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. 2019 May 28:325–350. doi: 10.1016/B978-0-323-55512-8.00036-3

TABLE 36.1.1.

Case Definitions for Dengue Hemorrhagic Fever/Dengue Shock Syndrome, Severe Dengue, and the Warning Signs for Severe Dengue

Case Definition for Dengue Hemorrhagic Fever (DHF) and DHF Severity Classification Case Definition for Severe Dengue Warning Signs for Severe Dengue
Signs/symptoms of dengue fever and:
  • 1.

    thrombocytopenia (platelet count <100,000/mm3), and

  • 2.

    evidence of plasma leakage (hematocrit rise ≥20% from baseline, pleural effusion, or ascites), and

  • 3.
    hemorrhagic manifestation
    • DHF grade I = criteria 1 + 2 + positive tourniquet test
    • DHF grade II = criteria 1 + 2 + spontaneous bleeding
    • DHF grade III = DHF grade I/II criteria + circulatory failure (hypotension, weak pulse)
    • DHF grade IV = DHF grade I/II criteria + profound shock
 Probable or laboratory-confirmed dengue and:
  • 1.

    severe plasma leakage (shock or fluid accumulation with respiratory distress), or

  • 2.

    severe hemorrhage (as evaluated by clinician), or

  • 3.
    severe organ impairment:
    • •
      liver: AST or ALT ≥1000 U/mL
    • •
      central nervous system: impaired consciousness
    • •
      heart and other organs

  • Abdominal pain or tenderness

  • Persistent vomiting

  • Clinical fluid accumulation

  • Mucosal bleed

  • Lethargy, restlessness

  • Liver enlargement >2 cm

  • Increase in hematocrit concurrent with rapid decrease in platelet count

ALT, Alanine aminotransferase; AST, aspartate transaminase.