Management of dengue hemorrhagic fever/dengue shock syndrome

Dengue is a serious public health problem worldwide. Dengue hemorrhagic fever (DHF)/Dengue shock syndrome (DSS) are severe forms of dengue virus infections. The main hallmark of DHF/DSS is an increase in vascular permeability in the critical/leakage phase resulting in plasma leakage of fluid from the intravascular compartment to the extravascular space. In less severe cases (nonshock DHF grade I, II) plasma leakage is mild to moderate, and patients will recover spontaneously or shortly after intravenous fluid administration. In more severe cases (DHF grade III, IV; DSS), when plasma loss is critical, hypovolemic shock ensues and can progress rapidly to profound shock. The patient in shock may die within 12- 24 hours if appropriate treatment is not promptly administered. Volume replacernent is the mainstay of treatment of DHF/DSS. Proper organization and good triage in the hospital; supplying enough essential equipment and intravenous fluids for the hospital; well-trained medical staff are essential factors to contribute to the reduction of fatality rates in DHF/DSS.