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.
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 ca...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-02-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | http://europepmc.org/articles/PMC5823472?pdf=render |
| _version_ | 1818150820449878016 |
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| author | Champica K Bodinayake L Gayani Tillekeratne Ajith Nagahawatte Vasantha Devasiri Wasantha Kodikara Arachchi John J Strouse October M Sessions Ruvini Kurukulasooriya Anna Uehara Shiqin Howe Xin Mei Ong Sharon Tan Angelia Chow Praveen Tummalapalli Aruna D De Silva Truls Østbye Christopher W Woods Duane J Gubler Megan E Reller |
| author_facet | Champica K Bodinayake L Gayani Tillekeratne Ajith Nagahawatte Vasantha Devasiri Wasantha Kodikara Arachchi John J Strouse October M Sessions Ruvini Kurukulasooriya Anna Uehara Shiqin Howe Xin Mei Ong Sharon Tan Angelia Chow Praveen Tummalapalli Aruna D De Silva Truls Østbye Christopher W Woods Duane J Gubler Megan E Reller |
| author_sort | Champica K Bodinayake |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T13:29:00Z |
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| id | doaj.art-330f70ba1925424c8339304c072cb8f1 |
| institution | Directory Open Access Journal |
| issn | 1935-2727 1935-2735 |
| language | English |
| last_indexed | 2024-12-11T13:29:00Z |
| publishDate | 2018-02-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj.art-330f70ba1925424c8339304c072cb8f12022-12-22T01:05:21ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352018-02-01122e000625810.1371/journal.pntd.0006258Evaluation 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.Champica K BodinayakeL Gayani TillekeratneAjith NagahawatteVasantha DevasiriWasantha Kodikara ArachchiJohn J StrouseOctober M SessionsRuvini KurukulasooriyaAnna UeharaShiqin HoweXin Mei OngSharon TanAngelia ChowPraveen TummalapalliAruna D De SilvaTruls ØstbyeChristopher W WoodsDuane J GublerMegan E RellerBACKGROUND: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.http://europepmc.org/articles/PMC5823472?pdf=render |
| spellingShingle | Champica K Bodinayake L Gayani Tillekeratne Ajith Nagahawatte Vasantha Devasiri Wasantha Kodikara Arachchi John J Strouse October M Sessions Ruvini Kurukulasooriya Anna Uehara Shiqin Howe Xin Mei Ong Sharon Tan Angelia Chow Praveen Tummalapalli Aruna D De Silva Truls Østbye Christopher W Woods Duane J Gubler Megan E Reller 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 |
| 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. |
| title_full | 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. |
| title_fullStr | 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. |
| title_full_unstemmed | 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. |
| title_short | 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. |
| title_sort | 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 |
| url | http://europepmc.org/articles/PMC5823472?pdf=render |
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