A 32-year-old woman presents with 5 days of high-grade fever, retro-orbital pain, severe myalgia, and a diffuse macular rash. She returned from India 6 days ago. CBC shows WBC 2,500/µL and platelets 52,000/µL. On day 6 of illness, she develops abdominal pain, persistent vomiting, and a hematocrit rise from 36% to 45%. Which finding best indicates progression to severe dengue?

• A Leukopenia
• B Thrombocytopenia
• C Elevated serum transaminases
• D Hematocrit rise of 25% from baseline ✓

Explanation

Severe dengue is defined by plasma leakage, which manifests as a rising hematocrit of 20% or more above baseline, pleural effusion, or ascites. The hematocrit rise from 36% to 45% represents a 25% increase, indicating hemoconcentration from plasma leakage. Leukopenia and thrombocytopenia are common in uncomplicated dengue and do not alone indicate severe disease.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.