Clinical Diagnosis of DHF

The disease manifests as a sudden onset of severe headache, muscle and joint pains (myialgias and arthragials) severe pain that gives it the nick-name break-bone fever or bonecrusher disease), fever, and rash. The dengue rash is characteristically bright red petechiae and usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting, or diarrhea. Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash is present. Thus travelers from tropical areas may pass on dengue in their home countries inadvertently, having not been properly diagnosed at the height of their illness. Patients with dengue can pass on the infection only through mosquitoes or blood products and only while they are still febrile. The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called biphasic pattern). Clinically, the platelet count will drop until the patient's temperature is normal. Cases of DHF also show higher fever, variable haemorrhagic phenomena, thrombocytopenia, and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate. DHF combined with a cirrhotic liver has been suspected in rapid development of hepatocellular carcinoma (HCC). Given that the DEN virus is related to the Hepatitis C virus, this is an avenue for further research as HCC is among the top five cancerous causes of death outside Europe and North America. Normally HCC does not occur in a cirrhotic liver for ten or more years after the cessation of the poisoning agent. DHF patients can develop HCC within one year of cessation of abuse.

The increasing value hematocryte is a sensitive indicator of the occurrence of shock. Hematocryte increase in value more than 20% showed clinical diagnosis DHF. If there isn’t tool for hemoconcentration test hemoconcentration can be measured with the examination use haemoglobin method sahli regularly and performed by the same examination. The increase in Hb level of 30% support the clinical diagnosis DHF.

DBD classified into four levels of illness. Degree III and IV are considered DSS. There is thrombositopenia with hemoconsentration distinguish degrees I and II in the DBD of dengue fever.

DBD according to the degree of division of the WHO (1986):

Degree I: a fever accompanied by non-specific constitutional symptoms; the only manifestation is bleeding tourniqet test positive.

Degree II: spontaneous bleeding manifestations in addition to the degree I patients, usually in the form of bleeding or bleeding skin of the other.

Degree III: fever, spontaneous bleeding, accompanied or not accompanied hepatomegaly and found symptoms of failure include pulse circulation rapid and weak pulse pressure decreased (<20>

Degree IV: fever, spontaneous bleeding, accompanied or not accompanied hepatomegaly and found shock great, not palpated pulse and blood pressure is not measurable.