WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas

Horstick, Olaf; Martínez, Eric; Guzmán, María G.; Martín, José Carlos; Ranzinger, Silvia Runge

doi:10.1179/2047773215y.0000000003

Cited by 47 publications

(39 citation statements)

References 20 publications

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“…The clinical spectrum of DENV is wide and varies from asymptomatic infection to an acute flu-like illness with or without warning signs of shock. 1 Approximately half of infections are asymptomatic even though these individuals have a sufficiently high enough viral load to transmit virus back to the mosquito population. 2 Symptomatic infection generally leads to high fever, headache, retroorbital pain, myalgias, arthralgias, and a diffuse erythematous maculopapular rash.…”

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confidence: 99%

“…3 Hemorrhage may also be evident in the form of petechiae, skin bruising, or subconjunctival hemorrhage. 1,3 Severe dengue with shock is the most serious manifestation of DENV infection, and it can be life threatening. 1 Warning signs include abdominal pain, abdominal tenderness, persistent vomiting, ascites, pleural effusion, mucosal bleeding, lethargy, restlessness, hepatomegaly, increase in hematocrit and a rapid decrease in platelet count.…”

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confidence: 99%

“…1,3 Severe dengue with shock is the most serious manifestation of DENV infection, and it can be life threatening. 1 Warning signs include abdominal pain, abdominal tenderness, persistent vomiting, ascites, pleural effusion, mucosal bleeding, lethargy, restlessness, hepatomegaly, increase in hematocrit and a rapid decrease in platelet count. 3 Hemorrhage and third spacing of fluids can occur rapidly leading to shock and death.…”

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confidence: 99%

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New insight on dengue virus-induced thrombocytopenia

Goldthorpe

Conway

2017

Virulence

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New insight on dengue virus-induced thrombocytopenia

Goldthorpe

Conway

2017

Virulence

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“…In a recent study, that used WHO case definition of DEN as the standard and evaluated the same RDT that we have evaluated the sensitivity and specificity was reported very low, probably because of using the clinical criteria as reference marker, that itself is debatable . Moreover, it is reported that the RDTs have different sensitivity and specificity in primary and secondary infection, Timing and storage of specimen, and to the infection by different serotypes .…”

Section: Discussionmentioning

confidence: 89%

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT‐PCR

Shukla

Singh

Sharma

et al. 2017

Journal of Medical Virology

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The objective of this study was to demonstrate the utility of dengue virus (DENV) non structural protein 1 (NS1) based rapid diagnostic test (RDT) for use in tribal and difficult to reach areas for early dengue (DEN) diagnosis in acute phase patients and evaluate its sensitivity and specificity against DENV NS1 enzyme linked immune sorbent assay (ELISA) and real time reverse transcriptase polymerase chain reaction (qRT-PCR). The DENV NS1 RDT was used for preliminary diagnosis during outbreaks in difficult to reach rural and tribal areas. The diagnosis was confirmed by DENV NS1 ELISA in the laboratory. The samples were also tested and serotyped by qRT-PCR. The results were evaluated using statistical tests. The DENV NS1 RDT showed 99.2% sensitivity and 96.0% specificity when analyzed using DENV NS1 ELISA as standard. The specificity and sensitivity of the RDT when compared with qRT-PCR was 93.6% and 91.1%, respectively. The serotype specific evaluation showed more than 90% sensitivity and specificity for DENV-1, 2, and 3. The RDT proved a good diagnostic tool in difficult to reach rural and tribal areas. Further evaluation studies with different commercially available RDTs in different field conditions are essential, that will help clinicians and patients for treatment and programme managers for timely intervention.

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“…However, the majority of experts attending a consensus meeting in Latin America felt that the 2009 WHO classification is helpful in identifying cases of dengue correctly for pathophysiological research, although they also recommended ongoing research to improve the sensitivity and specificity of the definitions. [32].…”

Section: Discussionmentioning

confidence: 99%

Severe dengue categories as research endpoints—Results from a prospective observational study in hospitalised dengue patients

et al. 2020

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Severe dengue was perceived as one clinical disease entity until the WHO 2009 classification stratified it into severe vascular leakage, severe bleeding, and severe organ dysfunction. The objectives of this study were to investigate the potential use of severe dengue categories as endpoints for intervention research. 271 patients with severe dengue among 1734 confirmed dengue patients were followed prospectively in this hospital-based observational study in Latin America and Asia. We compared the distribution of severe dengue categories according to gender and age (below/above 15y), and determined the relative frequency and the overlap of severe dengue categories in the same patients. In a next step, we extended the analysis to candidate moderate severity categories, based on recently suggested definitions which were adapted for our purposes. Severe vascular leakage occurred in 244 (90%), severe bleeding in 39 (14%), and severe organ dysfunction in 28 (10%) of 271 severe dengue patients. A higher frequency of severe leakage was seen in children or adolescents (<15y) compared to adults. More than 80% of the severe leakage cases, and 30-50% of the cases with severe bleeding or severe organ dysfunction, were defined as severe on the basis of that feature alone. In 136 out of 213 patients with severe leakage alone, neither moderate bleeding manifestation nor hepatic involvement was recorded. On the other hand, moderate leakage manifestations were detected in 4 out of 12 cases that were classified as severe based on bleeding alone. A major proportion of severe dengue patients exhibited clinical manifestations of severe vascular leakage only, which may constitute a useful endpoint for intervention research or pathophysiology studies. Severe bleeding and severe organ manifestation were recorded less frequently and exhibited a higher degree of overlap with severe leakage. Severe bleeding without leakage may be associated with individual PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.

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WHO Dengue Case Classification 2009 and its usefulness in practice: an expert consensus in the Americas

Cited by 47 publications

References 20 publications

New insight on dengue virus-induced thrombocytopenia

New insight on dengue virus-induced thrombocytopenia

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT‐PCR

Severe dengue categories as research endpoints—Results from a prospective observational study in hospitalised dengue patients

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