Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
WHO Classification
Dengue case classification published by WHO in 2009 categorizes the disease into probable dengue or laboratory-confirmed dengue (with or without warning signs) and severe dengue (encompassing severe plasma leakage, severe bleeding, and severe organ involvement). The tables below describe the definitions of each category:[1][2]
| Dengue ± Warning Signs
|
| Dengue (live in/travel to dengue endemic area)
|
| ❑ Fever
|
| PLUS
|
❑ Two of the following criteria:
❑ Nausea or vomiting
❑ Rash
❑ Aches and pains
❑ Tourniquet test positive
❑ Leukopenia
❑ Any warning sign
|
| Warning Signs
|
❑ Warning signs requiring strict observation and medical intervention:
❑ Abdominal pain or tenderness
❑ Persistent vomiting
❑ Clinical fluid accumulation
❑ Mucosal bleed
❑ Lethargy, restlessness
❑ Liver enlargment >2 cm
❑ Increase in hematocrit with rapid decrease in platelet count
|
|
| Severe Dengue
|
| Severe Plasma Leakage
|
❑ Severe plasma leakage leading to:
❑ Shock (dengue shock syndrome)
❑ Fluid accumulation with respiratory disrtess
|
| Severe Bleeding
|
❑ Severe bleeding as evaluated by clinician:
❑ Persistent and/or severe overt bleeding in the presence of unstable hemodynamic status, regardless of the hematocrit level
❑ A decrease in hematocrit after fluid resuscitation together with unstable hemodynamic status
❑ Refractory shock unresposive to fluid resuscitation of 40–60 ml/kg
❑ Hypotensive shock with low/normal haematocrit before fluid resuscitation
❑ Persistent or worsening metabolic acidosis ± a well-maintained systolic blood pressure, especially in those with severe abdominal tenderness and distension
|
| Severe Organ Involvement
|
❑ Severe organ involvement indicated by:
❑ Liver: AST or ALT ≥1000 IU/L
❑ CNS: impaired consciousness
❑ Heart or other organs
|
|
Referemces