Classification of dengue: The clinical use of World Health Organization 2009 guideline

Abstract

Dengue is an acute febrile infectious illness that is endemic in many countries, including Taiwan. Worldwide surveillance revealed increasing trends of dengue cases and countries reporting dengue since 1980s. Dengue is commonly described as a dynamic illness that follows a course with three phasesdfebrile, critical, and recovery. The severity of symptoms differs among patients, and the conditions of those who have major complications or unfavorable outcomes usually begin to deteriorate at around the time their fever abates. The crucial question for clinical management is how to differentiate severe from nonsevere dengue cases in order to plan and implement appropriate care. The second-edition guideline published by World Health Organization (WHO) in 1997 categorized symptomatic dengue patients into three groups: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Dengue patients would be classified as DHF or DSS when they fulfill all the following four criteria: fever lasting for 2e7 days, hemorrhage tendency, thrombocytopenia (platelet count <10 per mL), and evidence of a plasma leakage. However, the criteria have certain shortcomings. One