A 28-year-old man in dengue-endemic area presents on day 4 of fever with platelet count 28,000/μL, haematocrit rise from 38% to 49%, positive tourniquet test, and BP 95/70 mmHg with cold extremities. According to WHO 2009 classification, this is:
- A Dengue without warning signs
- B Dengue with warning signs
- C Dengue haemorrhagic fever grade II
- D Severe dengue (dengue shock syndrome) ✓
Explanation
WHO 2009 classification: Severe dengue is defined by any of — severe plasma leakage with shock (dengue shock syndrome: systolic BP <90 mmHg or pulse pressure <20 mmHg with clinical shock), severe bleeding, or severe organ impairment. This patient has haematocrit rise >20% (38→49% = 29% rise), indicating critical plasma leakage, plus clinical signs of shock (cold extremities, narrow pulse pressure: 95/70 = pulse pressure 25 mmHg, borderline). The combination of haematocrit rise >20% AND signs of circulatory compromise = dengue shock syndrome = severe dengue, requiring urgent IV fluid resuscitation. WHO 2009 replaced the older DHF grade I-IV classification with the current 3-tier system.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.