Dengue fever differential diagnosis

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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.

Diseases with Similar Symptoms

• Influenza
• Measles
• Rubella
• Malaria
• Yellow fever
• Zika fever

Comparison between Chikungunya and Dengue Fever Adapted from Clin Infect Dis. (2009) 49(6):942-948.

• 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%

Comparison Between Dengue Virus and Zika Virus

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