What is the ‘dengue hemorrhage shock syndrome’ that a 28-year-old Kolkata doctor died of?

What is Dengue Hemorrhage Shock Syndrome (DHSS)?

Dengue Hemorrhagic Shock Syndrome (DHSS) is a critical complication of dengue infection that demands proper understanding and immediate vigilance, stressed Dr Sauren Panja, senior consultant and administrative lead-critical care services, internal medicine at Narayana Health RN Tagore Hospital Mukundpur Kolkata.

Calling it “a critical form of dengue” i.e., severe dengue is characterised by severe plasma leakage leading to shock (low blood pressure), said Dr Aravinda G M, consultant – internal medicine, Manipal Hospital, Jayanagar, Bangalore.

“Initially, it mirrors common dengue symptoms – high fever, severe headaches, muscle pain, and a rash. Yet, it swiftly transforms into a life-threatening condition characterised by severe bleeding, abdominal pain, continuous vomiting, and shortness of breath,” elucidated Dr Panja.

According to Dr Aravinda, warning signs of severe dengue begin the 1st or 2nd day after the fever subsides which include severe stomach pain, persistent vomiting, blood from gums or nose, blood in urine, stools or vomit, bleeding under the skin, difficulty or rapid breathing, fatigue, and irritability or restlessness.

While the dengue virus itself is the culprit, triggering an aberrant immune response and disrupting the body’s ability for coagulation due to low platelets, it leads to bleeding tendencies and the leakage of fluids from intravascular space, culminating in shock and organ failure.

Who is at risk?

It primarily affects individuals who have been previously exposed to different serotypes of the dengue virus, said Dr Harikishan J, senior general physician, Kamineni Hospitals, L.B Nagar, Hyderabad. “This is known as antibody-dependent enhancement, leads to a more severe and aggressive form of the disease,” said Dr Harikishan.

Low platelet count is a major issue (Source: Getty Images/ Thinkstock)

According to Dr Harikishan, individuals residing in or travelling to regions where dengue is prevalent are at risk. “Those with a history of dengue infection and young children are particularly susceptible to DHSS. Additionally, people with compromised immune systems may be at greater risk,” said Dr Harikishan.

Treatment

Treating severe dengue requires maintaining good hydration (oral or intravenous), monitoring of platelet count and hematocrit, as well as organ support accordingly.

“Treatment should never be delayed. Timely diagnosis and hospitalisation are pivotal in case of warning signs. Swift interventions such as fluid replacement and blood transfusions (in case of bleeding manifestations) are essential to stabilise the patient and mitigate the risk of shock,” said Dr Panja.

Preventive measures?

According to Dr Panja, prevention relies on robust mosquito control measures – from insect repellents to the elimination of breeding sites.

Eliminate mosquito breeding sites by emptying containers that collect stagnant water, using mosquito nets, and applying insect repellent. “In regions where dengue is prevalent, vaccines may be available to reduce the risk of infection. Wear long sleeves and pants, especially during peak mosquito activity times,” said Dr Harikishan.

How is DHSS different from dengue?

DHSS stands apart from typical dengue due to its “rapid progression and severe bleeding tendencies”, explained Dr Panja. “Those at greater risk include infants, young children, and individuals with a history of prior dengue infections, as subsequent infections elevate the likelihood of developing DHSS. In dengue-prone regions, early detection and mosquito control measures are the strongest defence against this potentially fatal syndrome,” said Dr Panja.

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