== Based on the WHO 2011 case description [1], dengue infections is suspected in an individual with high fever and two of the next indicators: Headache Retro-orbital pain Myalgia Arthralgia/ bone tissue pain Rash Bleeding manifestations: petechiae, epistaxis, gum bleeding, hematemesis, melena, or positive tourniquet check. Leukopenia (WBC 5,000 cells/mm3) Platelet count number 150,000 cell/mm3 Hematocrit (Hct) increasing 510%. In Thailand, PF-AKT400 the entire case definition for dengue for surveillance, control and early scientific diagnosis PF-AKT400 uses the next two criteria: tourniquet IKK-gamma antibody check positive or petechiae + leukopenia. UF can’t be diagnosed as well as the medical diagnosis is dependant on serology or virology clinically. DF is known as to be always a minor disease because loss of life is certainly rarely reported, but massive bleeding may be associated with DF. DHF clinical presentations during the febrile phase are similar to those in DF. The distinct feature of DHF is the increase in vascular permeability (plasma leakage) that differentiates DHF from DF. The plasma leakage is selective leakage into the pleural and peritoneal cavities that results in pleural effusion and ascites. DSS presentations are the same as those in DHF but the plasma leakage is so severe that the patient develops shock. UD most of the unusual cases are DHF cases with prolonged shock or DHF inpatients with co-morbidities or DHF together with other infections [2]. The majority of the cases are UF and DF. DHF/DSS accounts for about 10% of the symptomatic cases [3]. == Case definition of suspected dengue infection == In the first few days of dengue illness, most patients present with acute febrile illness with nonspecific signs and symptoms: headache, malaise, nausea/vomiting, abdominal pain and sometimes rash. PF-AKT400 Retro-orbital pain, myalgia and arthralgia are found mostly in DF patients, but some DHF/DSS may also have these symptoms. The most common bleeding manifestations are petechiae and other symptoms (epistaxis, gum bleeding, hematemesis, melena, hypermenorrhea, hemoglobinuria) which help in identifying early suspected dengue but are often missed by doctors/nurses in busy out-patient or primary care units. Tourniquet test is a simple tool that helps in the early diagnosis of dengue infection. The standard tourniquet test, the Winthrobe technique, involves raising the blood pressure to midway between systolic and diastolic pressure for five minutes. Then release pressure and wait about one minute or until the circulation comes back to normal. PF-AKT400 Read the result. The positive test is 10 petechiae/mm3(Figure1). The Daisy technique for tourniquet test is easier and can be used in children > five years old and adults. In this technique, pressure is applied to 80 mmHg for five minutes and then released and the result read as in the Winthrobe technique [2]. == Fig. 1. == According to the WHO 2011 case definition [1], dengue infection is suspected in a patient with high fever and two of the following signs or symptoms: Headache Retro-orbital pain Myalgia Arthralgia/ bone pain Rash Bleeding manifestations: petechiae, epistaxis, gum bleeding, hematemesis, melena, or positive tourniquet test. Leukopenia (WBC 5,000 cells/mm3) Platelet count 150,000 cell/mm3 Hematocrit (Hct) rising 510%. In Thailand, the case definition for dengue for surveillance, control and early clinical diagnosis uses the following two criteria: tourniquet test positive or petechiae + leukopenia. The positive predictive value of this case definition is 7083% [3,4]. == Case definition of DHF == The modified WHO/SEARO 2011 criteria are as follows: Major criteria: plasma leakage: elevation of Hct 20%, detection of ascites, pleural effusion by physical examination, chest film (right lateral decubitus position) or ultrasound, Minor criteria: 1. bleeding or positive tourniquet test. 2. Platelet counts 100,000 cells/mm3. Patients PF-AKT400 who have evidence of plasma leakage do not necessarily have bleeding or positive tourniquet test and their platelet count can be around 100,000 cells/mm3. DHF severity is divided into four grades according to the severity: DHF grade I, DHF.
