A 28-year-old returning from SE Asia has fever, severe headache, retro-orbital pain, and a positive tourniquet test. Platelet count is 48,000/μL, haematocrit has risen by 22% from baseline. NS1 antigen is positive. This is dengue with warning signs. Which feature would indicate SEVERE dengue requiring ICU admission per WHO 2009 criteria?

• A Platelet count <100,000/μL
• B Persistent vomiting
• C Positive tourniquet test
• D Severe plasma leakage causing respiratory distress/pleural effusion, or severe bleeding, or severe organ impairment ✓

Explanation

WHO 2009 criteria define severe dengue as: (1) severe plasma leakage (dengue shock syndrome, dengue with respiratory distress due to pleural effusions), (2) severe bleeding (clinically significant), and (3) severe organ involvement (severe liver disease, CNS, renal impairment). Thrombocytopenia without bleeding is a dengue warning sign, not severe dengue. Persistent vomiting and positive tourniquet test are also warning signs, not indicators of severe disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.