A 32-year-old man presents on day 5 of dengue illness with platelet count of 22,000/μL, haematocrit rise of 22% from baseline, and pleural effusion detected on ultrasound. His pulse is 98 and BP is 105/76 mmHg. According to WHO 2009 dengue classification, how should this be classified?
- A Severe dengue — shock
- B Dengue without warning signs
- C Dengue with warning signs — haemoconcentration, pleural effusion, and thrombocytopenia ✓
- D Dengue haemorrhagic fever Grade IV
Explanation
WHO 2009 classification defines dengue with warning signs as dengue plus any of: abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation (pleural effusion/ascites), mucosal bleed, lethargy, liver enlargement >2 cm, or laboratory: haematocrit rise with platelet count fall. This patient has pleural effusion, >20% haematocrit rise, and severe thrombocytopenia — all warning signs. Severe dengue requires haemodynamic shock (hypotension), severe bleeding, or severe organ involvement. BP 105/76 with HR 98 without frank hypotension does not meet shock criteria yet.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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