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Classification of dengue using the current World Health Organization (WHO) system is not straightforward. In a large prospective study of pediatric dengue, no clinical or basic laboratory parameters clearly differentiated between children with and without dengue, although petechiae and hepatomegaly were independently associated with the diagnosis. Among the 712 dengue-infected children there was considerable overlap in the major clinical features. Mucosal bleeding was observed with equal frequency in those with dengue fever and dengue hemorrhagic fever (DHF), and petechiae, thrombocytopenia, and the tourniquet test differentiated poorly between the two diagnostic categories. Fifty-seven (18%) of 310 with shock did not fulfill all four criteria considered necessary for a diagnosis of DHF by the WHO, but use of the WHO provisional classification scheme resulted in considerable over-inflation of the DHF figures. If two separate entities truly exist rather than a continuous spectrum of disease, it is essential that some measure of capillary leak is included in any classification system, with less emphasis on bleeding and a specific platelet count.
Received April 16, 2003. Accepted for publication October 2, 2003.
Acknowledgments: We are grateful to Dr. Vu Kim Cac and Dr. Huynh Thi Thuan (Directors), Dr. Nguyen Lo (Vice-Director), and all the staff of the Dong Nai Paediatric Centre, in particular the staff of the infectious diseases ward, the intensive care unit, and the general laboratory for generous help and support throughout the study. We also thank Dr. Vuong Hung Viet (Director) and Dr. Tran Tinh Hien (Vice-Director) of the Hospital for Tropical Diseases in Ho Chi Minh City for invaluable assistance in setting up the study. Sadly, Dr. Cao Xuan Thanh Phuong, the principal investigator for this study, and Dr. Jean Paul Charlieu both died during the preparation of the manuscript. They are greatly missed by friends and colleagues.
Financial support: This study was supported by the Wellcome Trust.
Authors’ addresses: Ngo Thi Nhan, Pham Thi Thu Thuy, Chu Van Thien, Nguyen Thi Thuy Nga, and Tran Thanh Thuy, Dong Nai Paediatric Centre, Dong Nai Province, Bien Hoa, Vietnam. Rachel Kneen, Tom Solomon, Kasia Stepniewska, and Bridget Wills, The University of Oxford Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, Telephone: 84-8-923-7954, Fax: 84-8-923-8904, E-mail: bridgetw{at}hcm.vnn.vn.
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