Differential Diagnosis of Chikungunya, Dengue Viral Infection and Other Acute Febrile Illnesses in Children

Abstract

During a CHIK outbreak in a DVI-endemic area, overdiagnosis of CHIK was common. Skin rash during fever and white blood cell count ≥ 5000 cells/mm(3) or specific antigen testing (if available) can be helpful in differentiating CHIK from DVI.

Detection of dengue virus serotypes 1, 2 and 3 in selected regions of Kenya: 2011–2014

“…An opportunity to determine the etiology of arbovirus infections is often missed as fevers caused by arboviruses may be misdiagnosed as malaria or Vis versa. In addition, overlaps in geographical locations and concurrent infections of arboviruses from the same or different families are well documented in various parts of the world and Africa [40–45]. This highlights the need for continued vigilance and review of the existing testing algorithms for diseases associated with febrile manifestations.…”

Dengue virus serotype 3 and Chikungunya virus co-infection in a traveller returning from India to Portugal, November 2016

“…For instance, the inappropriate prescription of arthralgia-alleviating NSAIDs (especially acetylsalicylic acid) in CHIKV misdiagnosed infections (sometimes also because of misdiagnosis with other rheumatic disorders) can lead to severe bleeding in patients with dengue fever with thrombocytopenia or in dengue severe cases- [23]. Missing DENV in co-infection cases or misdiagnosis dengue fever as chikungunya may also delay or disrupt dengue-specific supportive treatment which can have a ten-fold impact on the likelihood of progression to severe disease [23], [24], [25]. For that, clinical management in dengue-endemic areas, recommends that patients with suspected CHIKV infection to be managed as dengue until dengue has been ruled out.…”

Chikungunya Virus Infections Among Patients with Dengue-Like Illness at a Tertiary Care Hospital in the Philippines, 2012–2013

“…Subgroup analysis comparing chikungunya cases ≥ 18 years old and < 18 years old showed patients who were < 18 years old had significantly higher frequency of skin rash (P = 0.022) while those ≥ 18 years old had higher occurrences of bleeding (P = 0.026) and nausea (P = 0.026) (Table 4). Sensitivity, specificity, and positive and negative predictive values for various combinations of clinical symptoms, 17 namely, fever, rash, muscle/body pain, and arthralgia for diagnosing chikungunya and dengue yielded no combination of symptoms with sufficiently high sensitivity and specificity in diagnosing either chikungunya or dengue (Tables 5 and 6). …”

“…25 In another study by Yoon and others, a high rate of subclinical and symptomatic CHIKV infections was reported in a prospective community cohort in Cebu, Philippines, from 2012 to 2013 with a total incidence density of 12.22 CHIKV infections per 100 person-years. 26 These studies provide further evidence that chikungunya has re-emerged as an important disease in the Philippines as well as in Asia, 17,27 and highlights the importance of distinguishing symptomatic CHIKV infection especially in the background of hyperendemic DENV transmission. Here, we describe laboratory-confirmed CHIKV infections clinically diagnosed as dengue at a tertiary care hospital in the Philippines.…”

“…14 Co-circulation with DENV is particularly problematic since many presenting signs and symptoms of both diseases may be similar making clinical diagnosis challenging. 13,[15][16][17][18] In the Philippines, CHIKV has been reported since the 1950s, although previously documented CHIKV outbreaks have been limited in scale, sporadic, and geographically isolated. [19][20][21][22][23][24] However, in a recent study by Capeding and others, chikungunya was the most common cause of febrile illnesses in a multicountry prospective cohort study including two sites from the Philippines in 2010-2011 with an overall incidence density of 10.8 per 100 person-years.…”