Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever
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DOI：
10.1111/j.1365-3156.2006.01678.x
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发表时间：
2006-08-01
影响因子：
3.3
通讯作者：
Kroeger, Axel
中科院分区：
文献类型：
--
作者：
Bandyopadhyay, Shibani;Lum, Lucy C. S.;Kroeger, Axel
目前世界卫生组织（WHO）对登革热的分类包括两个不同的实体：登革热（DF）和登革出血热（DHF）/登革休克综合征;它主要基于东南亚的儿科病例。登革热已蔓延到不同的热带地区和老年群体。从原来的描述登革热表现的变化正在reported. ACTIVES分析临床医生在使用登革热病例分类的经验，并确定在应用标准在常规clinical practice.METHOD系统的文献回顾1975年后的英语出版物登革classification.RESULTS三十七篇论文进行了审查。几项研究在DHF病例中严格应用了所有四项WHO标准;然而，大多数临床医生报告难以满足所有四项标准，并使用了修改后的分类。止血带试验阳性代表出血表现的最低要求，但不能区分DHF和DF。在DHF病例中，8.6- 96%观察到血小板减少，6-95%观察到血浆渗漏，22- 93%观察到出血表现。登革出血热分类的低敏感性可能是由于未能在适当的时间重复测试或体检，早期静脉输液治疗，以及在流行情况下缺乏足够的资源，以及不同登革热实体的临床表现可能有相当大的重叠。年龄组和卫生保健系统，其中描述了登革热的临床表现，包括简单的实验室参数，以便审查并在必要时修改目前的登革热分类。
BACKROUND The current World Health Organisation (WHO) classification of dengue includes two distinct entities: dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome; it is largely based on pediatric cases in Southeast Asia. Dengue has extended to different tropical areas and older age groups. Variations from the original description of dengue manifestations are being reported.OBJECTIVES To analyse the experience of clinicians in using the dengue case classification and identify challenges in applying the criteria in routine clinical practice.METHOD Systematic literature review of post-1975 English-language publications on dengue classification.RESULTS Thirty-seven papers were reviewed. Several studies had strictly applied all four WHO criteria in DHF cases; however, most clinicians reported difficulties in meeting all four criteria and used a modified classification. The positive tourniquet test representing the minimum requirement of a haemorrhagic manifestation did not distinguish between DHF and DF. In cases of DHF thrombocytopenia was observed in 8.6-96%, plasma leakage in 6-95% and haemorrhagic manifestations in 22-93%. The low sensitivity of classifying DHF could be due to failure to repeat the tests or physical examinations at the appropriate time, early intravenous fluid therapy, and lack of adequate resources in an epidemic situation and perhaps a considerable overlap of clinical manifestations in the different dengue entities.CONCLUSION A prospective multi-centre study across dengue endemic regions, age groups and the health care system is required which describes the clinical presentation of dengue including simple laboratory parameters in order to review and if necessary modify the current dengue classification.