Chikungunya differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2], Alonso Alvarado, M.D. [3]

Overview

• The differential diagnosis of chikungunya virus infection varies based on place of residence, travel history, and exposures.
• Dengue and chikungunya viruses are transmitted by the same mosquitoes and have similar clinical features.
• The two viruses can circulate in the same area and can cause occasional co-infections in the same patient.
• Chikungunya virus infection is more likely to cause high fever, severe arthralgia, arthritis, rash, and lymphopenia, while dengue virus infection is more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, and death.
• It is important to rule out dengue virus infection because proper clinical management of dengue can improve outcome.

• In addition to dengue, other considerations include leptospirosis, malaria, rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, other alphavirus infections (e.g., Mayaro, Ross River, Barmah Forest, O’nyong'nyong, and Sindbis viruses), post-infections arthritis, and rheumatologic conditions.