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Dengue fever
Dengue fever
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Diagnostic criteria
World Health Organization (WHO): case definition (2009) [3]
The 1997 dengue case definition (below) is limited in terms of its complexity and applicability. This led to
a new WHO classification where dengue severity is divided into dengue without warning signs, dengue
with warning signs, and severe dengue. While WHO still support both case definitions, there is a move
towards using the 2009 case definition due to its ease of use. One study found that the revised
classification has a high potential for facilitating dengue case management and surveillance, and that it
was more sensitive than the 1997 case definition for timely recognition of disease. [4]
Dengue without warning signs:
Fever and 2 of the following:
Nausea/vomiting
Rash
Aches and pains
Leukopenia
Positive tourniquet test.
Dengue with warning signs:
Dengue (as defined above) with any of the following:
Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation (e.g., ascites, pleural effusion)
Mucosal bleeding
Lethargy/restlessness
Liver enlargement >2 cm
Laboratory: increase in haematocrit concurrent with rapid decrease in platelet count.
Warning signs require strict observation and medical intervention.
Severe dengue:
Dengue with at least 1 of the following:
Severe plasma leakage leading to shock (dengue shock syndrome) or fluid accumulation with respiratory
distress
Severe bleeding (as evaluated by a clinician)
Severe organ involvement (i.e., AST or ALT 1000 or greater, impaired consciousness, organ failure).
[Centers for Disease Control and Prevention (CDC): clinical description for case definitions] (external link)
World Health Organization (WHO): case definition (1997) [3]
The traditional classification is divided into dengue fever, dengue haemorrhagic fever, and dengue shock
syndrome.
Dengue fever (DF):
Defined by the presence of fever and 2 or more of the following (but not meeting the case definition of
dengue haemorrhagic fever):
Retro-orbital or ocular pain
Headache
Rash
Myalgia
Arthralgia
Leukopenia
Haemorrhagic manifestations (e.g., positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis,
gum bleeding, blood in vomit/urine/stool, vaginal bleeding).
Dengue haemorrhagic fever (DHF):
Fever lasting from 2-7 days
Evidence of haemorrhagic manifestation or a positive tourniquet test
Thrombocytopenia
Evidence of plasma leakage shown by haemoconcentration, pleural effusion, or ascites.
Dengue shock syndrome (DSS):
Has all the criteria of DHF plus circulatory failure as evidenced by:
Rapid and weak pulse and narrow pulse pressure, or
Age-specific hypotension and cold, clammy skin and restlessness.
World Health Organization (WHO): laboratory criteria for diagnosis of dengue shock syndrome
(DSS)/dengue haemorrhagic fever (DHF)
Laboratory criteria for the diagnosis of DSS/DHF include: [1] [2]
Rapidly developing, severe thrombocytopenia (i.e., <100,000 cells/mm^3 [<100 x 10^9/L])
Decreased total WCC and neutrophils and changing neutrophil-to-lymphocyte ratio
Elevated haematocrit (i.e., 20% increase from baseline is objective evidence of plasma leakage)
Hypoalbuminaemia (i.e., serum albumin <35 g/L [3.5 g/dL] suggests plasma leakage)
Elevated LFTs (i.e., AST:ALT >2).
