Comparison of dengue case classification schemes and evaluation of biological changes in different dengue clinical patterns in a longitudinal follow-up of hospitalized children in Cambodia

Abstract

Background The World Health Organization (WHO) proposed guidelines on dengue clinical classification in 1997 and more recently in 2009 for the clinical management of patients. The WHO 1997 classification defines three categories of dengue infection according to severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Alternative WHO 2009 guidelines provide a cross-sectional classification aiming to discriminate dengue fever from dengue with warning signs (DWWS) and severe dengue (SD). The primary objective of this study was to perform a comparison of two dengue classifications. The secondary objective was to describe the changes of hematological and biochemical parameters occurring in patients presenting with different degrees of severity during the course of the disease, since progression to more severe clinical forms is unpredictable. Methodology/Principal findings We performed a prospective, monocentric, cross-sectional study of hospitalized children in Cambodia, aged from 2 to 15 years old with severe and non-severe dengue. We enrolled 243 patients with acute dengue-like illness: 71.2% were dengue infections confirmed using quantitative reverse transcription PCR or NS1 antigen capture ELISA, of which 87.2% and 9.0% of DF cases were respectively classified DWWS and SD, and 35.9% of DHF were PLOS NEGLECTED TROPICAL DISEASES

Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis

“…The major inconsistency in our findings regarding clinical signs was the existence of different case classifications. Given that the updated WHO classification, which includes broader clinical outcomes, is more sensitive to detecting severe cases than the 1997 guideline [6,99], the estimated effect of the markers defined was larger. This was apparent when comparing the effects of abdominal pain between two large cohorts, Nguyen et al Further, at the outcome level, bias and inconsistency may arise from the measurements of abdominal pain and vomiting.…”

Decreased Type I Interferon Production by Plasmacytoid Dendritic Cells Contributes to Severe Dengue

“…77% of DHF and DSS patients encountered a secondary infection while infection status could not be determined for 23% of the patients ( Figure 1B). As viremia is dependent on immune status, infecting serotype, day of fever and possibly comorbidities, we observe a wide variability in viral load in children with DF and DHF/DSS (36,37). As frequencies of immune cells and the immune response can vary from day to day during acute DENV infection (38), it is important to emphasize that not only were all patients recruited within 96 h of fever onset, there was no difference in day of fever at inclusion between DF and DHF/DSS patients ( Table 1).…”

Estimating the annual dengue force of infection from the age of reporting primary infections across urban centres in endemic countries

“…Interestingly, the mean age of those reporting with just warning signs of dengue, opposed to severe dengue, proved a superior indicator of FOI. The poor specificity dengue clinical diagnosis is well documented as other febrile infections can present with similar disease manifestations [ 28 – 30 ]. Yet, compared to warning signs, severe disease is a far rarer outcome, particularly among primary and older post-primary infections.…”