Symptoms of dengue fever may be absent or occur as undifferentiated fever, dengue fever, or Dengue hemorrhagic fever.
In clinically expressed cases, the incubation period of dengue fever lasts from 3 to 15 days, more often 5-8 days. There are classical, atypical hemorrhagic fever of Dengue (without the shock syndrome of dengue and accompanying it).
Classical dengue fever begins with a brief prodromal period. During it, note malaise, conjunctivitis and rhinitis. However, more often the prodromal period is absent. Symptoms of dengue fever start with a chill, a rapid increase in temperature to 38-41 C, persisting for 3-4 days (the initial period of the disease). Patients complain of severe headache, pain in the eyeballs, especially when moving, muscles, large joints, spine, lower limbs. This leads to difficulty in any movement, immobilizes the patient (the name of the disease comes from the English "dandy" - medical stretcher). In severe disease, along with a severe headache, vomiting, nonsense, and loss of consciousness are possible. Sleep is disturbed, appetite worsens, bitterness appears in the mouth, weakness and general malaise are pronounced.
Already from the first day of the illness, the appearance of the patient changes: the face is clearly hyperemic, the injection of vessels of the sclera, hyperemia of the conjunctiva is expressed. Often on the soft palate appears enanthema. The language is imposed. The eyes are covered because of photophobia. The liver is enlarged, but jaundice is not observed. Characteristic increase in peripheral lymph nodes. By the end of 3 days or on the 4th day the temperature drops to normal. The period of apyrexia lasts usually 1-3 days, then the temperature rises again to high figures. In some patients, apyrexia is not observed at the height of the disease. A characteristic symptom is exanthema. The rash usually appears on the 5th-6th day of the illness, sometimes earlier, first on the chest, the inner surface of the shoulders, then spreads to the trunk and limbs. Characteristic spotted-papular rash, which is often accompanied by itching, leaves after itself peeling.
The total duration of fever is 5-9 days. In the hemogram in the initial period - moderate leukocytosis and neutrophilia. Later - leukopenia, lymphocytosis. Possible proteinuria.
With an atypical fever, dengue is observed fever, anorexia. Headache, myalgia, ephemeral rash, polyadenopathy is absent. The duration of the disease does not exceed 3 days.
Dengue hemorrhagic fever has typical symptoms, of which 4 main symptoms are distinguished: high fever, hemorrhages, hepatomegaly and circulatory insufficiency.
Hemorrhagic fever of dengue begins with a sudden increase in body temperature to 39-40 C, severe chills, headache, cough, pharyngitis. Unlike classical dengue, myalgia and arthralgia are rarely observed. In severe cases prostration develops rapidly. Characterized by severe hyperemia and puffiness of the face, glitter of eyes, hyperemia of all visible membranes. Often, scarlatine-like reddening of the whole body is noted, against which there is a punctual rash, mainly on the extensor surfaces of the elbows and knee joints. In the next 3-5 days of the disease appears korepodobnaya patchy-papular or scarlet-like rash on the body, and then - on the limbs and face. Mark pain in the epigastric region or throughout the abdomen, accompanied by repeated vomiting. The liver is painful, enlarged.
After 2-7 days, body temperature often decreases to normal or low levels, symptoms of dengue fever can regress, recovery comes. In severe conditions, the patient's condition worsens. The most frequent hemorrhagic sign is a positive test with a tourniquet (most patients have bruises at the injection sites). On the skin there are petechiae, subcutaneous hemorrhage, bleeding. Significantly reduced the number of platelets, the hematocrit increases by 20% or more. Characteristic development of hypovolemic shock.
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