Criteria for Diagnosis of Dengue Fever

 

Diagnostic groups:

(1) clinical dengue fever

(2) clinical dengue hemorrhagic fever

(3) clinical dengue shock syndrome

(4) confirmed dengue diagnosis

(5) probable dengue diagnosis

 

Clinical dengue fever:

(1) acute illness

(2) 2 or more of the following:

(2a) headache

(2b) retro-orbital pain

(2c) myalgia

(2d) arthralgia

(2e) rash

(2f) hemorrhagic manifestations

(2g) leukopenia

 

where:

• Some of these clinical findings (like rash, fever and arthralgias) can be seen in many infectious diseases.

 

Clinical dengue hemorrhagic fever - all 3 of the following:

(1) thrombocytopenia (platelet count < 100,000 per µL)

(2) hemorhagic manifestations (positive tourniquet test, petechiae, ecchymoses, purpura, mucosal bleeding, GI bleeding, injection site bleeding)

(3) one or both of the following

(3a) evidence of plasma leakage associated with increased vascular permeability (fluctuation of packed red blood cell volume >= 20% during course of the illness)

(3b) clinical signs of plasma leakage (pleural effusion, ascites, hypoproteinemia)

 

Clinical dengue shock syndrome:

(1) presence of dengue hemorrhagic fever

(2) one of the following:

(2a) pulse pressure < 20 mm Hg

(2b) hypotension (for ages < 5 years systolic blood pressure < 80 mm Hg; for >= 5 years systolic blood pressure < 90 mm Hg)

 

where:

• Pulse pressure = (systolic blood pressure) - (diastolic blood pressure)

 

Confirmed dengue:

(1) isolation of virus on culture

(2) demonstration of the virus by immune method (immunofluorescence, immunohistochemistry, enzyme linked immunoabsorbent assay)

(3) positive PCR assay

(4) fourfold or greater increase in anti-dengue IgG antibody titer between acute and convalescent serum samples

(5) increase in anti-dengue IgM antibody titer between acute and convalescent serum samples

 

Probable dengue - one of the following:

(1) occurrence at the same time and location as a confirmed case of dengue fever

(2) single hemagglutination inhibition (HAI) titer >= 1:1280

(3) single IgG ELISA test titer >= 1:1280

(4) positive for IgM antibody to dengue