Dengue classification: current WHO vs. the newly suggested classification for better clinical application?

摘要: Introduction: There has been confusion regarding the clinical classification of dengue. The current WHO used since 70s classifies dengue into fever (DF), hemorrhagic (DHF), shock syndrome (DSS). In 2009, a new proposed by Tropical Disease Research (TDR) was published in TDR 2009 guidelines. This (D), with warning signs (DW) and severe (SD). Objective: To compare effectiveness management between newly suggested to assess 4 criteria DHF case definition for possible modification. Material Method: A prospective study suspected patients admitted Dengue Unit, Queen Sirikit National Institute Child Health June-August done. All cases were managed according Thai Guidelines 2008. final diagnoses based on Classification together laboratory confirmation. applied later author, using data from present report forms each patient. Statistical analysis comparing group done SPSS version 14. Results: Total 274 confirmed 24 non-dengue febrile illnesses (ND) analysis. 180 DF (65.7%), 53 grade I (19.3%), 19 II (6.9%), III (6.9%) 3 IV (1.1%) as classified while 85(31%), 160(58.4%) 29(1.1%) D, DW SD respectively. At least one found 50, 53.3, 83, 88.2, 100 100% ND, DF, I, II, patients. Vomiting abdominal pain 2 most common both ND Intensive monitoring careful medical fluid needed 94 compared 189 classification. 8 DSS who had AST > 1,000U patient presented encephalopathy. These cannot be properly One gastrointestinal bleeding SD. Bleeding and/or positive tourniquet test 69.7% Plasma leakage detected hemoconcentration, chest x-ray (CXR) ultrasonography. Hemoconcentration could detect plasma 44.7% CXR added up evidence 86.3%. Ultrasonography sensitive technique add 100%. Platelet < 100,000 cells/mm3 93.5% Conclusion: Current is recommended continuing use because creates about times workload health care personnel. addition, needs confirmatory tests. More than 90% defined are confirmed. However, modified more simple friendly use. modification address major criteria. Tourniquet or symptoms can considered minor Unusual cover those do not fit Keywords: classification, fever, DHF, syndrome, DSS, Warning