Dengue fever differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dengue fever must be differentiated from other diseases that prevent with flu like symptoms fever, retro-orbital headache, fatigue, joint aches or arthralgias (joint aches), myalgias (muscle aches), nausea/vomiting, and lymphadenopathy (swollen lymph nodes). Diseases with similar symptoms include influenza, measles, rubella, malaria, Zika virus, and Yellow fever.

Chikungunya should be distinguished from dengue fever, which has the potential for much poorer clinical outcomes, including death. The two diseases can occur together in the same patient.
Shock or severe hemorrhage is very rarely observed in Chikungunya.
In Chikungunya the onset of the disease is more acute and the duration of fever is much shorter.
A maculopapular rash is more frequent in Chikungunya, while petechia may occur in dengue fever.
In Chikungunya the pain is much more pronounced and localized to the joints and tendons in comparison of dengue fever, which the pain is generalized.

**Clinical and laboratory findings of chikunguyna and dengue fever**
Clinical Findings	Chikungunya	Dengue Fever
Fever (>102°F or 39°C)	+++	++
Headache	++	++
Rash	++	+
Arthralgias	+++	+/–
Myalgias	+	++
Shock	—	+/–
Bleeding dyscrasias	+/–	++
Laboratory Findings
Elevated hematocrit	—	++
Leukopenia	++	+++
Neutropenia	+	+++
Lymphopenia	+++	++
Thrombocytopenia	+	+++
Mean frequency of symptoms from studies where the two diseases were directly compared among patient seeking care; +++ = 70-100% of patients; ++ = 40-69%; + = 10-39%; +/– = <10%; — = 0%^[2]^[3]

The following table summarizes the distinguishing and common features between Zika fever and Dengue fever:

	Dengue Fever	Zika Fever
Common Clinical Features	Biphasic fever pattern, maculopapular rash, arthralgia, headache, and signs of hemorrhage	Fever, maculopapular rash, conjunctivitis, and headache
Hemorrhage Common?	Yes	No
Symptom Severity	May be severe	Usually mild
Symptom Duration	2 to 7 days	4 to 7 days
Incubation Period	4 to 10 days	3 to 12 days
Endemicity	Americas, Africa, Southeast Asia	Americas, Africa, Southeast Asia
Vector	Aedes mosquito	Aedes mosquito
Laboratory Findings	Leucopenia, rising hematocrit (suggestive of impending hemorrhage), thrombocytopenia, elevated liver function tests	Leucopenia but normal hematocrit, platelet count, and liver function tests
Diagnosis	RT-PCR or ELISA	RT-PCR or ELISA
Treatment	Supportive care, avoid aspirin and other NSAIDs	Supportive care

↑ Staples, J. Erin; Breiman, Robert F.; Powers, Ann M. (2009). “Chikungunya Fever: An Epidemiological Review of a Re‐Emerging Infectious Disease”. Clinical Infectious Diseases. 49 (6): 942–948. doi:10.1086/605496. ISSN 1058-4838.
↑ S. Nimmannitya, S. B. Halstead, S. N. Cohen & M. R. Margiotta (1969). “Dengue and chikungunya virus infection in man in Thailand, 1962-1964. I. Observations on hospitalized patients with hemorrhagic fever”. The American journal of tropical medicine and hygiene. 18 (6): 954–971. PMID 5355242. Unknown parameter |month= ignored (help)
↑ Patrick Hochedez, Ana Canestri, Amelie Guihot, Segolene Brichler, Francois Bricaire & Eric Caumes (2008). “Management of travelers with fever and exanthema, notably dengue and chikungunya infections”. The American journal of tropical medicine and hygiene. 78 (5): 710–713. PMID 18458301. Unknown parameter |month= ignored (help)