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

Area of Science:

• Medical Research
• Infectious Diseases
• Clinical Epidemiology

Background:

• The clinical classification of dengue has evolved, with the World Health Organization (WHO) introducing a new system in 2009 alongside the existing one.
• The existing WHO classification categorizes dengue into dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS).
• The newer WHO Tropical Disease Research (TDR) classification divides dengue into dengue (D), dengue with warning signs (DW), and severe dengue (SD).

Purpose of the Study:

• To compare the clinical management effectiveness of the current WHO dengue classification versus the new TDR classification.
• To evaluate and potentially modify the four criteria of the DHF case definition within the current WHO classification.

Main Methods:

• A prospective study was conducted on suspected dengue patients admitted to a specialized dengue unit.
• Patients were managed according to national guidelines, with final diagnoses based on the current WHO classification and laboratory confirmation.
• The TDR classification was applied retrospectively using collected patient data, followed by statistical analysis.

Main Results:

• The TDR classification identified more patients as dengue with warning signs (DW) or severe dengue (SD) compared to the current WHO classification's DHF/DSS categories.
• Warning signs like vomiting and abdominal pain were prevalent across various dengue classifications and even in non-dengue febrile illnesses.
• The TDR classification required intensive monitoring for a larger patient group (189 DW/SD) compared to DHF patients under the current WHO system (94 DHF).
• Ultrasonography proved to be the most sensitive method for detecting plasma leakage, identifying it in 100% of cases where it occurred.

Conclusions:

• The current WHO classification is recommended for continued use due to the TDR classification's potential to double healthcare workload and its reliance on confirmatory tests.
• Modifications to the current WHO classification are proposed, emphasizing plasma leakage as a major criterion and bleeding or positive tourniquet tests as minor criteria.
• The addition of an 'unusual dengue' category is suggested to accommodate cases not fitting existing classifications, improving dengue management and diagnosis.