A 25-year-old man presents on day 3 of illness with high fever, severe headache, retroorbital pain, and myalgia. Tourniquet test is positive. CBC: WBC 3,200/µL, platelets 88,000/µL, haematocrit 46%. NS1 antigen is positive. He is alert and haemodynamically stable. Which dengue category and warning sign assessment is most critical at this stage?
- A Dengue without warning signs (Category A/Group A); outpatient management with oral hydration and daily follow-up through the critical phase (defervescence) ✓
- B Dengue with severe plasma leakage; requires immediate IV colloid resuscitation
- C Dengue with warning signs; hospitalise for IV fluid therapy monitoring
- D Severe dengue due to thrombocytopenia < 100,000; transfuse platelets immediately
Correct answer: A. Dengue without warning signs (Category A/Group A); outpatient management with oral hydration and daily follow-up through the critical phase (defervescence)
Explanation
Current WHO 2009 dengue guidelines classify this as dengue without warning signs (fever, positive NS1, leucopenia, mild thrombocytopenia with stable haematocrit, no warning signs such as abdominal pain, persistent vomiting, bleeding, liver enlargement, or haematocrit rise). Group A patients can be managed as outpatients with adequate oral fluid intake and close daily monitoring during the critical phase around day 4–5 when plasma leakage peaks. Platelet transfusion is not indicated unless < 20,000/µL with active bleeding.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.