A 7-year-old girl with dengue fever develops lethargy and cold clammy extremities. Her pulse is 130/min and feeble, blood pressure is 90/70 mmHg, and she has mild gum bleeding but no frank shock. According to the traditional WHO grading of dengue haemorrhagic fever, her condition corresponds to:
- A Grade I
- B Grade II
- C Grade III ✓
- D Grade IV
Correct answer: C. Grade III
Explanation
In the classic WHO grading, Grade I shows only a positive tourniquet test or easy bruising with fever; Grade II adds spontaneous bleeding such as petechiae or gum bleeding; Grade III is defined by circulatory failure with rapid weak pulse, narrowing of pulse pressure to 20 mmHg or less or hypotension, but preserved blood pressure recording; Grade IV is profound shock with undetectable blood pressure and pulse. The narrow pulse pressure of 20 mmHg here places her in Grade III.
Reference: WHO Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever, SEARO Regional Publication ed.
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Written and medically reviewed by the StethoPrep medical team.