Dogma in Classifying Dengue Disease

Farrar, Jeremy; Hien, Tran Tinh; Horstick, Olaf; Hưng, Nguyễn Thành; Jaenisch, Thomas; Junghanns, Thomas; Kroeger, Axel; Laksono, Ida Safitri; Lum, Lucy Chai See; Martínez, Eric; Simmons, Cameron P.; Tami, Adriana; Tomashek, Kay M.; Wills, Bridget

doi:10.4269/ajtmh.13-0157

Cited by 31 publications

(22 citation statements)

References 30 publications

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“…[9][10][11] This issue confounds the ability to compare our results with those that used different case classifications or that were conducted in a pediatric setting. [12][13][14][15][16] Our study in adolescents and adults showed that, in this series, specific clinical aspects existed for each serotype.…”

Section: Discussionmentioning

confidence: 95%

Clinical Presentation of Dengue by Serotype and Year of Epidemic in Martinique

Thomas

Najioullah

Besnier

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. During the last decade Martinique experienced four dengue epidemics, each characterized by the predominance of 1 or 2 serotypes. In this retrospective database analysis, we investigated the relationship between dengue serotype and disease severity. Data on dengue were collected from 715 patients (male/female ratio 0.87), 14 to 91 years of age (median 35 years) examined in the adult emergency department between 2005 and 2010. In this series, DENV-4 infections more frequently had a milder clinical presentation. The DENV-2 infections were most often secondary infections admitted at the critical phase of dengue illness with signs of plasma leakage. The DENV-1 infections were disabling, particularly in females, and most often led to disease of intermediate severity, without overt plasma leakage. These data were consistent with there being differences in virulence between serotypes, regardless of the host's immune status. However, secondary DENV-2 infections showed an increased risk of plasma leakage.

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Section: Discussionmentioning

confidence: 95%

Clinical Presentation of Dengue by Serotype and Year of Epidemic in Martinique

Thomas

Najioullah

Besnier

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…The studies in refs. 26 and 29 argue—mainly with reference to the study by Alexander and others4 and the study in ref. 10—that D/SD offers a better categorization than the DF/DHF/DSS classification.…”

Section: Discussionmentioning

confidence: 96%

“…29). In this section, we will consider these three main areas of application of the dengue case classification.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Horstick¹,

Jaenisch²,

Martínez³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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The 1997 and 2009 WHO dengue case classifications were compared in a systematic review with 12 eligible studies (4 prospective). Ten expert opinion articles were used for discussion. For the 2009 WHO classification studies show: when determining severe dengue sensitivity ranges between 59–98% (88%/98%: prospective studies), specificity between 41–99% (99%: prospective study) - comparing the 1997 WHO classification: sensitivity 24.8–89.9% (24.8%/74%: prospective studies), specificity: 25%/100% (100%: prospective study). The application of the 2009 WHO classification is easy, however for (non-severe) dengue there may be a risk of monitoring increased case numbers. Warning signs validation studies are needed. For epidemiological/pathogenesis research use of the 2009 WHO classification, opinion papers show that ease of application, increased sensitivity (severe dengue) and international comparability are advantageous; 3 severe dengue criteria (severe plasma leakage, severe bleeding, severe organ manifestation) are useful research endpoints. The 2009 WHO classification has clear advantages for clinical use, use in epidemiology is promising and research use may at least not be a disadvantage.

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“…In a disease like dengue with a broad clinical spectrum, research to elucidate mechanistic pathways underlying specific phenomena relies on careful characterisation of individual clinical phenotypes. The extent to which the original WHO 1997 and the revised 2009 dengue classification systems facilitate pathophysiology research has been a matter of some debate [29,30]. For example, it has been argued that the 2009 severe dengue entity represents a mix of end-stage manifestations involving various clinical pathways and potentially including comorbidities and/or iatrogenic factors [31].…”

Section: Discussionmentioning

confidence: 99%

Severe dengue categories as research endpoints—Results from a prospective observational study in hospitalised dengue patients

et al. 2020

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Severe dengue was perceived as one clinical disease entity until the WHO 2009 classification stratified it into severe vascular leakage, severe bleeding, and severe organ dysfunction. The objectives of this study were to investigate the potential use of severe dengue categories as endpoints for intervention research. 271 patients with severe dengue among 1734 confirmed dengue patients were followed prospectively in this hospital-based observational study in Latin America and Asia. We compared the distribution of severe dengue categories according to gender and age (below/above 15y), and determined the relative frequency and the overlap of severe dengue categories in the same patients. In a next step, we extended the analysis to candidate moderate severity categories, based on recently suggested definitions which were adapted for our purposes. Severe vascular leakage occurred in 244 (90%), severe bleeding in 39 (14%), and severe organ dysfunction in 28 (10%) of 271 severe dengue patients. A higher frequency of severe leakage was seen in children or adolescents (<15y) compared to adults. More than 80% of the severe leakage cases, and 30-50% of the cases with severe bleeding or severe organ dysfunction, were defined as severe on the basis of that feature alone. In 136 out of 213 patients with severe leakage alone, neither moderate bleeding manifestation nor hepatic involvement was recorded. On the other hand, moderate leakage manifestations were detected in 4 out of 12 cases that were classified as severe based on bleeding alone. A major proportion of severe dengue patients exhibited clinical manifestations of severe vascular leakage only, which may constitute a useful endpoint for intervention research or pathophysiology studies. Severe bleeding and severe organ manifestation were recorded less frequently and exhibited a higher degree of overlap with severe leakage. Severe bleeding without leakage may be associated with individual PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.

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Dogma in Classifying Dengue Disease

Cited by 31 publications

References 30 publications

Clinical Presentation of Dengue by Serotype and Year of Epidemic in Martinique

Clinical Presentation of Dengue by Serotype and Year of Epidemic in Martinique

Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Severe dengue categories as research endpoints—Results from a prospective observational study in hospitalised dengue patients

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