Standardized Clinical Management: Evidence of
Reduction of Dengue Haemorrhagic Fever
Case-Fatality Rate in Thailand
By
Siripen Kalayanarooj
WHO Collaborating Centre for Case Management of Dengue/DHF/DSS,
Queen Sirikit National Institute of Child Health (Children's Hospital),
Department of Medical Services, Ministry of Public Health, Bangkok, Thailand

Abstract

00000000The first outbreak of dengue haemorrhagic fever (DHF) in Thailand occurred in 1958. There were 2,158 cases reported and 300 deaths, with a case-fatality rate (CFR) of 13.9%. Guidelines for the diagnosis and management of DHF were developed at the Children's Hospital, Bangkok, by Dr Suchitra Nimmannitty a few years after the outbreak. These guidelines were used widely in Thailand and have resulted in a marked reduction in the CFR from 14% to less than 1%. WHO adopted these criteria for the diagnosis and management of DHF in 1975 and has distributed it for worldwide use. The prognosis of DHF patients depends on early diagnosis and early detection of shock with proper management. This paper emphasizes on tourniquet test which is an important screening test for the diagnosis of dengue infection. CBC is an important laboratory test to be followed frequently in these patients. Leukopenia < 5,000 cells/cu mm and lymphocytosis indicate that the critical period is approaching within 24 hours and that warning signs and symptoms of shock should be told to the care-takers and they should be persuaded to bring the patient back to the hospital as soon as possible. Proper IV fluid management when the patients are in a critical period of 24 - 48 hours (when platelets are <100,000 cells/cu mm and 10 - 20% rising hematocrit) are explained in detail. Most DHF patients (60 - 70%) require only crystalloid solution (isotonic salt solution). Only 15 - 20% have massive plasma leakage and need colloidal solution for which dextran-40 with its hyperoncogenicity (about 3 times that of plasma) is recommended. Ten to 15% of DHF patients need blood transfusion. Platelet transfusion is recommended only for those with severe bleeding. With good medical and nursing care and appropriate management, all patients should recover rapidly and completely.
Key words: Dengue Haemorrhagic fever, Tourniquet test, Leukopenia, Fluid Management, Colloidal solution