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Dengue Fever: Differential Diagnoses & Workup
Updated: Jan 31, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Hepatitis | Tick-Borne Diseases, Rocky Mountain Spotted
Fever |
| Malaria | Yellow Fever |
| Meningitis | |
| Pediatrics, Bacteremia and Sepsis | |
| Pediatrics, Meningitis and Encephalitis |
Other Problems to Be Considered
Leptospirosis
Rickettsioses
River viruses
Scrub typhus
Typhoid
Viral infections (eg, influenza, chikungunya, Mayaro fever, Rift Valley fever, West Nile, Sindbis, and Ross River)
Workup
Laboratory Studies
- Isolation of virus in serum and detection of immunoglobulins (IgM and IgG) by enzyme-linked immunosorbent assay (ELISA) antibody capture, monoclonal antibody, or hemagglutination
- Complete blood count
- Hemoconcentration (hematocrit increased 20%)
- Thrombocytopenia (platelet count <100 x 109/L)
- Leukopenia
- Chemistry panel
- Electrolyte imbalances
- Acidemia
- Elevated BUN
- Liver function tests
- Elevated transaminases
- Hypoproteinemia
- Guaiac test for occult blood in stool (see Media file 3)
Signs of early coagulopathy may be as subtle as a guaiac test positive for occult blood in the stool. This test should be performed on all patients in whom dengue virus infection is suspected.
- DIC panel, as indicated
Imaging Studies
- Chest radiography
- Bronchopneumonia
- Pleural effusion
- Head CT scan without contrast
- For altered level of consciousness
- Intracranial bleeding
- Cerebral edema
Other Tests
- Electrocardiography
- Nonspecific changes may be effects of fever, electrolyte disturbances, tachycardia, or medications.
- Usefulness of these changes as a marker of cardiac involvement is unclear.
More on Dengue Fever |
| Overview: Dengue Fever |
Differential Diagnoses & Workup: Dengue Fever |
| Treatment & Medication: Dengue Fever |
| Follow-up: Dengue Fever |
| Multimedia: Dengue Fever |
| References |
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References
Guzman MG, Kouri G. Dengue and dengue hemorrhagic fever in the Americas: lessons and challenges. J Clin Virol. May 2003;27(1):1-13. [Medline].
Guzman MG, Kouri G. Dengue: an update. Lancet Infect Dis. Jan 2002;2(1):33-42. [Medline].
Halstead SB. Pathogenesis of dengue: challenges to molecular biology. Science. Jan 29 1988;239(4839):476-81. [Medline].
Hoeprich PD, Jordan MC, Ronald AR, eds; Halstead SB. Infectious Diseases: A Treatise of Infectious Processes. 1994:919-923.
Kao CL, King CC, Chao DY, et al. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. J Microbiol Immunol Infect. Feb 2005;38(1):5-16. [Medline].
Kuno G. Review of the factors modulating dengue transmission. Epidemiol Rev. 1995;(2):321-35. [Medline].
Malavige GN, Fernando S, Fernando DJ, et al. Dengue viral infections. Postgrad Med J. Oct 2004;80(948):588-601. [Medline].
Mandell GL, Douglas RG Jr, Bennett JE, eds; Monath TP. Principles and Practice of Infectious Disease. 3rd ed. Churchill Livingstone Inc; 1990:1248-1251.
Monath TP. Dengue and yellow fever--challenges for the development and use of vaccines. N Engl J Med. Nov 29 2007;357(22):2222-5. [Medline].
Monath TP. Yellow fever and dengue: The interactions of virus, vector, and host in the re-emergence of epidemic disease. Semin Virol. 1994;5:133-145.
Morens DM. Antibody-dependent enhancement of infection and the pathogenesis of viral disease. Clin Infect Dis. Sep 1994;19(3):500-12. [Medline].
Ray CG, Ryan KJ, ed. Sherris Medical Microbiology: An Introduction to Infectious Diseases. McGraw-Hill Professional Publishing; 1994:525-535.
Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ. Apr 2005;83(4):308-14. [Medline].
Tassniyom S, Vasanawathana S, Chirawatkul A, Rojanasuphot S. Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study. Pediatrics. Jul 1993;92(1):111-5. [Medline].
World Health Organization. Dengue Haemorrhagic Fever: Diagnosis, Treatment and Control. World Health Org; 1986:1-2.
Further Reading
Keywords
breakbone fever, ki denga pepo, mosquito-transmitted viral disease, febrile syndrome, bleeding diathesis, disseminated intravascular coagulation, DIC, dengue hemorrhagic fever, DHF, dengue shock syndrome, DSS, dengue viral infections, dengue fever


Differential Diagnoses & Workup: Dengue Fever