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Dengue fever and dengue haemorrhagic fever

2003; Elsevier BV; Volume: 361; Issue: 9352 Linguagem: Inglês

10.1016/s0140-6736(03)12220-9

1474-547X

T. Jacob John,

Dengue and Mosquito Control Research

In their Case report about a tourist with dengue fever and visual loss, Christos Haritoglou and colleagues (Oct 5, p 1070)1Haritoglou C Dotse SD Rudolph G et al.A tourist with dengue fever and visual loss.Lancet. 2002; 360: 1070Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar state that there are four stages of dengue fever. However, disease caused by dengue virus infection is classified into two clinical entities: dengue fever and dengue haemorrhagic fever; it is the latter that is divided into four grades.2Gubler DJ Dengue and dengue hemorrhagic fever.in: Guerrant RL Walker DH Weller PF Tropical infectious diseases: principles, pathogens and practice. vol 2. Churchill Livingstone, New York1999: 1265-1274Google Scholar The disease in the tourist was indeed dengue fever, but with bilateral retinal haemorrhage. Although correctly classified as dengue fever, the case seems to have been confused with dengue haemorrhagic fever (perhaps on account of the retinal bleeding), because Haritoglou and co-workers state that the disease they diagnosed “was divided into four stages”. The features of dengue fever and dengue haemorrhagic fever are similar at the onset of illness. Dengue haemorrhagic fever is characterised by abnormal capillary permeability, which usually develops as the fever subsides, with shift of fluid from intravascular to extravascular space.2Gubler DJ Dengue and dengue hemorrhagic fever.in: Guerrant RL Walker DH Weller PF Tropical infectious diseases: principles, pathogens and practice. vol 2. Churchill Livingstone, New York1999: 1265-1274Google Scholar This process leads to haemoconcentration and mild-to-moderate circulatory failure (dengue haemorrhagic fever grades 1 to 3), which is manifested by profuse sweating; cold skin over extremities; increased pulse rate; and decreased pulse pressure, blood pressure, or both, of varying severity. Profound shock with very low blood pressure and undetectable pulse characterise grade 4 dengue haemorrhagic fever, which is also called dengue shock syndrome. Haemorrhage and thrombocytopenia can occur in dengue fever, but are more common and severe in dengue haemorrhagic fever. Maculopapular rash is common in dengue fever; petechial rash is not uncommon in dengue fever, but is more common in dengue haemorrhagic fever. It is not the presence or absence of bleeding that distinguishes dengue haemorrhagic fever from dengue fever, but the development of capillary leak and its sequelae, after onset of an illness typical of dengue fever.2Gubler DJ Dengue and dengue hemorrhagic fever.in: Guerrant RL Walker DH Weller PF Tropical infectious diseases: principles, pathogens and practice. vol 2. Churchill Livingstone, New York1999: 1265-1274Google Scholar Although dengue fever is characterised by spontaneous recovery, dengue haemorrhagic fever may progress through the grades of severity unless treated with fluid replacement in the vascular space. Haritoglou and colleagues' patient had dengue fever with retinal haemorrhage in both eyes from the very beginning of fever, and with spontaneous recovery without worsening to dengue haemorrhagic fever. Although spontaneous bleeding is caused by a break in vascular integrity, the term “increased permeability” is usually applied to the leak of plasma without involvement of red blood cells. Therefore, Haritoglou and colleagues' description of “retinal haemorrhage as a sign of increased vascular permeability” might conflate dengue fever with dengue haemorrhagic fever.