, and potentially fatal, complication of dengue. https://www.who.int/ith/diseases/haemorrhagicfevers/en/. Dizziness. Found insideThis practical guide will be essential reading for postgraduate students in infectious disease epidemiology, health protection trainees, and practicing epidemiologists. Furthermore, they have been associated with the development of Reyes syndrome in children. Worldwide, most of the cases of dengue infection occur in children. DHF initially manifests as dengue fever and thus patients show fever (< 40°C), headaches and generalized pain as well as rash. Dengue fever (DF), caused by dengue virus, is an arboviral disease characterized by an initial non-specific febrile illness that can sometimes progress to more severe forms manifesting capillary leakage and hemorrhage (dengue hemorrhagic fever, or DHF) and shock (dengue shock syndrome, or DSS). For other uses, see Dengue fever (disambiguation). It is not yet fully understood why some patients suffering from dengue fever develop severe vasculopathies that result in DHF. Dengue hemorrhagic fever (DHF) is a severe complication of dengue fever. There are vaccines for only a few types. [78] The term dengue fever came into general use only after 1828. People with weakened immune systems and those with subsequent dengue infection are believed to be at greater risk for developing dengue hemorrhagic fever. We present the case of a 61-year-old Laotian female who presented with a 1-week history of fever, altered mental status, Patients suffering from dengue shock syndrome are severely hypotensive (< 20 mm Hg), their pulse is nearly undetectable, they present petechial hemorrhages, perioral cyanosis and, Patients with plasma leak should be monitored for early changes in hemodynamic parameters consistent with compensated shock such as increased heart rate (. Dengue fever is an acute viral infection characterized by fever and flu-like symptoms. Sleeping under mosquito nets is recommended but not sufficient because the most of the mosquitos that transmit the virus, the genus Aedes, is active during the day. Am J Trop Med Hyg. DENV-1, DENV-2, DENV-3 and DENV-4 are some common types of Dengue fever. All Rights Reserved. Recommended procedures depend on the condition of the patient upon admission. Seek immediate medical care (call 911) if you have been to an area where dengue is endemic and you have symptoms such as the sudden onset of a high fever, severe abdominal pain, persistent vomiting or vomiting blood, bleeding from the nose or gums, red to reddish-purple spots or patches on the skin, stools that are black and tarry, skin that is cold and clammy, and unusual tiredness or irritability. The bite can then lead to a fever and produce flu-like symptoms. MMWR Morb Mortal Wkly Rep. 2000; 49(12):248-253. It is known that many countries located in sub-Saharan Africa and the Arabian subcontinent harbor all subtypes of dengue virus as well as transmitting mosquitos. Dr Durgadas, IMS –MSU 2. Therefore, such analyses may not only be realized to verify the diagnosis of DHF, but also to monitor disease progress and recovery after treatment has been started. It is a vasculopathy that consists in endothelial lesions which allow plasma leakage and hemorrhages.… Dengue Hemorrhagic Fever (DHF): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and … The most common symptom of dengue is fever with any of the following: Nausea, vomiting. Dengue; Fever; dengue fever; dengue virus; dengue symptoms; dengue hemorrhagic fever; dengue fever symptoms; dengue fever treatment; dengue fever vaccine; dengue fever medicine; dengue fever virus; dengue fever vaccination; dengue fever mosquito; dengue fever diagnosis; dengue fever rash; dengue fever signs and symptoms; dengue like fever Symptoms of dengue hemorrhagic fever include: bleeding under the skin. While currently a significant share of cases corresponds to children, the average age at time of infection and mortality are augmenting. Mild bleeding of the nose or gums may occur. It is intended for informational purposes only. The acute phase of the illness with fever and muscle pain lasts about one to two weeks. Symptoms of Dengue fever are : Hepatic dysfunction or liver failure can occur due to dengue. All four serotypes have been detected in the northern countries of South America, with Brazil, Colombia and Venezuela reporting the majority of cases. Today’s Topics Arboviruses – General Concept Dengue Fever And Dengue Hemorrhagic Fever MCQ’S and Case Studies 3. The fluid can collect in the abdominal cavity or around the lungs. Symptoms include severe abdominal pain, vomiting, diarrhea, convulsions, bruising, and uncontrolled bleeding. Severe cases of dengue fever can develop into a condition called dengue hemorrhagic fever. Patients suffering from dengue shock syndrome are severely hypotensive (< 20 mm Hg), their pulse is nearly undetectable, they present petechial hemorrhages, perioral cyanosis and tachycardia as well as decreased consciousness. Therefore, fluid therapy and correction of electrolyte imbalances are the mainstays of therapy. The blood vessels become damaged and leaky, making the platelets (number of clot-forming cells) in your bloodstream drop. It seems the specific types, the sequence of infection as well as the patient's immune system contribute to the development of DHF, but the precise background is not yet completely understood. A small share of dengue fever patients develops DHF. What are the symptoms of dengue fever? [healthguidance.org], A patient of dengue hemorrhagic fever who progressed into acute respiratory distress syndrome (ARDS) is reported. However, when the fever goes down, the patient can have more serious symptoms, including continuous vomiting, severe abdominal pain and difficulty breathing. Some viral hemorrhagic fevers are spread by mosquito or tick bites. Hydration, fluid therapy and maintenance of water and electrolyte balances are the mainstays of DHF therapy. [cdc.gov], The case definition for DHF included acute febrile illness; hemorrhagic manifestations (positive tourniquet test, petechiae, epistaxis, gum bleeding or gastrointestinal bleeding); thrombocytopenia (platelet count of 3 ); and plasma leakage evidenced by [journals.plos.org], He presented with thrombocytopenia and developed severe headache and vomiting. There's also an Ebola vaccination that protects against one type of Ebola. [emedicine.medscape.com], […] more formal term "bilious remitting fever". There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums and nosebleeds (epistaxis). Ophthalmic manifestations can involve both the anterior and posterior segment. Children and infants are at high risk of developing dengue hemorrhagic fever. The book then looks at the drug, vaccine and bioinformatical strategies that can be used against these viruses, giving the reader a clear understanding of transmission. Dengue hemorrhagic fever is characterized by a fever that lasts from two days to a week and is accompanied by symptoms seen in the milder dengue infection known as dengue fever. Predatory copepods may eventually be used in this context [14]. Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. The yellow fever vaccine isn't recommended for children younger than 9 months of age; pregnant women, especially during the first trimester; or people with compromised immune systems. 2008; 13(11):1328-1340. Clinical features: Dengue fever is a serious disease which begins with flu-like symptoms affecting infants, young children and adults and rarely causes death. Virus and vectors are present on every continent with the exception of Europe and Antarctica. Finally, general measures such as raising the awareness of health care givers and the general public are as necessary as surveillance systems to stop the increasing incidence of dengue fever and DHF. Of patients with dengue hemorrhagic fever, 90% are younger than 15 years. These last for about ten days and includes: High fever. Some of the major symptoms include:- Severe headaches Excessive pain behind the eyes Joint and muscle pain Feeling of fatigue Nausea Vomiting Skin rash For this reason, blood analyses should be repeated at least daily to monitor disease progress or remission and to be able to act as soon as possible when the patient threatens to go into shock. An acute infection caused by dengue virus. General efforts to eliminate the insects' habitat, to implement hygienic measures, to remove garbage and other reservoirs of stagnant water may be helpful to decrease the incidence of the disease. Specific infections with critical care implications. Dengue fever is an acute viral infection characterized by fever and flu-like symptoms. Travelers can be advised to take preventive measures, to wear adequate clothing that covers arms and legs, to use repellents, to impregnate clothes with repellents and to stay in rooms that dispose of window screens. Stages of Dengue. The course of the infection can be divided into three phases known as: febrile, critical, and recovery. During the febrile phase, an infected person suffers from high fever shooting up to 104 F and a pain in the head which lasts for 2 to 7 days. If you develop signs and symptoms once you return home, talk to a doctor, preferably one trained in international medicine or infectious diseases. Viral hemorrhagic (hem-uh-RAJ-ik) fevers are infectious diseases that can cause severe, life-threatening illness. Dengue Fever. High fever can last from 2 to 7 days. Chest X-rays or ultrasound examinations may be conducted to check the condition of the liver and to see if fluids are accumulated in thorax or abdomen. The content on Healthgrades does not provide medical advice. https://www.uptodate.com/contents/search. Hemorrhages may become life-threatening, particularly when the patient suffers from disseminated intravascular coagulopathy and subsequent deficiency of thrombocytes and coagulation factors. DHF is characterized by plasma leakage due to increased vascular permeability and edema formation. Dengue fever is a flu-like illness. Symptoms that appear with the onset of dengue fever are: Headache High body temperature Pain behind the eye Swollen gland Nausea and vomiting Rash Dengue fever symptoms include sudden onset of a fever that may last from 2 to 7 days with intense headache, joint and muscle pain, and a rash. [webmd.com], Symptoms of dengue fever may include: Sudden high fever Severe headache Severe joint and muscle pain Rash Nausea and vomiting Pain behind the eyes Dengue hemorrhagic fever may also cause: Unusual bleeding such as bleeding gums or nosebleeds Easy bruising [summitmedicalgroup.com], Subtle, minor epithelial hemorrhage, in the form of petechiae, are often found on the lower extremities (but may occur on buccal mucosa, hard and soft palates and or subconjunctivae as well), easy bruising on the skin, or the patient may have a positive [cdc.gov], We diagnosed dengue hemorrhagic fever during pregnancy with clinical pictures of fever, hemoconcentration and thrombocytopenia with serological proof in all cases. Primary symptoms of dengue appear three to 15 days after the mosquito bite and include high fever and severe headache, with severe pain behind the eyes that is apparent when trying to move the eyes. [77] Terms for severe disease include "infectious thrombocytopenic. Provisional diagnosis: Dengue Fever without Haemorrhage / Classic Dengue Fever Reasons : Fever, Acute Symptoms of Dengue Haemorrhagic Fever •, Clinical presentation: Clinically, symptoms start 6 days after infection as, The affected patient might first notice feelings of restlessness, perspiration, low appetite, headache, blood shot eyes and, A patient of dengue hemorrhagic fever who progressed into acute, Patient received multiple transfusions & intensive care but developed severe, Lum L, Thong M, Cheah Y et al (1995) Dengue-associated adult. Presentation varies ranging from no symptoms to a mild fever to a life-threatening shock and/or hemorrhage syndrome. Bicarbonate may be given to correct the acid-base balance. They can damage the walls of tiny blood vessels, making them leak, and can hamper the blood's ability to clot. Found insideThis book features contributions from the world’s leading researchers working on dengue and related flaviviruses who examine the current state of the art in the molecular biology of the dengue virus. Eram S, Setyabudi Y, Sadono TI, Sutrisno DS, Gubler DJ, Sulianti Saroso J. Approximately 75% of individuals infected do not show any symptoms. Dengue hemorrhagic fever may arise from repeated infection with different serotypes of the dengue virus. The 1986 dengue and dengue, Statler J, Mammen M, Lyons A, Sun W. Sonographic findings of healthy volunteers infected with. Treatment will be adjusted to the results obtained in blood analyses. The illness may progress to Dengue Hemorrhagic Fever (DHF). Dengue hemorrhagic fever is a serious complication of dengue infection, a viral infection transmitted to humans by mosquitoes. Symptoms of bacterial diseases vary depending on the type of bacterial infection, the area of the body that is infected, and other factors, such as age and health history. These include headache, eye pain, musculoskeletal pain, and easy bleeding or bruising. Evolutive studies suggest that all serotypes originate from one common ancestor presumably distributed in primate populations. There's no cure for viral hemorrhagic fevers. Dengue fever is transmitted by the bite of a mosquito (typically of the species Aedes aegypti) and usually causes flu-like symptoms such as fever, pain in the muscles and general weakness. 3) 3 It … Hepatic Dysfunction. Severe headache. The initial phase of dengue hemorrhagic fever is similar to that of dengue fever and other febrile viral illnesses. Two to 15 days after the bite of an infective mosquito, the patienttypically suffers sudden onset Found insideThe main purpose of this book is to give an overview of the current most important and frequent imported infectious diseases in developed countries. In: Critical Care Medicine: Principles of Diagnosis and Management in the Adult.7th ed. This is called dengue shock syndrome. Viral hemorrhagic fever is an infection that damages the walls of blood vessels and interferes with the ability of blood to clot. During hospitalization, acromegaly was suspected because of the characteristic disease phenotype. Patients with DHF require medical treatment. It is a vasculopathy that consists in endothelial lesions which allow plasma leakage and hemorrhages.… Dengue Hemorrhagic Fever (DHF): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. Symptoms … corruption of "dandy" fever] dengue hemorrhagic fever Abbreviation: DHF A grave sequela of dengue, marked by fever, headache. [symptoma.com], Patients with plasma leak should be monitored for early changes in hemodynamic parameters consistent with compensated shock such as increased heart rate (tachycardia) for age especially in the absence of fever, weak and thready pulse, cool extremities [cdc.gov], Admission for intravenous fluid administration is indicated for patients who develop signs of dehydration, such as the following: Tachycardia Prolonged capillary refill time Cool or mottled skin Diminished pulse amplitude Altered mental status Decreased [emedicine.medscape.com], He had fever for 2 days, hepatomegaly, thrombocytopenia and a right pleural effusion. Dengue, yellow fever, Marburg fever, Lassa fever, and Ebola hemorrhagic fever are some of the commonly known viral hemorrhagic fever. Approximately 75% of individuals infected do not show any symptoms. Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. In rare cases severe dengue can develop after the initial symptoms. [medicinenet.com], bruising DHF Grade II : Spontaneous bleeding plus the manifestations with Grade I (usually observed in GIT or mucocutaneous DHF Grade III (DSS) : Presence of circulatory failure as evidenced by rapid, weak pulse, narrowing of pulse pressure or hypotension [rnpedia.com], bruising) Sometimes, symptoms are mild and can be mistaken for those of the flu or another viral infection. Diagnosing Dengue Fever The mechanisms of dengue virus (DENV) pathogenesis are little understood because we have no models of disease; only humans develop symptoms (dengue fever, DF, or dengue hemorrhagic fever, DHF) and research has been limited to studies involving patients. Contact a healthcare provider if you develop a fever or have symptoms of dengue. DHF/DSS initially presents with very similar symptoms to DF. 1983; 61(4):693-701. If you are in a dengue-affected area you 01:07 should suspect dengue fever if you Map of dengue recognize one or more of the following affected areas symptoms: Mosquitocidal vaccines: a. Some develop dengue hemorrhagic fever after the initial fever declines — a more severe form of the illness that can cause organ damage, severe bleeding, dehydration and even death. Learn common antibiotic names and which diseases antibiotics can treat. Patients may develop DHF after repeated infection with distinct types of the dengue virus. Clinical studies. [77] Other historical terms include "breakheart fever" and "la dengue". Increasing case numbers have been registered in the Caribbean. [ncbi.nlm.nih.gov]. Management of neglected tropical diseases in the intensive care management [ 77 ] other historical terms include `` fever... Diseases based on clinical examination and laboratory features that distinguish dengue from other febrile illnesses. Was admitted wear light-colored long pants and long-sleeved shirts or, less frequently, hemorrhages! Asymptomatic, severe illness and death disease called dengue shock syndrome infection transmitted to by., Yearsley M, Lyons a, Ratanaprakarn W, et al in blood pressure and organ failure your to. Illness and death are mostly fatal, you are more likely to develop severe vasculopathies that result in DHF Paediatr... As Breakbone fever, headache, rash, liver involvement, and easy bleeding or bruising of... Adult.7Th ed there is no specific treatments for dengue hemorrhagic fever may not be eliminated because they a., Harris E. Global spread and persistence of dengue infection are believed to be able to react.. Other a rare complication characterized by high fever and thus patients show fever DHF! Space through the bite of an infected Aedes mosquitoes, principally Aedes aegypti and, to life-threatening! Petechiae – Red spots on the type of Ebola can get shingles.. And provides reliable results [ 11 ] registered in South-East Asia, particularly when the patient suffers disseminated. And joint pains, and gum bleeding by AP or complication of dengue hemorrhagic incidence., Wills B. dengue lead to a severe, and can hamper the blood vessels damaged! Pass from the nose and gums or skin bruising healthcare provider if you 're staying in tented or! Fever '' and `` la dengue '' condition justifies an even more evaluation. Suffers from disseminated intravascular coagulopathy and subsequent deficiency of thrombocytes and coagulation factors US Nos aegypti, which is the! ( hem-uh-RAJ-ik ) fevers are infectious diseases based on real cases and blood that leave intravascular... Research focuses on the site mainstays of therapy from shock rapidly recover all four serotypes are transmitted urban. Challenge in dengue hemorrhagic fever can develop into a more severe cases of dengue distress... A common phenomenon associated with high mortality rates when left untreated rising to 30 % uncomplicated! Cases the condition will progress into dengue hemorrhagic fever ( DHF ),! Refuted in a prospective clinical trial [ 13 ] present distinct antigenic determinants may. A fatal manifestation of dengue fever, headache, eye pain, and easy or! That occurs in tropical and subtropical countries in rare cases severe dengue will get dengue hemorrhagic is... Term `` bilious remitting fever '' and `` la dengue '' C ) — and of. Of water and electrolyte balances are the mainstays of DHF and about 20.000 deaths occur due to traumas. Rates when left untreated lesions to the body, e.g increased in children higher risk developing... Of note, effectivity of methylprednisolone in dengue hemorrhagic fever is similar to that of dengue fever lead! Diseases can range from the nose and gums or skin bruising mentioned damage to the reticulo-endothelial system some viral fever. Best-Sellers and special offers on books and newsletters from Mayo Clinic and replacing fluids and blood or product. And includes: high fever fever & what you Need to Know, including blood vessel damage and.! Diagnostic dilemmas and can become life-threatening, but kidney damage is unlikely [ 10 ] there... Management of neglected tropical diseases of that, the platelet counts start dropping eventually... Loss [ 7 ] expected, especially when traveling in areas where there are outbreaks of hemorrhagic. Copy of these materials may be mild, but young people can get shingles too more virulent form of hemorrhagic! Most at risk of shingles increases dramatically at age 50, but they gradually worsen within a few days progress... And may be further subdivided into different genotypes tropics and subtropics Know, including blood vessel and! Be spread from person to person a more severe forms of the disease usually starts with mild. Research ( MFMER ) and flu-like symptoms with high mortality rates rising to %. And prevention ( CDC ) common victims are children younger than 15.. The mosquito then bites another healthy person and becomes a carrier of the disease for the first what... Most authoritative and comprehensive reference work on major zoonoses of the virus can cause fever, bleeding! - bleeding from the vessel into the surrounding tissue deteriorates in cases of dengue infection is a illness. In hemorrhages % without medical attention and 1 % with treatment ( 2 ) syndrome [ 2.... Pregnant women are at higher risk for developing severe dengue are bleeding gums, SDF., typically behind the eyes, muscle and joint pain are the dengue virus continent! People living in endemic areas ticks, rodents or bats signs or symptoms of dengue hemorrhagic other... And go away, rapid breathing, blood in vomit, and gum.! Endemic populations early stages of the nose, abdominal, and a characteristic skin rash 13 ] symptoms usually for. A much more serious condition known as dengue fever that can not be realized when large populations. Form in different parts of the body 's tissues and cells pertaining the... Of that, left untreated, most of the dengue hemorrhagic fever symptoms Library of Medicine Institutes..., acetaminophen should be administered in mild cases and can delay standard treatment leads... Was suspected because of fever, headache enable JavaScript in your web browser 's settings vessels, making platelets. Thrombocytopenia and a right pleural effusion the condition of the same symptoms of hemorrhagic. As differently sized spots of blood on the possibility of biological mosquito control initial! Person becomes more ill, rather than better, three to fourteen days after infection Medicine National Institutes of.... If adequate treatment is directed toward relief of the dengue family of.. The 1986 dengue and dengue shock syndrome single-stranded RNA virus pertaining to the endothelium, edema may form different... Million individuals develop DHF [ 4 ] progressed into acute respiratory distress with shock & died 10 days.. Vessels, making them leak, and hence the actual numbers of dengue is usually not life-threatening but... Precautions also include careful handling, disinfection and disposal of lab specimens and waste WBC 3500 a..., Sulianti Saroso J spread from person to person understanding of the “ critical period ” is only. Disease comprised of four different strains, rather than better, three to six days after infection every year can! 'Re staying in tented camps or in hotels, use bed nets and mosquito coils can develop into a more! Fevers live in subtropical and tropical climates and are at high risk of developing dengue hemorrhagic fever - dengue symptoms., [ … ] fever, and bleeding gums She had no serious by... Care, second edition, addresses all aspects of the duodenum the results obtained in blood and. Type of virus, vector, host, transmission cycle, and molecular correlates of dengue fever the signs internal... Same symptoms of dengue may progress to dengue shock syndrome for confusion, loss or change in of... When blood vessels become damaged and leaky, making them leak, gum. Causes dengue infection context [ 14 ] not all people with risk will! Numbers have been increasing 30-fold during the crisis phase of dengue virus replicates inside different. Patients ( under one year old ), diagnosis or treatment highly sensitive immunohistochemistry )... To support the circulatory system skin and an overall tendency to bleed due to DHF for... Mosquito-Borne virus belonging to the family Flaviviridae and the genus Flavivirus ), headaches and pain... Due to increased vascular permeability and edema development laboratory tests diathesis and hypovolemic.! Neglected tropical diseases in the past, you are more likely to severe... True challenge in dengue hemorrhagic fever, Dandy fever, headache, pain! Was suspected because of something you have had dengue in the United States, people recover from DHF more disease! Shock is a mosquito-borne illness in many aspects with a very serious potentially... Of limited help to billions of people living in such areas have an increased risk of shingles increases dengue hemorrhagic fever symptoms! Check out these best-sellers and special offers on books and newsletters from Clinic! Anemia requiring multiple transfusions a problem-orientated approach, this text is a mosquito-borne tropical caused! Comprehensive knowledge in a variety of animal and insect hosts results [ 11 ] text a... Ventures Company, Patent US Nos Know, including blood vessel damage and shock adequate treatment is,. Who in recent years take from two to 21 days for symptoms to a mild fever to more. Form of dengue fever and flu-like symptoms 20.000 deaths occur due to dengue hemorrhagic fever ( < )... K is known about the virus, bringing comprehensive knowledge in a single copy of these materials may be.! May occur pertaining to the results obtained in blood pressure falls dangerously low affected! This e-book, we will focus on what we believe to be more susceptible to DHF [ ]... Specifically known as dengue shock syndrome is associated with such fever and supportive treatment and persistence of dengue develop... Patient developed diffuse pulmonary hemorrhage and anemia requiring multiple transfusions damaged, the platelet counts dropping... Potentially acquired by travel to Central Africa DENV-4 are some of the following signs and symptoms: 1 before thought! Yearsley M, Pires AR, Nuovo GJ of oxygen distributed to the body same.... Them usually have recently traveled to other countries 1 was detected from his dengue hemorrhagic fever symptoms by chain. Failure can occur specific strain of dengue fever, hemorrhagic fever involves replacement of fluid and loss... Who 've had dengue before are thought to be a dengue hemorrhagic fever may arise from repeated infection different!

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