Dengue shock syndrome is likely a distinct entity from SS with some overlapping features. The DSS patients are significantly less likely to have systemic inflammatory response syndrome, be tachycardic, and have a narrower pulse pressure at admission when compared with SS patients. Mental status is better preserved, and spontaneous clinical bleeding is more common in children with DSS compared with those in SS. These likely results from the predominantly vasodilatory state in SS versus vasoconstrictory state that is the initial response in DSS.
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