Dengue Shock Syndrome

CEBU, Philippines - Dengue shock syndrome is one syndrome that is actually not that shocking anymore.

The syndrome manifests because of the dengue virus that tends to affect children under 10, causing abdominal pain, hemorrhage (bleeding) and circulatory collapse (shock).

Ivan, seven years old, had fever for three days. His parents began suspecting the condition was caused by the dengue virus when the fever hadn’t subsided in four days. So they rushed the boy to the nearest hospital.

After being administered intravenous rehydration and medicines taken orally, the fever lowered from 40ºC to 36ºC. After which, Ivan started to feel hunger pangs, so he was given soup, porridge and biscuits. His father mentioned Ivan craved for orange juice. The following day, he was already sitting in bed, playing with his small cars and toy soldiers, and talking to his dad about going home. But in the nighttime, at half past seven, the fever recurred. Ivan started complaining of abdominal pains. At 11 p.m., Ivan succumbed to dengue shock syndrome.

DSS, known in its initial stage as dengue hemorrhagic fever or Philippine/Southeast Asian hemorrhagic fever, starts abruptly with high continuous fever and headache plus respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. According to medterms.com, shock occurs after two to six days with sudden collapse, cool clammy extremities, weak thready pulse, and blueness around the mouth (circumoral cyanosis). “There is bleeding with easy bruising, blood spots in the skin (petechiae), spitting out blood (hematemesis), blood in the stool (melena), bleeding gums and nosebleeds (epistaxis). Pneumonia and heart inflammation (myocarditis) may be present,” it added.

“The mortality is appreciable ranging from six to 30 percent. Most deaths occur in children. Infants under a year of age are especially at risk of death.”

As the virus attacks the blood vessels, these can collapse, causing shock.

Why do children tend to be the most susceptible? This is because, compared to adults, children have the endurance of the weaker. The other group at risk the most is the elderly.

Can DSS be managed? PubMed of the US National Library of Medicine-National Institutes of Health presented in one of its journals the following: “Dengue hemorrhagic fever is an important cause of morbidity among Asian children, and the more severe Dengue Shock Syndrome causes a significant number of childhood deaths.”

“DSS,” the journal entry pointed out, “is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia.” It was further learned that this condition pertains to decrease in blood volume or drop in volume of blood plasma, to be specific. This is characterized by the depletion of sodium or salts in the body.

“Fluid resuscitation is critical, but as yet there have been no large trials to determine the optimal fluid regimen. In a case for example, a randomized blinded comparison of four fluids (dextran, gelatin, lactated Ringer’s, and “normal” saline) were undertaken for initial resuscitation of 230 affected children suffering from DSS.”

“All the children survived,” the PubMed report noted, “and there was no clear advantage to using any of the four fluids, but the longest recovery times occurred in the lactated Ringer’s group.”

“The most significant factor determining clinical response was the pulse pressure at presentation. A comparison of the colloid and crystalloid groups suggested benefits in children presenting with lower pulse pressures who received one of the colloids.”

As for the Department of Health, it sticks to its main strategy in the prevention and control of dengue: That for one to avoid contracting the virus, one must destroy possible breeding grounds of mosquitoes. This is called “source reduction.”

A vaccine has been developed to prevent dengue fever but it is still under trial. And if it does come available in the market, the DOH recently issued an advisory (to the highly marginalized), as such wouldn’t be given to the public for free.