BACKGROUND: Difficulties in the classification of dengue infection have been documented. Such difficulties could be due to the low awareness of the World Health Organization diagnostic guidelines among clinicians. OBJECTIVE: To study the diagnostic practices of clinicians in classifying patients as dengue fever (DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the time of discharge during an outbreak. METHODS: A prospective descriptive study of clinical features and disease classification in adult and pediatric dengue patients in the University of Malaya Medical Centre. RESULTS: Five hundred and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and evidence of plasma leakage were present in 8% of adult and 19% of pediatric patients. Of these, 93% and 49%, respectively, were given the discharge diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and thrombocytopenia were not recognized in clinicians' discharge diagnosis of DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve suggested a lack of consistency in the use of WHO guidelines in establishing DHF/DSS in adult patients, while implying otherwise for pediatric patients. CONCLUSION: DHF/DSS is an under-recognized condition by clinicians managing these patients. This can affect the case fatality rate of DHF/DSS and the economic burden of the disease. The lack of awareness in disease manifestations especially plasma leakage, can lead to delayed recognition of DHF/DSS.
BACKGROUND: Difficulties in the classification of dengue infection have been documented. Such difficulties could be due to the low awareness of the World Health Organization diagnostic guidelines among clinicians. OBJECTIVE: To study the diagnostic practices of clinicians in classifying patients as dengue fever (DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the time of discharge during an outbreak. METHODS: A prospective descriptive study of clinical features and disease classification in adult and pediatric dengue patients in the University of Malaya Medical Centre. RESULTS: Five hundred and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and evidence of plasma leakage were present in 8% of adult and 19% of pediatric patients. Of these, 93% and 49%, respectively, were given the discharge diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and thrombocytopenia were not recognized in clinicians' discharge diagnosis of DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve suggested a lack of consistency in the use of WHO guidelines in establishing DHF/DSS in adult patients, while implying otherwise for pediatric patients. CONCLUSION: DHF/DSS is an under-recognized condition by clinicians managing these patients. This can affect the case fatality rate of DHF/DSS and the economic burden of the disease. The lack of awareness in disease manifestations especially plasma leakage, can lead to delayed recognition of DHF/DSS.
Authors: Jessica R Fried; Robert V Gibbons; Siripen Kalayanarooj; Stephen J Thomas; Anon Srikiatkhachorn; In-Kyu Yoon; Richard G Jarman; Sharone Green; Alan L Rothman; Derek A T Cummings Journal: PLoS Negl Trop Dis Date: 2010-03-02
Authors: Nina Rocha Dutra; Marília Barbosa de Paula; Michelle Dias de Oliveira; Leandro Licursi de Oliveira; Sérgio Oliveira De Paula Journal: J Glob Infect Dis Date: 2009-01
Authors: Jenny G H Low; Adrian Ong; Li Kiang Tan; Shera Chaterji; Angelia Chow; Wen Yan Lim; Koon Wui Lee; Robert Chua; Choon Rong Chua; Sharon W S Tan; Yin Bun Cheung; Martin L Hibberd; Subhash G Vasudevan; Lee-Ching Ng; Yee Sin Leo; Eng Eong Ooi Journal: PLoS Negl Trop Dis Date: 2011-05-31
Authors: Lucy C S Lum; Sharifah Faridah Syed Omar; Sasheela Sri La Sri Ponnampalavanar; Lian H Tan; Shamala Devi Sekaran; Adeeba Kamarulzaman Journal: PLoS Negl Trop Dis Date: 2015-06-05