Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever

BACKGROUND: The current World Health Organisation (WHO) classification of dengue includes two distinct entities: dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome; it is largely based on pediatric cases in Southeast Asia. Dengue has extended to different tropical areas and...

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Main Authors: Bandyopadhyay, S., Lum, L.C., Kroeger, A.
Format: Article
Published: 2006
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Online Access:http://eprints.um.edu.my/613/
http://www.ncbi.nlm.nih.gov/pubmed/16903887
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spelling my.um.eprints.6132014-10-21T04:53:55Z http://eprints.um.edu.my/613/ Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever Bandyopadhyay, S. Lum, L.C. Kroeger, A. R Medicine (General) BACKGROUND: The current World Health Organisation (WHO) classification of dengue includes two distinct entities: dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome; it is largely based on pediatric cases in Southeast Asia. Dengue has extended to different tropical areas and older age groups. Variations from the original description of dengue manifestations are being reported. OBJECTIVES: To analyse the experience of clinicians in using the dengue case classification and identify challenges in applying the criteria in routine clinical practice. METHOD: Systematic literature review of post-1975 English-language publications on dengue classification. RESULTS: Thirty-seven papers were reviewed. Several studies had strictly applied all four WHO criteria in DHF cases; however, most clinicians reported difficulties in meeting all four criteria and used a modified classification. The positive tourniquet test representing the minimum requirement of a haemorrhagic manifestation did not distinguish between DHF and DF. In cases of DHF thrombocytopenia was observed in 8.6-96%, plasma leakage in 6-95% and haemorrhagic manifestations in 22-93%. The low sensitivity of classifying DHF could be due to failure to repeat the tests or physical examinations at the appropriate time, early intravenous fluid therapy, and lack of adequate resources in an epidemic situation and perhaps a considerable overlap of clinical manifestations in the different dengue entities. CONCLUSION: A prospective multi-centre study across dengue endemic regions, age groups and the health care system is required which describes the clinical presentation of dengue including simple laboratory parameters in order to review and if necessary modify the current dengue classification. 2006-08 Article PeerReviewed Bandyopadhyay, S. and Lum, L.C. and Kroeger, A. (2006) Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Tropical Biomedicine, 11 (8). pp. 1238-55. ISSN 0127-5720 http://www.ncbi.nlm.nih.gov/pubmed/16903887 16903887
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine (General)
spellingShingle R Medicine (General)
Bandyopadhyay, S.
Lum, L.C.
Kroeger, A.
Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
description BACKGROUND: The current World Health Organisation (WHO) classification of dengue includes two distinct entities: dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome; it is largely based on pediatric cases in Southeast Asia. Dengue has extended to different tropical areas and older age groups. Variations from the original description of dengue manifestations are being reported. OBJECTIVES: To analyse the experience of clinicians in using the dengue case classification and identify challenges in applying the criteria in routine clinical practice. METHOD: Systematic literature review of post-1975 English-language publications on dengue classification. RESULTS: Thirty-seven papers were reviewed. Several studies had strictly applied all four WHO criteria in DHF cases; however, most clinicians reported difficulties in meeting all four criteria and used a modified classification. The positive tourniquet test representing the minimum requirement of a haemorrhagic manifestation did not distinguish between DHF and DF. In cases of DHF thrombocytopenia was observed in 8.6-96%, plasma leakage in 6-95% and haemorrhagic manifestations in 22-93%. The low sensitivity of classifying DHF could be due to failure to repeat the tests or physical examinations at the appropriate time, early intravenous fluid therapy, and lack of adequate resources in an epidemic situation and perhaps a considerable overlap of clinical manifestations in the different dengue entities. CONCLUSION: A prospective multi-centre study across dengue endemic regions, age groups and the health care system is required which describes the clinical presentation of dengue including simple laboratory parameters in order to review and if necessary modify the current dengue classification.
format Article
author Bandyopadhyay, S.
Lum, L.C.
Kroeger, A.
author_facet Bandyopadhyay, S.
Lum, L.C.
Kroeger, A.
author_sort Bandyopadhyay, S.
title Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
title_short Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
title_full Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
title_fullStr Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
title_full_unstemmed Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
title_sort classifying dengue: a review of the difficulties in using the who case classification for dengue haemorrhagic fever
publishDate 2006
url http://eprints.um.edu.my/613/
http://www.ncbi.nlm.nih.gov/pubmed/16903887
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