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Infectious Disease Online

Pathology of Dengue Virus

Infection and Dengue

Hemorrhagic Fever

Dr Sampurna Roy MD




Dengue the most prevalent arthropod-borne viral (Arborvirus) disease of humans caused by  four serotypes of dengue virus (DENV 1-4) of the genus Flavivirus.

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It is transmitted to man by mosquito Aedes aegypti.

It is common in tropical and subtropical countries, especially in coastal areas. 

In terms of numbers of individuals infected, it is by far the most devastating of all the recognised arthropod-transmitted virus diseases. It is estimated that more than 3 billion humans live in dengue endemic regions of the world, and currently, more than 50 million infections occur annually with at least 500,000 individuals requiring hospitalisation.

Source: Man is infective to mosquito and mosquito transmits the disease  to man.

Clinical presentation:

Clinically, symptoms start 6 days after infection as malaise and headache, followed by sudden onset of fever, intense backache and generalized pains, mainly in the orbital and periarticular areas.

After an afebrile interval of 24 to 48 hours, there is recurrence of fever for a day or two (‘saddleback fever’).

There may be skin rash and lymphadenopathy.

In persons, previously exposed to Dengue virus, antiviral antibodies may enhance the uptake of virus into host cells and cause disseminated intravascular coagulation, shock and death (hemorrhagic dengue).

Pathological features:

Biopsy studies of the rash seen in nonfatal dengue fever show a lymphocytic vasculitis in the dermis.

In cases of fatal dengue hemorrhagic fever the gross findings are petechial hemorrhages in the skin and hemorrhagic effusions in the pleural, pericardial and abdominal cavities.

Hemorrhage and congestion are seen in many organs.

Histopathological examination show hemorrhage, perivascular edema and focal necrosis but no vasculitic or endothelial lesions.

It is believed that most of the morphologic abnormalities seen result from disseminated intravascular coagulation and shock.

Related post: Chikungunya virus infection

Differential diagnosis : Includes malaria , typhoid fever, leptospirosis, West Nile virus infection, measles , rubella, acute human immunodeficiency virus conversion disease, Epstein–Barr virus infection, viral hemorrhagic fevers, rickettsial diseases, early severe acute respiratory syndrome (SARS), and any other disease that can manifest in the acute phase as an undifferentiated febrile syndrome.

Diagnosis:  A confirmed diagnosis is established by culture of the virus, polymerase-chain-reaction (PCR) tests, or serologic assays.

The diagnosis of dengue hemorrhagic fever is made on the basis of the following triad of symptoms and signs: 

- Hemorrhagic manifestations;

- A platelet count of less than 100,000 per cubic millimeter; and

- Objective evidence of plasma leakage, shown either by fluctuation of packed-cell volume (greater than 20 percent during the course of the illness) or by clinical signs of plasma leakage, such as pleural effusion, ascites, or hypoproteinemia.

Hemorrhagic manifestations without capillary leakage do not constitute dengue hemorrhagic fever.


Further reading:

The pathology of dengue hemorrhagic fever.

Histologic, viral, and molecular correlates of dengue fever

Liver histopathology and biological correlates in five cases of fatal dengue fever in Vietnamese children.

Dengue virus pathogenesis: an integrated view

Coagulopathy in dengue infection and the role of interleukin-6.

Dengue Fever in malaria endemic areas.

Clinical case report: Dengue hemorrhagic fever in a patient with acquired immunodeficiency syndrome.

Dengue hemorrhagic fever patients with acute abdomen: clinical experience of 14 cases.

Serotype-specific differences in clinical manifestations of dengue.



Dengue outbreak in India kills 38, infects thousands. 05 Oct 2006:  Read more....

Dengue Outbreak Kills 14 in India - NEW DELHI, Oct. 3, 2006 :  Read more...

Dengue fever outbreak overwhelms Delhi hospitals - October 3, 2006: Read more...

Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi.  

Experience in adult population in dengue outbreak in Delhi

The 1996 outbreak of dengue hemorrhagic fever in Delhi, India.

An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi.  

Dengue haemorrhagic fever in adults: a prospective study of 110 cases.

The first major outbreak of dengue hemorrhagic fever in Delhi, India.

The 2003 outbreak of Dengue fever in Delhi, India.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

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