Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person is bitten by a mosquito that is infected with the virus. The mosquito Aedes aegypti is the main species that spreads this disease.
There are more than 100 million new cases of dengue fever every year throughout the world. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from an earlier infection.
Early symptoms of dengue hemorrhagic fever are similar to those of dengue fever. But after several days the infected person becomes irritable, restless, and sweaty. These symptoms are followed by a shock-like state.
Bleeding appears as tiny spots of blood on the skin and larger patches of blood under the skin. Minor injuries can cause bleeding.
Shock can lead to death. If the person survives, recovery begins after a 1-day crisis period.
Early symptoms include:
Joint or muscle aches
General ill feeling
Acute phase symptoms include restlessness followed by:
Patches of blood under the skin
Tiny spots of blood on the skin
Worsening early symptoms
The acute phase also includes a shock-like state with:
Thomas SJ, Endy TP, Rothman AL, Barrett AD. Flaviviruses (Dengue, Yellow Fever, Japanese Encephalitis, West Nile Encephalitis, St. Louis Encephalitis, Tick-Borne Encephalitis, Kyasanur Forest Disease, Alkhurma Hemorrhagic Fever, Zika). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2014:chap 155.
Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.