A 30-year-old man presents with 5 days of high fever, severe myalgia, retro-orbital pain, and a petechial rash. Platelet count has dropped from 160,000 to 48,000/µL over 3 days. NS1 antigen is positive. He has no warning signs. Which clinical parameter, if present, would mandate hospital admission per WHO dengue classification?
- A Platelet count < 100,000/µL
- B Fever > 39°C for > 3 days
- C Abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, or mucosal bleeding (warning signs) ✓
- D Positive NS1 antigen in the absence of symptoms
Correct answer: C. Abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, or mucosal bleeding (warning signs)
Explanation
WHO 2009 dengue classification divides cases into dengue without warning signs, dengue with warning signs, and severe dengue. Warning signs include abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation (ascites, pleural effusion), mucosal bleed, lethargy, liver enlargement >2 cm, or a rising haematocrit with rapid platelet fall. Presence of any warning sign mandates hospital admission for close monitoring. Platelet count <100,000 alone without symptoms/warning signs does not automatically require admission.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.