Dengue: an evaluation of dengue severity in French Polynesia based on an analysis of 403 laboratory-confirmed cases

We conducted a retrospective study of 403 laboratory-confirmed dengue cases hospitalized in Tahiti between August 1989 and March 1997. According to st andard WHO criteria, 337 of these cases were dengue fever (DF) and 64 were dengue haemorrhagic fever (DHF). Of the 10 fatal cases, 6 were DF and 4 wer e DHF. As an alternative, we used a correspondence analysis procedure to de fine dengue severity based on basic clinical and biological criteria for wh ich we assigned a severity score, and then selected the 50 most severe case s from this analysis. Of the latter, 17 patients had been classified as DF and 33 as DHF by the WHO criteria. From this analysis, haemorrhages and dec reased platelets counts associated with hepatic disorders are the main crit eria associated with the severe dengue cases. Thus in our study population, the WHO classification does not account for the overall severity of dengue ; hepatic failure should be considered as a specific severe form of dengue since plasma leakage, which is the pathophysiological hallmark of DHF, is o nly one of the pathogenic mechanisms leading to severity.