Dengue Differential Diagnoses

Updated: Dec 12, 2018
  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Michael Stuart Bronze, MD  more...
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Diagnostic Considerations

Studies indicate that as many as 50% of dengue cases may be misdiagnosed, as a result of inaccurate assessment of the signs and symptoms of disease presentation. This inaccuracy can lead to increased cost of treatment, such as unneeded hospitalizations, as well as possibly increased morbidity and mortality due to volume overload from overzealous use of intravenous fluids. [53]

A Belgian study examined predictors of diagnosis in 1962 febrile travelers and expatriates returning from the tropics. After malaria was ruled out, the main predictors of dengue infection included skin rash, thrombocytopenia, and leukopenia. [54]

Dengue must be carefully differentiated from preeclampsia during pregnancy. An overlap of symptoms and signs, including thrombocytopenia, impaired liver function, capillary leak, ascites, and decreased urine output may make this clinically challenging. Definitive diagnosis is confirmed via serology.

Rare cases of vertical dengue transmission have been reported. If the mother acquires infection in the peripartum period, newborns should be evaluated for dengue with platelet counts and serologic studies. [55, 56]

Other problems to be considered in the differential diagnosis of dengue include the following:

  • Chikungunya virus

  • Zika virus infection

  • Mayaro fever

  • Ross River fever

  • Sindbis virus

  • Ebola virus

  • Hemorrhagic fever viruses

  • River Virus

  • Orbivirus

  • West Nile encephalitis

  • Roseola infantum

  • Scarlet fever

  • Idiopathic thrombocytopenic purpura

Differential Diagnoses