Affiliations: Pediatric Intensive Care Unit, Apollo Hospitals,
Chennai, India | Department of Pediatrics, University of British
Columbia, Vancouver, British Columbia, Canada | Pediatric Intensive Care Unit, Manipal Hospitals,
Note:  Correspondence: Suchitra Ranjit, MD, Senior Consultant,
Pediatric ICU, Apollo Hospitals, Greams Rd, Chennai 600006, India. Tel.: +91 44
28296517; Fax: +91 44 28294429; E-mail: [email protected]
Abstract: Dengue viral infections are caused by one of four single stranded
RNA viruses of the family Flaviviridae. They can occur virtually throughout the
tropics and are transmitted by their mosquito vector, Aedes aegypti.
Dengue, the most common arboviral disease in the world, has become more
prevalent now than ever before and its prevalence is expected to increase. The
risk for severe disease is determined by a complex interplay of
epidemiological, virus and host factors. The clinical syndromes caused by
dengue viral infections occur in an iceberg fashion along a severity continuum.
Most cases are asymptomatic and a much smaller proportion present with severe
forms of the disease-dengue hemorrhagic fever/dengue shock syndrome-that are
characterized by sudden increase in vascular permeability and consequent shock.
The traditional WHO classification and grading of dengue fever, dengue
hemorrhagic fever and dengue shock syndrome are described along with a
discussion of the timing and methods of laboratory diagnosis. Management is
predominantly supportive. In patients with severe shock, treatment strategies
are double pronged and include methods to judiciously resolve shock and control
bleeding while simultaneously preventing fluid overload and its complications,
including the need for assisted ventilation. These considerations are
especially relevant in resource limited tropical countries where dengue viral
infections are amongst the leading causes of childhood hospitalization,
morbidity and death.
Keywords: Dengue, dengue hemorrhagic fever, dengue shock syndrome, shock, dengue immunopathogenesis, dengue diagnosis, management of shock, prevention of fluid overload