Differential Diagnosis of Dengue Fever

Clinical Presentation and Diagnostic Approach

The Centers for Disease Control and Prevention recommends considering chikungunya, Zika virus, malaria, rubella, measles, hepatitis A, parvovirus, adenovirus, enterovirus, leptospirosis, rickettsiosis, and group A streptococcal infections in the differential diagnosis of dengue fever 1
The World Health Organization suggests that the classic dengue presentation includes fever with one or more of the following: nausea, vomiting, rash, headache, retro-orbital pain, myalgia, arthralgia, positive tourniquet test, or leukopenia 1
The American College of Physicians recommends testing for Zika virus NAAT if there is risk for both infections, and simultaneously testing for dengue fever 1
The Centers for Disease Control and Prevention recommends ordering dengue PCR/NAAT on serum as the preferred diagnostic method for patients presenting ≤7 days after symptom onset 2, 3
The World Health Organization suggests that NS1 antigen detection serves as an excellent alternative, detectable from day 1 to day 10 after symptom onset 3, 4

The Centers for Disease Control and Prevention recommends that pregnant women must be tested by NAAT for both dengue and Zika viruses, regardless of outbreak patterns, due to risk of maternal death, hemorrhage, preeclampsia, eclampsia, vertical transmission, fetal loss, microcephaly, and serious birth defects 1, 2, 3

The World Health Organization suggests considering the patient's travel history and local outbreak patterns, and that during a dengue outbreak, jurisdictions may elect to forego Zika virus testing in nonpregnant persons with suspected dengue 1
The Centers for Disease Control and Prevention recommends noting that the incubation period for dengue ranges from 3-14 days, with most cases developing symptoms 4-8 days after infection 3