Global & Disaster Medicine

Dengue: New Dengue Case Definitions (2009)


Dengue without Warning Signs expanded

Fever and two of the following:

Nausea, vomiting


Aches and pains


Positive tourniquet test


Dengue with Warning Signs** collapsed

Dengue as defined above with any of the following:

Abdominal pain or tenderness

Persistent vomiting

Clinical fluid accumulation (ascites, pleural effusion)

Mucosal bleeding

Lethargy, restlessness

Liver enlargement >2 cm

Laboratory: increase in HCT concurrent with rapid decrease in platelet count

**requires strict observation and medical intervention


Severe Dengue collapsed

Dengue with at least one of the following criteria:
Severe Plasma Leakage leading to:

– Shock (DSS)
– Fluid accumulation with respiratory distress

Severe Bleeding as evaluated by clinician

Severe organ involvement

– Liver: AST or ALT ≥ 1000

– CNS: impaired consciousness

– Failure of heart and other organs




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