scholarly journals An evaluation of the World Health Organization’s 1997 and 2009 dengue classifications in hospitalized dengue patients in Malaysia

2014 ◽  
Vol 8 (07) ◽  
pp. 869-875 ◽  
Author(s):  
Zuraihan Zakaria ◽  
Nur A Zainordin ◽  
Benedict LH Sim ◽  
Masliza Zaid ◽  
Umi S Haridan ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Dengue Shock Syndrome ◽  
Signs And Symptoms ◽  
Hemorrhagic Fever ◽  
Peninsular Malaysia ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
The World ◽  
Dengue With Warning Signs

Introduction: The latest revised version of the World Health Organization’s dengue classification was released in 2009. A handful of studies have taken initiatives to evaluate the old and revised guidelines to determine early signs and symptoms of severe dengue. This retrospective study aimed to compare the classification of dengue using both the 1997 and 2009 guidelines in a selected cohort of dengue patients from Peninsular Malaysia between 2008 and 2012. Methodology: Adult dengue patients were recruited from tertiary hospitals in two different states, Selangor and Kelantan, in Peninsular Malaysia. Their clinical manifestations were assessed. Results: A total of 281 confirmed dengue patients were enrolled; the mean duration of illness at admission was five days. Of these, 88.6%, 10.7%, and 0.7% were classified according to the 1997 guidelines as having dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS), respectively. When the WHO 2009 guidelines were applied, 17.1%, 78.3%, and 4.6% were classified as dengue without warning signs, dengue with warning signs, and severe dengue, respectively. Conclusions: Our data suggests that the revised WHO 2009 guidelines stratify a much larger proportion of patients into a category that requires a higher level of medical and nursing care.

scholarly journals Cytokine IL-12, Dengue in children: analysis of a unique relationship

2018 ◽  
Vol 5 (3) ◽  
pp. 1109
Author(s):  
Rakesh Manoharan ◽  
Umapathy Pasupathy ◽  
Latha Ravichandran ◽  
Elayaraja Sivaprakasam ◽  
Srinivasan V. ◽  
...  
Keyword(s):  
Clinical Features ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Study Groups ◽  
Denv Infection ◽  
Warning Signs ◽  
Severe Dengue ◽  
Potential Biomarker ◽  
Paediatric Age ◽  
Dengue With Warning Signs

Background: Dengue is a mosquito borne viral infection caused by one of the four serotypes of dengue viruses (DENV1-DENV4). The consequences of DENV infection range from asymptomatic condition, dengue fever (DF), or severe forms, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The host immune responses have been considered as the major factor responsible for dengue pathogenesis. In this study, the cytokine IL-12 is reviewed for its utility as potential biomarker of severe dengue disease.Methods: 120 children of paediatric age group with either dengue NS1 antigen or dengue IgM positive were included. Cases were classified as uncomplicated dengue (dengue without warning signs) and complicated dengue (dengue with warning signs and severe dengue). Clinical features and IL-12 (ELISA KIT) levels were analyzed in the study population.Results: Analysis of clinical features among the study groups revealed children with complicated dengue had persistent vomiting (95%), abdominal pain (80%), decreased urine output (50%), bleeding manifestations (83.3%), Hepatomegaly (70%) Haemoconcentration with concurrent thrombocytopenia (93.3%), altered coagulation profile (28.3%), ICU stay (54.7%), leukocytosis (15%), leucopoenia (66.6%) normal leucocytes, (18.4%). Analysis of IL-12 levels revealed children with complicated dengue showed significant elevation compared to controls and uncomplicated dengue.Conclusions: In our study IL-12 levels were significantly higher in complicated dengue patients in comparison with uncomplicated dengue patients as well as normal control population.

scholarly journals Clinical manifestations and hematological and serological findings in children with dengue infection

2011 ◽  
Vol 51 (3) ◽  
pp. 157 ◽  
Author(s):  
Mulya Rahma Karyanti
Keyword(s):  
Public Health ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Dengue Shock Syndrome ◽  
Signs And Symptoms ◽  
Hemorrhagic Fever ◽  
Severe Dengue ◽  
The Mean ◽  
Serological Data

Background Dengue hemorrhagic fever (DHF) is endemic to Indonesia and remains a public health problem, with its highest incidence in children. There have been few reports on the clinical, hematological and serological data in children \\lith dengue.Objective To assess the clinical and laboratory profiles of children \\lith dengue infection in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.Methods Clinical, hematological and serological infonnation from children diagnosed v.ith dengue infection in Cipto Mangunkusumo Hospital were collected from 2007 to 2009.Results Of611 children admitted with dengue, 143 (23.4%) had dengue fever (DF), 252 (41.2%) had DHF grades I and II; and 216 (35.4%) had DHF grades III and IV. Of the 81 cases where dengue serotypes were identified, 12.3% were DENV1, 35.8% were DENV-2, 48.2% were DENV-3 and 3.7% were DENV-4. Mean age of subjects was 8.9 years (SD 4.4), and 48.4% of cases were boys. The mean length of fever before hospital admission was 4.2 days (SD 1.1) and mean length of stay in the hospital was 4 days (SD 2.7). Common symptoms observed were petechiae, hepatomegaly and epistaxis. Complications found mostly in those with dengue shock syndrome (DSS) were hematemesis (30 cases, 4.9% of all patients), encephalopathy (19 cases, 3.1 %) and melena (17 cases, 2.8%).Conclusion Signs and symptoms of fever, bleeding manifestations and thrombocytopenia were present in children 'With DF and DHF, while signs of increased vascular permeability were found only in those 'With DHF. Encephalopathy and gastrointestinal bleeding were found mostly in DSS cases. At admission, leukopenia was found in more DF patients than in DHF patients. Absence of leukopenia may be a sign of more severe dengue infection. 

scholarly journals Clinical Profiles of Dengue Infection during an Outbreak in Northern India

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Anish Laul ◽  
Poonam Laul ◽  
Vamsi Merugumala ◽  
Ravi Pathak ◽  
Urvashi Miglani ◽  
...  
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Dengue Shock Syndrome ◽  
Acalculous Cholecystitis ◽  
Signs And Symptoms ◽  
Hemorrhagic Fever ◽  
Warning Signs ◽  
Mosquito Vector ◽  
Diagnostic Dilemma ◽  
Atypical Presentations

Introduction.Dengue fever is an arboviral disease, which is transmitted by mosquito vector and presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Unless we are aware of these presentations, diagnosis as well as early initiation of treatment becomes difficult. We studied the various clinical presentations of dengue infection during an outbreak of disease in 2015.Materials and Methods. A total of 115 confirmed cases of dengue infection from Department of Medicine of Deen Dayal Upadhyay Hospital, New Delhi, were enrolled in this observational study.Results.The common signs and symptoms of dengue infection were fever, headache, body ache, backache, retro-orbital pain, bleeding manifestations, and rash in 100%, 87%, 86%, 58%, 41%, 21%, and 21%, respectively. Nonspecific or warning signs and symptoms included vomiting, weakness, abdominal pain, breathlessness, vertigo, sweating, and syncope. Other possible signs and symptoms of coinfections, comorbidities, or complications included diarrhea, sore throat, and neurological manifestations. There were seven patients with coinfections and four with comorbidities. The final diagnosis of these patients was DF (73%), DHF (16.5%), DSS (1.7%), and EDS (4.3%). Among EDS patients, the atypical presentations included encephalopathy, lateral rectus nerve palsy, acalculous cholecystitis, and myocarditis. Four patients required ICU care and there was no death in this study.Conclusion. Knowledge of atypical presentations is a must for early diagnosis and timely intervention to prevent life-threatening complications.

scholarly journals Serum sodium level in dengue infected children: a retrospective study

2018 ◽  
Vol 5 (5) ◽  
pp. 1801
Author(s):  
Reshma Raj ◽  
Rashmi Alva
Keyword(s):  
Dengue Fever ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Warning Signs ◽  
Severe Dengue ◽  
Dengue With Warning Signs ◽  
Group B

Background: Dengue fever is one of the most common arbo virus mediated outbreaks, being reported from different parts of the world. Now as the outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. Aim of this study is to document the serum Sodium level in dengue infected children in a tertiary care centre.Methods: A total 128 cases of NS1 antigen, IgM positive or ELISA positive dengue patients were included in this observational study and analyzed.Results: The serum Sodium level in dengue varies according to the different groups. In group A (dengue with no warning signs) the serum Sodium level was normal, whereas in case of group B (dengue with warning signs), there was significant hyponatremia. In group C, severe dengue the serum Sodium was normalConclusions: Mild hyponatremia is a common electrolyte disturbance in patients with dengue with warning signs. Hence, the lower the serum Sodium levels the higher is the incidence of complications associated with dengue fever.

scholarly journals Comparing the 2009 and 1997 World Health Organization dengue case classifications in a large cohort of South Asian patients

2020 ◽  
Vol 14 (07) ◽  
pp. 781-787 ◽  
Author(s):  
Umesh Jayarajah ◽  
Upul Dissanayake ◽  
Visula Abeysuriya ◽  
Pradeep K De Silva ◽  
Priyankara Jayawardena ◽  
...  
Keyword(s):  
World Health Organisation ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
Dengue Case ◽  
Dengue Disease ◽  
Asian Patients ◽  
Resource Limited ◽  
Dengue With Warning Signs ◽  
Health Organization

Introduction: Due to the shortcomings in the 1997-World Health Organisation (WHO) dengue case classification (DCC), a revised classification was proposed in 2009. This study was aimed to assess the clinical usefulness of the two classifications during a large dengue epidemic. Methodology: Clinical data of dengue patients admitted to selected units at National Hospital of Sri Lanka, Panadura Base Hospital and Nawaloka Hospital Colombo between June and August 2017 were collected prospectively. Cases were classified using the 1997 and 2009 WHO DCCs. Results: 1,878 patients [adult = 1,573 (83.8%)] were studied. Based on 1997-WHO-DCC-DF (Dengue Fever): 1,316 (70.1%), DHF (Dengue Haemorrhagic Fever) -1: 468 (24.9%), DHF-2: 86 (4.6%) and DHF-3: 8 (0.4%). Based on 2009-WHO-DCC–Dengue with warning signs (WS): 1647 (87.7%), Dengue without WS: 231 (12.3%) and severe dengue (SD): 41 (2.18%). A total of 1,088 (82.7%) DF and 559 (99.5%) DHF patients developed WS. Of those without WS, 228 (17.3%) were DF patients and 3 (0.5%) were DHF patients. Three (0.23%) DF and 38 (6.76%) DHF patients had SD. All SD patients had WS. The level of agreement between the two systems of classification was poor (Kappa = - 0.035, p < 0.001). Conclusions: The 2009-WHO-DCC was more useful than 1997-WHO-DCC in predicting dengue disease severity as few DF patients also had SD. Furthermore, the presence of WS identified patients with SD. However, the 2009-WHO-DCC may not suit the resource limited countries as WS are non-specific, and lack of diagnostic tests can result in case overload.

scholarly journals The clinical characteristics and outcome of children hospitalized with dengue in Barbados, an English Caribbean country

2015 ◽  
Vol 9 (04) ◽  
pp. 394-401 ◽  
Author(s):  
Alok Kumar ◽  
Marquita Gittens-St. Hilair ◽  
Vincent Jason ◽  
Christian Ugwuagu ◽  
Kandamaran Krishnamurthy
Keyword(s):  
Case Fatality Rate ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Case Fatality ◽  
Population Based ◽  
Warning Signs ◽  
Severe Dengue ◽  
Fatality Rate ◽  
Case Files ◽  
Dengue With Warning Signs

Introduction: Although dengue is endemic in all English-speaking Caribbean countries, there are no published studies on the clinical presentations and outcomes of children hospitalized with dengue from this region. This study aims to assess the clinical charcteristics and the outcome in children hospitalized with dengue. Methods: This was a population-based prospective study of all the children hospitalized with confirmed dengue in 2009 in Barbados. All children suspected to have dengue were routinely screened for dengue infection and underwent routine blood tests. Relevant data was extracted from their case files at the time of their discharge from the hospital. Results: Of the 199 children who were hospitalized with suspected dengue, 115 (58%) were confirmed. The overall incidence rate of  dengue among children that required hospitalization was 2.1/1,000 children. Besides the typical clinical features of dengue, 64 children hospitalized with confirmed dengue also presented with gastrointestinal manifestations (56%), 39 with respiratory manifestations (51%), 11 with hepatic manifestations (10%), 8 with neurologic manifestations (7%), and 7 with cardiovascular manifestations (6%). Twenty (17.4%) children hospitalized with confirmed dengue met the criteria for the diagnosis of severe dengue. The other 82.6% had uncomplicated or non-severe (53.9% had dengue and 28.7% had dengue with warning signs) forms of dengue. The case fatality rate in this series was 1.7%. Conclusions: Less than a third of all the children with confirmed dengue required hospitalization. Atypical clinical manifestations were common, and only a minority of these children had severe dengue. Overall, the case fatality rate for dengue in this select population of children hospitalized with dengue was low.

scholarly journals Assessment of the new World Health Organization’s dengue classification for predicting severity of illness and level of healthcare required

2019 ◽  
Author(s):  
Balgees A. Ajlan ◽  
Maram M. Alafif ◽  
Maha M. Alawi ◽  
Naeema A. Akbar ◽  
Eman K. Aldigs ◽  
...  
Keyword(s):  
Retrospective Study ◽  
World Health Organization ◽  
Chronic Diseases ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
New Classification ◽  
The World ◽  
Health Organization ◽  
Higher Sensitivity

AbstractThe objective of this observational study was to assess the validity of the new dengue classification proposed by the World Health Organization (WHO) in 2009 and to develop pragmatic guidelines for case triage and management. This retrospective study involved 357 laboratory-confirmed cases of dengue infection diagnosed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 4-year period from 2014 to 2017. The sensitivity of the new classification for identifying severe cases was limited (65.0%) but higher than the old one (30 0%). It had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one (72.0% versus 32.0%, respectively). We propose adding decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification. This modification improves sensitivity from 72.0% to 97.5% for identifying patients who need advanced healthcare without altering specificity (96.7%). It also improves sensitivity in predicting severe outcomes from 32% to 88.0%. In conclusion, the new classification had a low sensitivity for identifying patients needing advanced care and for predicting morbidity and mortality. We propose to include decompensation of chronic diseases and thrombocytopenia-related bleeding to the category of severe dengue in the new classification to improve the sensitivity of predicting cases requiring advanced care.Author summaryDengue fever, the most prevalent arthropod-borne viral disease in human, has been conventionally classified into four main categories: non-classical, classical, dengue hemorrhagic fever, and dengue shock syndrome. Several studies reported lack of correlation between the categories of the conventional classification and the disease severity. As a consequence, the World Health organization proposed in 2008 a new classification that divides dengue into two categories: non-severe and severe dengue; the non-severe dengue is further divided into two categories: dengue with warning signs and dengue without warning signs. In this retrospective study we reviewed 357 cases of dengue diagnosed in our institution over a 4-year period to assess the validity of the new dengue classification in order to develop pragmatic guidelines for case triage and management in the Emergency Departments. We found that the sensitivity of the new classification for identifying severe cases was limited even though it had a higher sensitivity for identifying patients who needed advanced healthcare compared to the old one. We propose adding decompensation of chronic diseases and low platelets-related bleeding to the category of severe dengue in the new classification. This modification dramatically improves the sensitivity for identifying patients who need advanced healthcare and the sensitivity to predict severe outcomes.

scholarly journals Utility of C-Reactive Protein Levels for Early Prediction of Dengue Severity in Adults

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Chien-Chih Chen ◽  
Ing-Kit Lee ◽  
Jien-Wei Liu ◽  
Shi-Yu Huang ◽  
Lin Wang
Keyword(s):  
Characteristic Curve ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
World Health ◽  
Severe Dengue ◽  
Early Prediction ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Health Organization

Dengue has broad clinical presentation with unpredictable clinical evolution and outcome. We aimed to evaluate the utility of C-reactive protein (CRP) levels for distinguishing between mild and severe cases in the early phase of the dengue illness. We retrospectively evaluated adults with dengue from 2006 to 2014, according to 1997 and 2009 World Health Organization (WHO) criteria for severity. Of 191 included patients, 32.9% had nonshock dengue hemorrhagic fever (DHF), 3.1% dengue shock syndrome (DSS), and 7.9% severe dengue. The risk of DHF/DSS and severe dengue is significantly related to the increasing levels of CRP. Of 191 patients, 97 had CRP levels measured during the febrile (days 1–3); 85 during the critical (days 4–6); and 9 during the convalescent (days 7–10) illness phases. During the febrile phase, there was significant higher CRP level for DSS versus DF/nonshock DHF and severe dengue versus nonsevere dengue, with CRP cutoff level 30.1 mg/L (area under the receiver operating characteristic curve (AUC), 0.938; 100% sensitivity, 76.3% specificity) and 24.2 mg/L (AUC, 0.717; 70% sensitivity, 71.3% specificity), respectively. Our study highlights the utility of the CRP levels in early prediction of DSS and severe dengue in adult patients.

FACTORS PREDICTING SEVERITY OF ILLNESS IN DENGUE FEVER: AN OBSERVATIONAL STUDY

2021 ◽  
pp. 54-55
Author(s):  
Abhay John Gray ◽  
Sheela Mathew ◽  
Gayathri R ◽  
Akhila Arya ◽  
Aswathy MA ◽  
...  
Keyword(s):  
Dengue Fever ◽  
Ldl Cholesterol ◽  
Severe Disease ◽  
Dengue Infection ◽  
Clinical Manifestations ◽  
Severity Of Illness ◽  
Warning Signs ◽  
Severe Dengue ◽  
Detailed History ◽  
Dengue With Warning Signs

Introduction: Dengue is a systemic viral infection caused by the virus from genus Flaviviridae. Dengue infection has got a wide clinical spectrum that includes both severe and non-severe clinical manifestations. The group progressing from non-severe to severe disease is difcult to dene. Early detection and access to proper medical care signicantly lower fatality rates and would help to reduce the burden of hospital stay and economy loss. Objectives: To study the inammatory markers predicting the severity of dengue infection. Methods: 250 diagnosed patients were evaluated with detailed history, physical examination and blood investigations. Inammatory markers associated with severity of dengue were studied. Observations and conclusions- 97 patients (39%) had dengue without warning signs, 62(25%) had dengue with warning signs, 63(25%) had severe dengue and 28(11%) had expanded dengue. Low CRP, ESR, HDL and LDL cholesterol were observed in dengue fever, without any statistical signicance. Ferritin levels more than 1000 and triglyceride more than 200 was signicantly associated with severity of dengue.

scholarly journals DENGUE FEVER: STAGES, COMPLICATION, DIAGNOSIS, AND PREVENTION STRATEGIES

2021 ◽  
pp. 3-11
Author(s):  
POULOMI BISWAS ◽  
SANTOSH GANGULY ◽  
BIPLAB DEBNATH
Keyword(s):  
Dengue Fever ◽  
Rna Virus ◽  
Incidence Structure ◽  
Clinical Signs ◽  
Dengue Shock Syndrome ◽  
Signs And Symptoms ◽  
Hemorrhagic Fever ◽  
The Other ◽  
Severe Dengue ◽  
Modes Of Transmission

Dengue fever virus (DENV) is said to be a single-stranded, positive-sense RNA virus that belongs to the family Flaviviridae and the genus is Flavivirus. The disease can be transmitted through infected blood products and also through organ donation. Vertical transmission (from mother to child) at the time of pregnancy or during birth has been reported. Other unusual reports showed man-to-man modes of transmission. Hemorrhagic fever is specified by hemorrhage, thrombocytopenia, leakage of blood plasma, or dengue shock syndrome. Dengue is basically transmitted by various species of mosquito among the genus Aedes, the most uniquely identified one is Aedes aegypti. There are four different but very closely related serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) of the virus that causes Dengue. Lifelong immunity against the particular serotype that has caused the infection is believed to have been imparted upon recovery. However, cross-immunity to the other serotypes is either partial or temporary upon recovery and hence future infections by any of the other serotypes enhance the risk of developing severe dengue. Prevention is identified by reducing the habitat and the number of mosquitoes and also by limiting exposure to bites. Treatment of mild or moderate type is supportive, with oral or intravenous rehydration. The intravenous fluids and blood transfusion for more severe cases are found to be effective. The present study aimed to present brief and informative salient features of various facts regarding dengue, including its global incidence, structure, mode of transmission, clinical signs and symptoms, control, and preventive measures.

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