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10/12/2015

DengueDifferentialDiagnoses

DengueDifferentialDiagnoses
Author:SuzanneMooreShepherd,MD,MS,DTM&H,FACEP,FAAEMChiefEditor:MichaelStuart
Bronze,MDmore...
Updated:Oct05,2015

DiagnosticConsiderations
Studiesindicatethatasmanyas50%ofdenguecasesmaybemisdiagnosed,asa
resultofinaccurateassessmentofthesignsandsymptomsofdiseasepresentation.
Thisinaccuracycanleadtoincreasedcostoftreatment,suchasunneeded
hospitalizations,aswellaspossiblyincreasedmorbidityandmortalityduetovolume
overloadfromoverzealoususeofintravenousfluids. [47]
ABelgianstudyexaminedpredictorsofdiagnosisin1962febriletravelersand
expatriatesreturningfromthetropics.Aftermalariawasruledout,themain
predictorsofdengueinfectionincludedskinrash,thrombocytopenia,and
leukopenia. [48]
Denguemustbecarefullydifferentiatedfrompreeclampsiaduringpregnancy.An
overlapofsymptomsandsigns,includingthrombocytopenia,impairedliverfunction,
capillaryleak,ascites,anddecreasedurineoutputmaymakethisclinically
challenging.Definitivediagnosisisconfirmedviaserology.
Rarecasesofverticaldenguetransmissionhavebeenreported.Ifthemother
acquiresinfectionintheperipartumperiod,newbornsshouldbeevaluatedfor
denguewithplateletcountsandserologicstudies. [49,50]
Otherproblemstobeconsideredinthedifferentialdiagnosisofdengueincludethe
following:
Chikungunyavirus
Mayarofever
RossRiverfever
Sindbisvirus
Ebolavirus
Hemorrhagicfeverviruses
RiverVirus
Chikungunya
Orbivirus
WestNileencephalitis
Roseolainfantum
Scarletfever
Idiopathicthrombocytopenicpurpura

DifferentialDiagnoses
Arenaviruses
Influenza
Leptospirosis
Malaria
Meningitis
RickettsialInfection
RockyMountainSpottedFever
Typhus
ViralHepatitis
YellowFever
Workup

ContributorInformationandDisclosures
Author
SuzanneMooreShepherd,MD,MS,DTM&H,FACEP,FAAEMProfessorofEmergencyMedicine,Education
Officer,DepartmentofEmergencyMedicine,HospitaloftheUniversityofPennsylvaniaDirectorofEducation
andResearch,PENNTravelMedicineMedicalDirector,FastTrack,DepartmentofEmergencyMedicine
SuzanneMooreShepherd,MD,MS,DTM&H,FACEP,FAAEMisamemberofthefollowingmedicalsocieties:
AlphaOmegaAlpha,AmericanAcademyofEmergencyMedicine,AmericanSocietyofTropicalMedicineand
Hygiene,InternationalSocietyofTravelMedicine,SocietyforAcademicEmergencyMedicine,Wilderness
MedicalSociety
Disclosure:Nothingtodisclose.
Coauthor(s)
PatrickBHinfey,MDEmergencyMedicineResidencyDirector,DepartmentofEmergencyMedicine,Newark
BethIsraelMedicalCenterClinicalAssistantProfessorofEmergencyMedicine,NewYorkCollegeof
OsteopathicMedicine
PatrickBHinfey,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency

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Medicine,WildernessMedicalSociety,AmericanCollegeofEmergencyPhysicians,SocietyforAcademic
EmergencyMedicine
Disclosure:Nothingtodisclose.
WilliamHShoff,MD,DTM&HDirector,PENNTravelMedicineAssociateProfessor,DepartmentofEmergency
Medicine,HospitaloftheUniversityofPennsylvania,UniversityofPennsylvaniaSchoolofMedicine
WilliamHShoff,MD,DTM&Hisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,
AmericanSocietyofTropicalMedicineandHygiene,InternationalSocietyofTravelMedicine,Societyfor
AcademicEmergencyMedicine,WildernessMedicalSociety
Disclosure:Nothingtodisclose.
ChiefEditor
MichaelStuartBronze,MDDavidRossBoydProfessorandChairman,DepartmentofMedicine,StewartG
WolfEndowedChairinInternalMedicine,DepartmentofMedicine,UniversityofOklahomaHealthScience
CenterMasteroftheAmericanCollegeofPhysiciansFellow,InfectiousDiseasesSocietyofAmerica
MichaelStuartBronze,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
MedicalAssociation,OklahomaStateMedicalAssociation,SouthernSocietyforClinicalInvestigation,
AssociationofProfessorsofMedicine,AmericanCollegeofPhysicians,InfectiousDiseasesSocietyofAmerica
Disclosure:Nothingtodisclose.
Acknowledgements
JosephDomachowske,MDProfessorofPediatrics,MicrobiologyandImmunology,DepartmentofPediatrics,
DivisionofInfectiousDiseases,StateUniversityofNewYorkUpstateMedicalUniversity
JosephDomachowske,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AcademyofPediatrics,AmericanSocietyforMicrobiology,InfectiousDiseasesSocietyofAmerica,Pediatric
InfectiousDiseasesSociety,andPhiBetaKappa
Disclosure:Nothingtodisclose.
HagopAIsnar,MD,FACEPDepartmentofEmergencyMedicine,CrouseHospital
HagopAIsnar,MD,FACEPisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergency
Physicians,AmericanMedicalAssociation,andSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
ThomasMKerkering,MDChiefofInfectiousDiseases,VirginiaTech,CarilionSchoolofMedicine,Roanoke,
Virginia
ThomasMKerkering,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
CollegeofPhysicians,AmericanPublicHealthAssociation,AmericanSocietyforMicrobiology,AmericanSociety
ofTropicalMedicineandHygiene,InfectiousDiseasesSocietyofAmerica,MedicalSocietyofVirginia,and
WildernessMedicalSociety
Disclosure:Nothingtodisclose.
DeborahSentochnik,MDConsultingStaff,DepartmentofInternalMedicine,DivisionofInfectiousDisease,
TheMaryImogeneBassettHospital
DeborahSentochnik,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,
InfectiousDiseasesSocietyofAmerica,andMedicalSocietyoftheStateofNewYork
Disclosure:Nothingtodisclose.
RussellWSteele,MDHead,DivisionofPediatricInfectiousDiseases,OchsnerChildren'sHealthCenter
ClinicalProfessor,DepartmentofPediatrics,TulaneUniversitySchoolofMedicine
RussellWSteele,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,
AmericanAssociationofImmunologists,AmericanPediatricSociety,AmericanSocietyforMicrobiology,
InfectiousDiseasesSocietyofAmerica,LouisianaStateMedicalSociety,PediatricInfectiousDiseasesSociety,
SocietyforPediatricResearch,andSouthernMedicalAssociation
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhD,AdjunctAssistantProfessor,UniversityofNebraskaMedicalCenter
CollegeofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeReferenceSalaryEmployment
MaryLWindle,PharmD,AdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeof
PharmacyEditorinChief,MedscapeDrugReference
Disclosure:Nothingtodisclose.

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