Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pntd.0006258
Title: Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic
Authors: Bodinayake C.K.
Tillekeratne L.G.
Nagahawatte A.
Devasiri V.
Kodikara Arachchi W.
Strouse J.J.
Sessions O.M. 
Kurukulasooriya R.
Uehara A.
Howe S.
Ong X.M. 
Tan S. 
Chow A.
Tummalapalli P.
De Silva A.D.
Østbye T.
Woods C.W.
Gubler D.J. 
Reller M.E.
Keywords: immunoglobulin G
immunoglobulin M
adult
arthralgia
Article
bleeding
blood sampling
crackle
dengue
Dengue virus 1
enzyme linked immunosorbent assay
epidemic
fatigue
female
fever
follow up
human
leukopenia
major clinical study
male
middle aged
oliguria
physician
real time polymerase chain reaction
seroconversion
sore throat
tertiary care center
thrombocytopenia
virus isolation
world health organization
young adult
acute disease
adolescent
child
classification
cohort analysis
complication
dengue
Dengue virus
epidemic
evaluation study
fever
genetics
hospitalization
isolation and purification
leukopenia
polymerase chain reaction
preschool child
severe dengue
severity of illness index
Sri Lanka
thrombocytopenia
Acute Disease
Adolescent
Adult
Child
Child, Preschool
Cohort Studies
Dengue
Dengue Virus
Epidemics
Female
Fever
Hospitalization
Humans
Leukopenia
Male
Middle Aged
Polymerase Chain Reaction
Severe Dengue
Severity of Illness Index
Sri Lanka
Tertiary Care Centers
Thrombocytopenia
World Health Organization
Young Adult
Issue Date: 2018
Publisher: Public Library of Science
Citation: Bodinayake C.K., Tillekeratne L.G., Nagahawatte A., Devasiri V., Kodikara Arachchi W., Strouse J.J., Sessions O.M., Kurukulasooriya R., Uehara A., Howe S., Ong X.M., Tan S., Chow A., Tummalapalli P., De Silva A.D., Østbye T., Woods C.W., Gubler D.J., Reller M.E. (2018). Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic. PLoS Neglected Tropical Diseases 12 (2) : e0006258. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pntd.0006258
Abstract: Background: Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. Methodology/Principal findings: The new WHO 2009 classification of dengue divides suspected cases into three categories: dengue without warning signs, dengue with warning signs and severe dengue. We evaluated the WHO 2009 classification vs physicians' subjective clinical diagnosis (gestalt clinical impression) in a large cohort of patients presenting to a tertiary care center in southern Sri Lanka hospitalized with acute febrile illness. We confirmed acute dengue in 388 patients (305 adults � 18 years and 83 children), including 103 primary and 245 secondary cases, of 976 patients prospectively enrolled with AFI. At presentation, both adults and children with acute dengue were more likely than those with other AFI to have leukopenia and thrombocytopenia. Additionally, adults were more likely than those with other AFI to have joint pain, higher temperatures, and absence of crackles on examination whereas children with dengue were more likely than others to have sore throat, fatigue, oliguria, and elevated hematocrit and transaminases. Similarly, presence of joint pain, thrombocytopenia, and absence of cough were independently associated with secondary vs primary dengue in adults whereas no variables were different in children. The 2009 WHO dengue classification was more sensitive than physicians' clinical diagnosis for identification of acute dengue (71.5% vs 67.1%), but was less specific. However, despite the absence of on-site diagnostic confirmation of dengue, clinical diagnosis was more sensitive on discharge (75.2%). The 2009 WHO criteria classified almost 75% as having warning signs, even though only 9 (2.3%) patients had evidence of plasma leakage and 16 (4.1%) had evidence of bleeding Conclusions/Significance: In a large cohort with AFI, we identified features predictive of dengue vs other AFI and secondary vs primary dengue in adults versus children. The 2009 WHO dengue classification criteria had high sensitivity but low specificity compared to physicians' gestaldt diagnosis. Large cohort studies will be needed to validate the diagnostic yield of clinical impression and specific features for dengue relative to the 2009 WHO classification criteria. © 2018 Bodinayake et al.
Source Title: PLoS Neglected Tropical Diseases
URI: https://scholarbank.nus.edu.sg/handle/10635/165621
ISSN: 19352727
DOI: 10.1371/journal.pntd.0006258
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