A 28-year-old man presents on day 3 of dengue fever with fever, severe myalgia, thrombocytopaenia (platelet count 65,000/μL), haematocrit rise of 18% from baseline, and clinical evidence of plasma leakage (bilateral pleural effusions). According to WHO dengue classification, what is his category and does he need hospitalisation?
- A Severe dengue (Group C); emergency ICU care required
- B Dengue without warning signs (Group A); outpatient management appropriate
- C Dengue with warning signs (Group B); hospitalisation and IV fluid management required ✓
- D Dengue haemorrhagic fever Grade III; platelet transfusion is mandatory
Explanation
WHO 2009 dengue classification places this patient in Group B (dengue with warning signs) based on the ≥20% haematocrit rise (plasma leakage), bilateral pleural effusions, and thrombocytopaenia. Warning signs include abdominal pain, persistent vomiting, mucosal bleeding, lethargy, liver enlargement, rising haematocrit with rapid platelet fall, and clinical fluid accumulation. Group B requires hospitalisation and careful IV fluid therapy. Group C (severe dengue) requires shock, severe haemorrhage, or severe organ impairment. Platelet transfusion is not indicated merely for thrombocytopaenia without bleeding.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.