Severe dengue (dengue haemorrhagic fever/dengue shock syndrome) is characterised by plasma leakage. The WHO 2009 dengue classification includes 'dengue with warning signs.' Which warning sign is the STRONGEST predictor of severe dengue requiring hospitalisation?
- A Abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy, liver enlargement >2 cm, rising haematocrit with rapid platelet drop ✓
- B Fever for 5 days with dengue-positive serology
- C Platelet count <100,000 cells/µL on day 3 of fever
- D Positive tourniquet test (Hess test) on day 1
Explanation
The WHO 2009 dengue classification defines warning signs that predict progression to severe dengue and mandate hospital admission: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation (ascites, pleural effusion), mucosal bleeding, lethargy or restlessness, liver enlargement >2 cm, and a rising haematocrit with concurrent rapid platelet decline (indicating plasma leakage onset). The rising haematocrit with falling platelets specifically reflects the critical phase of plasma leakage and is the most actionable combination for monitoring. Management focuses on intravenous crystalloid fluid resuscitation during the critical phase.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.