Dengue Haemorrhagic Fever (DHF) grade III and IV together constitute dengue shock syndrome. According to WHO classification, which clinical feature differentiates DHF Grade II from Grade I?
- A Thrombocytopenia (platelet count <100,000)
- B Spontaneous bleeding from skin or other sites ✓
- C Haemoconcentration (Hct rise ≥20%)
- D Positive tourniquet (Rumpel-Leede) test
Correct answer: B. Spontaneous bleeding from skin or other sites
Explanation
WHO's 1997 DHF grading: Grade I — fever with positive tourniquet test (capillary fragility) only; Grade II — Grade I features PLUS spontaneous bleeding (from skin, gums, epistaxis, GI); Grade III — circulatory failure (rapid, weak pulse, narrowing pulse pressure, cold clammy skin, restlessness); Grade IV — profound shock (undetectable BP/pulse). All grades of DHF require thrombocytopenia ≤100,000/μL and haemoconcentration ≥20%. The tourniquet test alone is positive in Grade I; spontaneous bleeding distinguishes Grade II.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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