Dengue hemorrhagic fever / Dengue
shock syndrome (DHF / DSS):



Mild to moderate cases:
Fever subsides with profuse sweating. Mild changes in pulse rate and blood pressure may be noticed with cold extremities and skin congestion. Patient recovers spontaneously or after fluids and electrolyte therapy.

Severe cases:
Sudden deterioration may after few days. Fever subsides in 3-7 days and signs of circulatory collapse appear. Skin becomes cool, congested with circumoral cyanosis, weak and rapid pulse, acute abdominal pain and narrow pulse pressure (< 20 mm Hg). Consciousness is usually intact. Patient may die of profound shock if untreated or recovers after volume replacement. Complications include metabolic acidosis, severe gastrointestinal bleeds, intracranial hemorrhage, convulsions, encephalitis etc. Survivors recover within 2-3 days. Return of appetite is a good prognostic sign. During convalescent stage, bradycardia or arrhythmia may be noted.

Lab investigations: