Rift valley fever differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aakash Hans, MD[2]

Overview

The majority of differential diagnoses for Rift valley fever arise from other diseases which are prevalent in travelers and present with fever. All these disease would share a similar history of recent travel to an endemic area, followed by development of fever and body aches. A few of these diseases are listed below.

Differential Diagnosis

• Malaria
  • The disease presents with fever like Rift valley fever, but the major difference is the pattern of fever in malaria. The fever recurs every 3-4 days in malaria while no such patterns are seen in RVF.
  • Malaria is common in African countries, so paying attention to the time and onset of fevers can be useful in distinguishing between the two diseases.
• Typhoid fever
  • Typhoid usually has a pattern of step-ladder form of fever, meaning the temperature rises with each passing day.
  • The patient also complaints of bowel abnormalities along with fever. Individuals report either constipation or diarrhea along with fever.
  • A rash is seen on the chest, known as rose-spots in patients with Typhoid.
• Crimean-Congo hemorrhagic fever
• Ebola virus disease
• Dengue
  • Patients with dengue also complain of fever but have greater joint pains than in Rift valley fever.
  • A characteristic feature of dengue fever is retro-orbital pain.
  • Dengue has a longer incubation period of 7 days, followed by a week of febrile phase, 1-2 days of the critical phase and 3-5 days of the recovery phase.
• Yellow fever
  • It is a rare disease caused by mosquitos found in South America and Africa.
  • There are vaccines for travelers traveling to these areas.
  • The disease is usually a self limiting febrile illness but may lead to cardiac, renal and hepatic complications.
• Lassa fever
  • The disease is usually seen in West Africa.
  • It is transmitted by rats and risk factors include handling food materials infected with rat feces or contact with infected humans.
  • The incubation period ranges from 2-21 days and most of the people do not report any symptoms.
  • Common symptoms are fever, throat pain, headache, swelling of the face, vomiting and diarrhea.
• Chikungunya
  • It is caused by the Aedes aegypti mosquito and is commonly seen in African and Asian countries.
  • The course of the disease is self limiting and involves fever, headaches and generalized body pain.
• Q fever
  • Q fever is caused by infection by a bacteria called Coxiella burnetii.
  • The bacteria is usually found in domestic animals such as sheep, goats, cats and ticks also.
  • Risk factors include drinking raw milk, breathing in contaminated dust or droplets.
  • Acute infection is characterised by fever, pneumonia and hepatitis. Chronic infections presents with cardiac, musculoskeletal or vascular symptoms.
• Zika virus
• Marburg virus disease

References

• https://www.who.int/en/news-room/fact-sheets/detail/rift-valley-fever
• https://www.cdc.gov/vhf/rvf/index.html