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Dengue guidelines

1997
T
it
l
e
Pa
ge
s

C
o
n
t
e

Guideline for
treatment of DF and
DHF in small
hospitals WHO
Searo 1999

33
Clinical manifestation,
diagnosis, case
management

2009

2011

Dengue Guidelines
for diagnosis,
treatment,
prevention and
control WHO TDR
2009

Comprehensive
guideline for
prevention and
control of Dengue
and DHF WHO Searo
2011

160

212

Chapters : (6)
Epidemiology and
burden of disease,
clinical management,
vector management, lab
diagnostic tests,
surveillance and
emergency response,
new avenues

Chapters : (15)
Epidemiology, disease
burden,clinical
manifestation and
diagnosis, lab diagnosis,
management,
surveillance, vector,
vector management,
IVM, Combi, PHC
approach, case

Diagnosis Classification
1997

2009

2011

Dengue fever

Dengue without
warning signs

Dengue fever

DHF grade I

Dengue with
warning signs

DHF grade I

DHF grade II
DHF grade III

DHF grade II
Severe dengue
( severe plasma
leakage, severe
hemorrhage, severe
organ involvement)

DHF grade IV

DHF grade III

DHF grade IV
* Expanded dengue
syndrome
Adult management

Adult management

Grad
e
DF
DHF

Sign and Symptomps

Laboratory

DHF without plasma leakage


I

Fever with non-specific constitutional


symptoms; the only hemorrhagic
manifestation is a positive tourniquet
test &/or easy bruising
evidence of plasma leakage

II

DHF grade I plus spontaneous bleeding

III

Circulatory failure manifested by a


rapid, weak pulse, narrowing of pulse
pressure, or hypotension, cold &
clammy skin, restlessness

IV

Profound shock with undetectable blood


pressure

Thrombocytope
nia (platelet
count
100,000/L)

WHO Dengue Classification 1997

1. Fever 2-7 days


2. Bleeding tendency

Positive tourniquet test or


Spontaneous bleeding

3. Thrombocytopaenia
100,000/mm

DF DHF
+
+
+/-

+/-

4. Plasma leakage

Pleural effusion /ascites


/hypoproteinaemia
20% increase in HCT from
baseline

Dengue virus
infection
Asymptomat
ic

Symptomati
c

Expanded Dengue
syndrome/isolated
organophaty (unusual
manifestation)

Undefferentiat
ed fever
(viral
syndrome)
Dengue
Fever (DF)

Without
haemorrha
ge

201
1

With unusual
haemorrhag
e

Dengue
Haemorrhagic Fever
(DHF)
(with plasma
leakage)
DHF non
shock

DHF with shock


Dengue Shock
Syndrome
(DSS)

O classification of Dengue infections and grading of severity of DHF (20


DF/
DHF

Grad
e

DF

Signs and Symptoms

Laboratory

Fever with two of the following:


Headache
Retro-orbital pain
Myalgia
Athralgia/bone pain
Rash
Haemorrhagic manifestations
No evidence of plasma leakage

Leucopenia (WBC <5000


cells/mm3)
Thrombocytopenia <150.000
cells/mm3)
Rising Hct (5-10%)
No evidence of plasma loss

DHF

Fever and haemorrhagic


manifestation (positive tourniquet
test) and evidence of plasma
leakage

Thrombocytopenia <100.000
cells/mm3
Hct rise >20%

DHF

II

As in Grade I plus spontaneous


bleeding

Thrombocytopenia <100.000
cells/mm3
Hct rise >20%

*DHF

III

As in Grade I or II plus circulatory


failure

Thrombocytopenia <100.000
cells/mm3
Hct rise >20%

*DHF
III and
IV are DSS
*DHF
IV

As in Grade III plus profound shock

Thrombocytopenia <100.000