Grading severity of dengue haemorrhagic fever

00000000DHF is classified into four grades of severity, where grades III and IV are considered to be DSS. The presence of thrombocytopenia with concurrent haemoconcentration defferentiates grades I and II DHF from DF.

Grade I: Fever accompanied by non-specific constitutional symptoms; the only haemorrhagic manifestation is a positive tourniquet test and/or easy bruising.

Grade II: Spontaneous bleeding in addition to the manifestations of Grade I patients, usually in the forms of skin or other haemorrhages.

Grade III: Circulatory failure manifested by a rapid, weak pulse and narrowing of pulse pressure or hypotension, with the presence of cold, clammy skin and restlessness.

Grade IV: Profound shock with undetectable blood pressure or pulse.

00000000 Grading the severity of the disease at the time of discharge has been found clinically and epidemiologically useful in DHF epidemics in children in the WHO Regions of the Americas, South-East Asia and the Western Pacific, and experience in Cuba, Puerto Rico and Venezuela suggests that grading is also useful for adult cases.

Table 2.3 Criteria for differential diagnosis of
dengue haemorrhagic fever and chikungunya fevera

a Modified from Nimmannitya S et al. American journal of tropical medicine and hygiene, 1969, 18: 954-971.