Division of Infectious Diseases, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2013 Aug;46(4):271-81. doi: 10.1016/j.jmii.2012.07.005. Epub 2012 Sep 28.
BACKGROUND/PURPOSE: Dengue cases, traditionally classified as dengue fever (DF) or dengue hemorrhagic fever (DHF) by the World Health Organization (WHO) dengue classification 1997 scheme, are categorized into Group A (without warning signs), Group B [with warning signs (e.g., abdominal pain/vomiting/fluid accumulation/mucosal bleeding/lethargy/liver enlargement/increasing hematocrit with decreasing platelets)], or Group C (severe plasma leakage/severe bleeding/organ failure) by the WHO 2009 version. We compared differences in clinical/laboratory features between patients separately classified as DF/DHF and in Group A/B/C.
We performed a retrospective analysis of dengue patients diagnosed between 2008 and 2010.
A total of 148 adult patients (119 DF/29 DHF; 64 Group A/77 Group B/7 Group C) were included. Compared with DF, significantly younger age, lower hospitalization rate, and higher platelet count were found in Group A. Compared with DHF, higher platelet count was found in Group B. Six of seven patients (86%) classified as Group C fulfilled the criteria of DHF. A cross tabulation showed DF cases were distributed in all of the severity groups stratified by the WHO dengue 2009 scheme (53.8% Group A/45.4% Group B/0.8% Group C); of the DHF cases, 23 (79%) were categorized as Group B, and six (20.7%) as Group C. All patients in Group A fell into the category DF.
The WHO 2009 scheme is effective in identifying severe dengue cases. Heterogeneity in severity suggests careful severity discrimination in patients classified in Group B is needed. Our data suggest that it is safe to treat patients classified as Group A on an outpatient basis.
背景/目的：登革热病例曾由世界卫生组织（WHO）1997 年登革热分类方案按登革热（DF）或登革出血热（DHF）进行传统分类，但现在根据 WHO 2009 年版方案分为 A 组（无预警症状）、B 组（有预警症状[如腹痛/呕吐/体液蓄积/黏膜出血/嗜睡/肝肿大/血小板减少性血细胞比容增加]）或 C 组（严重血浆渗漏/严重出血/器官衰竭）。我们比较了分别按 DF/DHF 和 A/B/C 组分类的患者的临床/实验室特征差异。
我们对 2008 年至 2010 年期间诊断的登革热患者进行了回顾性分析。
共纳入 148 例成年患者（119 例 DF/29 例 DHF；64 例 A 组/77 例 B 组/7 例 C 组）。与 DF 相比，A 组患者年龄更小、住院率更低、血小板计数更高。与 DHF 相比，B 组患者血小板计数更高。7 例 C 组患者中，有 6 例（86%）符合 DHF 标准。交叉制表显示，根据 WHO 2009 年登革热方案，DF 病例分布于所有严重程度组（A 组占 53.8%、B 组占 45.4%、C 组占 0.8%）；DHF 病例中，23 例（79%）为 B 组，6 例（20.7%）为 C 组。A 组所有患者均归入 DF 类别。
WHO 2009 年方案可有效识别重症登革热病例。严重程度的异质性表明，需要对归入 B 组的患者进行仔细的严重程度鉴别。我们的数据表明，对归入 A 组的患者进行门诊治疗是安全的。
