Diagnostic Considerations

Because of overlapping clinical and laboratory features, it may be difficult to distinguish between dengue and COVID-19 disease in endemic areas.^[20]Diagnosis with one does not rule out a concomitant infection with the other, as co-infections have been reported.^{[21, 22, 23]}

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

Typhoid fever
Shigellosis
Meningococcemia
Rickettsial infections
Acute leukemia
Idiopathic or thrombotic thrombocytopenic purpura

Differential Diagnoses

Workup

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Media Gallery

Ebola virus. Electron micrograph courtesy of the Centers for Disease Control and Prevention.
Marburg virus. Negative stain image courtesy of the Centers for Disease Control and Prevention.
Mastomys rodent, natural host of Lassa virus. Image courtesy of the Centers for Disease Control and Prevention.
Bunyavirus infection. Ecchymoses encompassing left upper extremity one week after onset of CCHF. Ecchymoses often are accompanied by hemorrhage in other locations: epistaxis, puncture sites, hematemesis, melena, and hematuria. Image provided by Robert Swaneopoel, PhD, DTVM, MRCVS, National Institute of Virology, Sandringham, South Africa.
Apodemus agrarius, the vector of Korean hemorrhagic fever caused by a hantavirus. Photo courtesy of David McClain, MD.
Bunyavirus infection - Hantaan virus. Patient with Korean hemorrhagic fever caused by Hantaan virus demonstrating typical 'sunburn flush' of cheeks, chin, and base of neck. Photo courtesy of John Huggins, PhD.
Bunyavirus infection. A patient with Korean hemorrhagic fever demonstrating conjunctival hemorrhages, facial petechiae, and "sunburn flush" of the cheeks. Photo courtesy of John Huggins, PhD.
Filovirus disease - Ebola fever. Patient with Ebola hemorrhagic fever during 1976 outbreak in Zaire demonstrating palatal petechiae and hemorrhage. Photo courtesy of Joel Breman.
Patient with morbilliform exanthem of dengue fever. Note islands of sparing, which is characteristic for dengue. Photo courtesy Duane Gubler, PhD.
Patient with dengue hemorrhagic fever complicated by ecchymoses. Photo courtesy of Duane Gubler, PhD.
Dengue Virus Notice posted outside Maracanã Stadium, Rio de Janeiro, Brazil, 2012. Translation: This site is a strategic point for controlling Dengue.
Mastomys natalensis, natural host of Lassa virus. Photo courtesy of BioMed Central, originally published in Kelly JD, Barrie MB, Ross RA, Temple BA, Moses LM, Bausch DG. Housing equityfor health equity: a rights-based approach to the control of Lassa fever inpost-war Sierra Leone. BMC Int Health Hum Rights. 2013 Jan 2;13:2.

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Table. Viral Families Causing Viral Hemorrhagic Fever

Table. Viral Families Causing Viral Hemorrhagic Fever

Virus Family	Disease (Virus)	Natural Distribution	Usual Source of Human Infection	Incubation (Days)
Arenaviridae
Arenavirus	Lassa fever	Africa	Rodent	5-16
	Argentine HF (Junin)	South America	Rodent	7-14
	Bolivian HF (Machupo)	South America	Rodent	9-15
	Brazilian HF (Sabia)	South America	Rodent	7-14
	Venezuelan HF (Guanarito)	South America	Rodent	7-14
Bunyaviridae
Phlebovirus	Rift Valley fever	Africa	Mosquito	2-5
Nairovirus	Crimean-Congo HF	Europe, Asia, Africa	Tick	3-12
Hantavirus	Hemorrhagic fever with renal syndrome, Hantavirus pulmonary syndrome	Asia, Europe, worldwide	Rodent	9-35
Filoviridae
Filovirus	Marburg and Ebola	Africa	Fruit bat	2-216
Flaviviridae
Flavivirus	Yellow fever	Tropical Africa, South America	Mosquito	3-6
	Dengue HF	Asia, Americas, Africa	Mosquito	Unknown for dengue HF, 5-7 for dengue

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Author

David C Pigott, MD, RDMS, FACEP Professor of Emergency Medicine, Co-Director of Emergency Ultrasound, Vice Chair for Academic Development, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine

David C Pigott, MD, RDMS, FACEP is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MS, MPH, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences; Senior Research Scientist, Data Science IV, Battelle Memorial Institute, Battelle Connecticut Operations

Zygmunt F Dembek, PhD, MS, MPH, LHD is a member of the following medical societies: American Chemical Society, American Legion, American Public Health Association, Association of Military Surgeons of the US, Council of State and Territorial Epidemiologists, Delta Omega Public Health Honorary Society, New York Academy of Sciences, Polish Legion of American Veterans, Reserve Organization of America, Society of American Federal Medical Laboratory Scientists, Veterans of Foreign Wars

Disclosure: Nothing to disclose.

Additional Contributors

Jerry L Mothershead, MD Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, Thomas W McGovern, MD, to the development and writing of this article.

Sections CBRNE - Viral Hemorrhagic Fevers
Overview
Presentation
DDx
Workup
Treatment
Medication
Media Gallery
Tables
References

CBRNE - Viral Hemorrhagic Fevers Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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