Dengue: The Syndromic Basis to Pathogenesis Research. Inutility of the 2009 WHO Case Definition

Dengue diseases comprise major health problems for around half of the world’s population 1 ; each year millions of patients with overt dengue infections are seen by thousands of clinicians with varying degrees of experience, training, and clinical skills. The clinical records they generate feed into an ever-expanding dengue research community and contribute to burgeoningscientificliterature.Laboratoryresearchersaredependent upon careful clinical observations that, in turn, are given a clinical diagnosis. For the patient with a dengue infection in most cases this means selecting a diagnostic term based upon case definitions promulgated by the World Health Organization (WHO). In 2009, WHO issued new case definitions that combine disparate clinical responses into diagnostic categories that when widely adopted almost certainly will adversely affect the analytic clarity needed to understand mechanisms underlying dengue pathophysiology, pathogenesis, treatment, and therapeutics. How this might occur is the subject of this perspective.