Dengue Differential Diagnosis

Differential Diagnosis

The differential diagnosis for dengue includes a wide variety of viral (including chikungunya), bacterial, rickettsial, and parasitic infections that produce a similar syndrome and comprise the following: 

• Influenza: Rhinitis and/or nasal congestion are more prominent in influenza
• Measles
• Chikungunya: Symmetric arthritis of small joints differentiates chikungunya from dengue
• Infectious mononucleosis
• Human immunodeficiency virus (HIV)
• COVID-19
• Measles, rubella: First appearance of the rash (head to trunk) differentiates measles and rubella from dengue rash (trunk to face and extremities); measles patients present with cough, rhinitis, and conjunctivitis
• Typhoid fever: Splenomegaly and prolonged fever are more prominent
• Infectious hepatitis: Fever, malaise, vomiting, liver enlargement, and elevated liver enzymes are similar symptoms to dengue but the presence of plasma leakage during defervescence and thrombocytopenia is more commonly seen in dengue
• Meningococcemia, bacterial sepsis: Should be considered in patients with shock
• Leptospirosis: The presence of jaundice may help differentiate leptospirosis from dengue
• Malaria, scarlet fever, Epstein-Barr virus, rickettsial infections
• Severe abdominal pain of dengue may mimic acute appendicitis or acute cholecystitis
• Bleeding, thrombocytopenia, and shock may be confused with viral hemorrhagic fever diseases such as yellow fever, lassa fever, Rift Valley fever, Ebola fever, Marburg fever, hemorrhagic fever with renal syndrome, etc.