Usefulness of World Health Organization (WHO) dengue case classifications in a Sri Lankan clinical setting
Abstract
Background: Dengue viral infections are a major public health problem in many tropical and sub-tropical countries of the world. Early diagnosis and appropriate therapeutic interventions are critical for reducing both morbidity and mortality. The WHO has proposed a revised classification based on warning signs as the validity and usefulness of the WHO 1997 dengue classification has been questioned in recent times. The objective of this study was to assess the usefulness and applicability of these guidelines in the clinical setting.
Methods: Clinical and laboratory findings were recorded in a standard format and cases were classified using the two classifications. Presence of warning signs in clinical DF and DHF groups were compared.
Results: One hundred and six patients with clinically suspected dengue between January and July 2010 were studied. Seventy eight (75.7%) had dengue fever (DF) and 28 (26.4%) had dengue haemorrhagic fever (DHF) according the clinical parameters. Of the patients with DHF, only five (17.9%) fulfilled all four WHO criteria for DHF. Application of the revised WHO classification revealed 19 (17.9%) dengue without warning signs, 82 (77.4%) dengue with warning signs and 5 (4.7%) severe dengue. Presence of warning signs was compared in clinical DF and DHF groups. In total, 60 (76.9%) DF and 26 (92.9%) DHF patients developed warning signs, and 1 (3.6%) DHF patient did not have any warning signs. Thirty three (42.3%) DF patients had 2 or more warning signs while 22 (78.5%) DHF patients had two or more warning signs.
Conclusion: There were limitations in applying the WHO 1997 classification in making a diagnosis of DHF. We were able to classify all patients using the revised WHO 2009 classification and is more compatible with observed clinical findings and user-friendly to the practicing physician.
DOI: http://dx.doi.org/10.4038/jccp.v42i1-2.4550
Journal of the Ceylon College of Physicians, 2011, 42, 21-27
© 2012 Kamani Wanigasuriya, Padmalal Gurugama, Ananda Wijewickrama, Suranjith L Seneviratne, Saman B Gunatilake, published by Ceylon College of Physicians
This work is licensed under the Creative Commons License.