Dengue hemorrhagic fever

Also known as: Hemorrhagic dengue, Dengue shock syndrome, Philippine hemorrhagic fever, Thai hemorrhagic fever or Singapore hemorrhagic fever


Dengue hemorrhagic fever is a severe, potentially deadly infection spread by some mosquitos.


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:

  • Decreased appetite
  • Fever
  • Headache
  • Joint or muscle aches
  • General ill feeling
  • Vomiting

Acute phase symptoms include restlessness followed by:

  • Patches of blood under the skin
  • Tiny spots of blood on the skin
  • Generalized rash
  • Worsening early symptoms

The acute phase also includes a shock-like state with:

  • Cold, clammy arms and legs
  • Sweating

Exams and Tests

A physical examination may reveal:

Tests may include:

  • Arterial blood gases
  • Blood tests (to find signs of the virus in the blood)
  • Coagulation studies
  • Electrolytes
  • Hematocrit
  • Liver enzymes
  • Platelet count
  • Serum studies from samples taken during acute illness and afterwards
  • Tourniquet test (causes blood patches to form below the tourniquet)
  • X-ray of the chest (may show buildup of fluid in the lungs and chest)


Because dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms. These treatments may include:

  • A transfusion of fresh blood or platelets to correct bleeding problems
  • Intravenous (IV) fluids and electrolytes to correct electrolyte imbalances
  • Oxygen therapy to treat abnormally low blood oxygen
  • Rehydration with intravenous (IV) fluids to treat dehydration
  • Supportive care in an intensive care unit or similar setting

Outlook (Prognosis)

With early and aggressive care, most people recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive.

Possible Complications

Dengue hemorrhagic fever may cause these complications:

  • Brain disease
  • Liver damage
  • Residual brain damage
  • Seizures
  • Shock

When to Contact a Medical Professional

See your health care provider right away if you have symptoms of dengue fever and have been in an area where dengue fever occurs, especially if you have had dengue fever before.


Because there is no way to prevent dengue fever, use personal protection such as:

  • Full-coverage clothing
  • Mosquito nets
  • Mosquito repellent containing DEET

If possible, travel during times of the day when mosquitoes are less active. Mosquito control programs can also reduce the risk of infection.


Haile-Mariam T, May L. Viral illnesses. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 130.

Lupi O. Mosquito-borne hemorrhagic fevers. Dermatologic Clinics. 2011;29:33-8. PMID: 21095525

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.

Review date:
July 12, 2014
Reviewed by:
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.
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