What are the World Health Organization (WHO) minimum criteria for diagnosing dengue fever?

From the Guidelines

Diagnosis of Dengue Fever

The World Health Organization (WHO) minimum criteria for diagnosing dengue fever are fever with one or more other characteristic findings, such as nausea, vomiting, rash, headache, retro-orbital pain, myalgia, arthralgia, positive tourniquet test, or leukopenia 1.

• Key findings that support the diagnosis of dengue fever include:
  • Fever
  • Nausea
  • Vomiting
  • Rash
  • Headache
  • Retro-orbital pain
  • Myalgia
  • Arthralgia
  • Positive tourniquet test
  • Leukopenia
• The diagnosis can be confirmed by laboratory tests, such as nucleic acid amplification tests (NAATs) or immunoglobulin M (IgM) antibody testing, which can identify the presence of the dengue virus or antibodies against it 1.
• The Centers for Disease Control and Prevention (CDC) recommends that patients with suspected dengue or Zika virus disease undergo NAATs, which are the preferred method of diagnosis, as they can provide confirmed evidence of infection and distinguish between the two viruses 1.
• In addition to laboratory tests, the CDC also recommends considering the patient's clinical and epidemiologic history, including recent travel to areas where dengue and Zika viruses are endemic, when making a diagnosis 1.
• The Infectious Diseases Society of America and the American Society for Microbiology provide guidance on the utilization of the microbiology laboratory for diagnosis of infectious diseases, including dengue virus infection, and recommend the use of serologic methods, such as detection of IgM- and/or IgG-class antibodies to the virus, or detection of the DENV nonstructural protein 1 (NS1) antigen 1.

From the Research

World Health Organization (WHO) Minimum Criteria for Diagnosing Dengue Fever

The WHO has established criteria for diagnosing dengue fever, which include:

• Dengue fever (DF): characterized by acute onset, high fever, severe headache, pain behind the eyes, joint and muscle pain, rash, and mild bleeding [(2,3,4)]
• Dengue hemorrhagic fever (DHF): characterized by severe plasma leakage, severe bleeding, and organ failure [(3,4,5)]
• Severe dengue: characterized by severe plasma leakage, severe bleeding, and organ failure [(4,5,6)]

Warning Signs for Adult Dengue Severity

The WHO 2009 guidelines propose seven warning signs for adult dengue severity, including:

• Abdominal pain or tenderness
• Vomiting
• Fluid accumulation
• Mucosal bleeding
• Lethargy
• Liver enlargement
• Increasing hematocrit with decreasing platelets 5

Limitations of the WHO Classification Schemes

The WHO classification schemes have limitations, including:

• Poor diagnostic accuracy of clinical criteria 2
• Difficulty in distinguishing between DF and DHF 3
• Limited applicability of the 1997 case definitions 4
• Need for further modification of the 2009 classification system [(4,5)]