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WHO Grading of Dengue Hemorrhagic Fever

Purpose: To grade Dengue Hemorrhagic Fever using the WHO grading scheme.

Description

Dengue is a flavivirus transmitted by Aedes mosquitoes. Dengue Fever is characterized by the sudden onset of fever, headache, myalgia, arthralgia, rash, nausea and vomiting. The presence of hemorrhagic findings constitutes Dengue Hemorrhagic Fever (DHF). The World Health Organization (WHO) divides the hemorrhagic fever into 4 grades based on the clinical severity of illness. The most severe form is also called Dengue Shock Syndrome (DSS).


Clinical Findings

Grade

fever with nonspecific constitutional symptoms OR

positive tourniquet test OR scattered petechiae

I

Grade I findings, plus spontaneous hemorrhage

II

circulatory failure

III

profound shock, with undetectable pulse and blood pressure

IV

 

Features seen in circulatory failure: one or more of the following

(1) hypotension

(2) rapid, weak pulse

(3) narrow pulse pressure (<= 20 mm Hg)

 

where:

• A positive tourniquet test is the presence of >= 20 petechiae per square inch distal to a blood pressure cuff maintained midway between systolic and diastolic blood pressure for 5 minutes. It is nonspecific and indicates only that a person has increased capillary fragility.

• Spontaneous hemorrhage includes large ecchymoses, epistaxis, bleeding gums and gastrointestinal hemorrhage.

• Laboratory values may include thrombocytopenia, hypoalbuminemia and increasing hematocrit.

• The pulse pressure = (systolic blood pressure in mm Hg) - (diastolic blood pressure in mm Hg)

 


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Specialty

Objective

ICD-10