Dengue shock syndrome

00000000 The condition of patients who progress to shock suddenly deteriorates after a fever of 2 - 7 days' duration. This deterioration occurs at the time of, or shortly after, the fall in temperature-between the third and the seventh day of the disease. There are the typical signs of circulatory failure: the skin becomes cool, blotchy, and congested; circumoral cyanosis is frequently observed; the pulse becomes rapid. Patients may initially be lethargic, then become restless and rapidly enter a critical stage of shock. Acute abdominal pain is a frequent complaint shortly before the onset of shock.

00000000 DSS is usually characterized by a rapid, weak pulse with narrowing of the pulse pressure (<20 mmHg (2.7 kPa), regardless of pressure levels, e.g. 100/90 mmHg (13.3-12.0 kPa)) or hypotension with cold, clammy skin and restlessness. Patients in shock are in danger of dying if appropriate treatment is not promptly administered. Patients may pass into a stage of profound shock, with the blood pressure or pulse becoming imperceptible. However, most patients remain conscious almost to the terminal stage. The duration of shock is short: typically the patient dies within 12 - 24 hours, or recovers rapidly following appropriate volume-replacement therapy. Pleural effusion and ascites may be detected by physical examination or radiograpy. Uncorrected shock can give rise to a complicated course, with the development of metabolic acidosis, bevere bleeding from the gastrointestinal tract and other otgans, and a poor prognosis. Patients with intracranial haemorrhages may convulse and enter a coma. Encephalopathy, reported occasionally, can occur in association with metabolic and electrolyte disturbances or intracranial bleeding.

00000000 Convalescence in patients with corrected DSS is short and uneventful. Even in cases of profound shock, once shock is overcome, surviving patients recover within 2 - 3 days, although pleural effusion and ascites may still be present. Good prognostic signs are adequate urine output and the return of appetite.

00000000 Common findings during the convalescence of DHF patients are sinus bradycardia or arrhythmia and the characteristic confluent petechial rash with small round areas of normal skin. Maculopapular or rubella-type rashes are less common in DHF than in DF and may be observed either early or late in the disease. The course of DHF is approximately 7 - 10 days. In general, there is no prolonged fatigue.