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In 1997 the dengue case definition was limitated in terms of its complexity and applicability. This
recognition of the limitations led to a multicenter study in seven countries in Asia and Latin America and
a new case definition emerged from this study. The new WHO classification for dengue severity is
divided into Dengue without Warning Signs, Dengue with Warning Signs, and Severe Dengue.
Nausea, vomiting
Rash
Leukopenia
Mucosal bleeding
Lethargy, restlessness
– Shock (DSS)
The traditional WHO classification is defined as follows: Dengue Fever (DF), Dengue Hemorrhagic Fever
(DHF), and Dengue Shock Syndrome (DSS).
Dengue fever is most commonly an acute febrile illness defined by the presence of fever and two or
more of the following, retro-orbital or ocular pain, headache, rash, myalgia, arthralgia, leukopenia, or
hemorrhagic manifestations (e.g., positive tourniquet test, petechiae; purpura/ecchymosis; epistaxis;
gum bleeding; blood in vomitus, urine, or stool; or vaginal bleeding) but not meeting the case definition
of dengue hemorrhagic fever. Anorexia, nausea, abdominal pain, and persistent vomiting may also occur
but are not case-defining criteria for DF
Evidence of plasma leakage shown by hemoconcentration (an increase in hematocrit ≥20% above
average for age or a decrease in hematocrit ≥20% of baseline following fluid replacement therapy), or
pleural effusion, or ascites or hypoproteinemia.
Dengue shock syndrome has all of criteria for DHF plus circulatory failure as evidenced by:
Rapid and weak pulse and narrow pulse pressure (<20mm Hg), or
Related Links
Johnson, B. W., Russell, B. J., Lanciotti, R. S. (2005). Serotype-Specific Detection of Dengue Viruses in a
Fourplex Real-Time Reverse Transcriptase PCR Assay. J. Clin. Microbiol. 43: 4977-4983 [ Abstract ] [ Full
Text ]
Martin DA, Muth DA, Brown T, Johnson AJ, Karabatsos N, Roehrig JT. (2000) Standardization of
immunoglobulin M capture enzyme-linked immunosorbent assays for routine diagnosis of arboviral
infections. J Clin Microbiol;38 (5):1823-1826. [ Free Full Text ]