Volume 73, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The World Health Organization (WHO) scheme for classification of dengue severity was evaluated in a three-year study of 1,671 confirmed dengue cases in three Nicaraguan hospitals. The WHO classification of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) was compared with the presence of hemorrhagic manifestations, signs of vascular permeability, marked thrombocytopenia, and shock in 114 infants, 1,211 children, and 346 adults. We found that strict application of the WHO criteria fails to detect a significant number of patients with severe manifestations of dengue, especially in adults.


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  1. Gibbons RV, Vaughn DW, 2002. Dengue: an escalating problem. BMJ 324 : 1563–1566. [Google Scholar]
  2. Technical Advisory Committee on DHF for SE Asia and Western Pacific Regions, 1974. Guide for Diagnosis, Treatment and Control of Dengue Fever. Geneva: World Health Organization.
  3. Halstead SB, 1965. Dengue and hemorrhagic fevers of Southeast Asia. Yale J Biol Med 37 : 434–454. [Google Scholar]
  4. Harris E, Videa E, Perez L, Sandoval E, Tellez Y, Perez ML, Cuadra R, Rocha J, Idiaquez W, Alonso RE, Delgado MA, Campo LA, Acevedo F, Gonzalez A, Amador JJ, Balmaseda A, 2000. Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua. Am J Trop Med Hyg 63 : 5–11. [Google Scholar]
  5. Murgue B, Deparis X, Chungue E, Cassar O, Roche C, 1999. Dengue: an evaluation of dengue severity in French Polynesia based on an analysis of 403 laboratory-confirmed cases. Trop Med Int Health 4 : 763–773. [Google Scholar]
  6. Phuong CXT, Nhan NT, Kneen R, Thuy PT, van Thien C, Nga NT, Thuy TT, Solomon T, Stepniewska K, Wills B, and the Dong Nai Study Group, 2004. Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the World Health Organization classification system helpful? Am J Trop Med Hyg 70 : 172–179. [Google Scholar]
  7. Cao XT, Ngo TN, Wills B, Kneen R, Nguyen TT, Ta TT, Tran TT, Solomon TKD, Simpson T, White JA, Farrar NJ, and the Dong Nai Pediatric Hospital Study Group, 2002. Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam. Trop Med Int Health 7 : 125–132. [Google Scholar]
  8. Hammond SN, Balmaseda A, Pérez L, Tellez Y, Saborío SI, Mercado JC, Videa E, Rodriguez Y, Pérez MA, Cuadra R, Solano S, Rocha J, Idiaquez W, Gonzalez A, Harris E, 2005. Differences in dengue severity in infants, children, and adults in a 3-year hospital-based study in Nicaragua. Am J Trop Med Hyg 73 : 1063–1070. [Google Scholar]
  9. World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization.
  10. Pan American Health Organization, 1994. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control. Washington, DC: Pan American Health Organization.
  11. Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta AK, 1998. An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi. Indian Pediatr 35 : 727–732. [Google Scholar]
  12. Rahman M, Rahman K, Siddque AK, Shoma S, Kamal AHM, Ali KS, Nisaluk A, Breiman R, 2002. First outbreak of dengue hemorrhagic fever, Bangladesh. Emerg Infect Diseases 8 : 738–740. [Google Scholar]
  13. Wali JP, Biswas A, Handa R, Aggarwal P, Wig N, Dwivedi SN, 1999. Dengue haemorrhagic fever in adults: a prospective study of 110 cases. Trop Doct 29 : 27–30. [Google Scholar]
  14. Hayes CG, Manaloto CR, Gonzales A, Ranoa CP, 1988. Dengue infections in the Philippines: clinical and virological findings in 517 hospitalized patients. Am J Trop Med Hyg 39 : 110–116. [Google Scholar]
  15. Diaz A, Kouri G, Guzman MG, Lobaina L, Bravo J, Ruiz A, Ramos A, Martinez R, 1988. Description of the clinical picture of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) in adults. Bull Pan Am Health Organ 22 : 133–144. [Google Scholar]
  16. Qiu FX, Gubler DJ, Liu JC, Chen QQ, 1993. Dengue in China: a clinical review. Bull World Health Organ 71 : 349–359. [Google Scholar]
  17. Shah I, Deshpande GC, Tardeja PN, 2004. Outbreak of dengue in Mumbai and predictive markers for dengue shock syndrome. J Trop Pediatr 50 : 301–305. [Google Scholar]
  18. Richards AL, Bagus R, Baso SM, Follows GA, Tan R, Graham RR, Sandjaja B, Corwin AL, Punjabi N, 1997. The first reported outbreak of dengue hemorrhagic fever in Irian Jaya, Indonesia. Am J Trop Med Hyg 57 : 49–55. [Google Scholar]
  19. Wallace HG, Lim TW, Rudnick A, Knudsen AB, Cheong WH, Chew V, 1980. Dengue hemorrhagic fever in Malaysia: the 1973 epidemic. Southeast Asian J Trop Med Public Health 11 : 1–13. [Google Scholar]
  20. Guzman MG, Kouri G, Martinez E, Bravo J, Riveron R, Soler M, Vazquez S, Morier L, 1987. Clinical and serologic study of Cuban children with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Bull Pan Am Health Organ 21 : 270–279. [Google Scholar]
  21. Lucas GN, Amerasinghe A, Sriranganathan S, 2000. Dengue haemorrhagic fever in Sri Lanka. Indian J Pediatr 67 : 503–504. [Google Scholar]
  22. Kabra SK, Jain Y, Pandey RM, Madhulika, Singhal T, Tripathi P, Broor S, Seth P, Seth V, 1999. Dengue haemorrhagic fever in children in the 1996 Delhi epidemic. Trans R Soc Trop Med Hyg 93 : 294–298. [Google Scholar]
  23. Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N, 2002. Dengue fever epidemic in Chennai: a study of clinical profile and outcome. Indian Pediatr 39 : 1027–1033. [Google Scholar]
  24. Pancharoen C, Thisyakorn U, 2001. Neurological manifestations in dengue patients. Southeast Asian J Trop Med Public Health 32 : 341–345. [Google Scholar]
  25. Ooi EE, Goh KT, Chee Wang DN, 2003. Effect of increasing age on the trend of dengue and dengue hemorrhagic fever in Singapore. Int J Infect Dis 7 : 231–232. [Google Scholar]
  26. Phillips I, Need J, Escamilla J, Colan E, Sanchez S, Rodriguez M, Vasquez L, Seminario J, Betz T, da Rosa AT, 1992. First documented outbreak of dengue in the Peruvian Amazon region. Bull Pan Am Health Organ 26 : 201–207. [Google Scholar]
  27. Andrade CS, Caceres AG, Vaquerizo A, Ibanez-Bernal S, Cachay LS, 2001. Reappearance of Aedes aegypti (Diptera: Culicidae) in Lima, Peru. Mem Inst Oswaldo Cruz 96 : 657–658. [Google Scholar]

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  • Received : 06 May 2005
  • Accepted : 20 Aug 2005

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