Diagnosis is generally late, which involves a strong economic and functional impact on the life of patients. Some individuals remain symptomatic for 6—8 years post-infection. Neonatal manifestations due to CHIK include central nervous system abnormalities, bleeding disorders and cardiac manifestations. The CHIMERE study reported severe manifestations of infection acquired in utero in neonates who had seizures, required mechanical ventilation or had encephalitis confirmed through magnetic resonance imaging during the acute phase of the disease.
ZIKV is characterised by being highly neurotropic, and so its main complications manifest primarily in the nervous system. The first country to report this association was French Polynesia with 42 cases.
Abnormalities in neonates are even more significant. This alert reported in Brazil an increase 20 times the expected rate in cases of microcephaly: Diagnosis of dengue, chikungunya and Zika is mainly clinical.
In regions where the risk of dengue is significant, it is important to intentionally look for warning symptoms, with a comprehensive medical history and physical examination in addition to a complete blood count and transaminases to determine the phase and severity of the disease. Specific tests include the enzyme-linked immunosorbent assay ELISA to detect the NS1 antigen, which is abundant in the first five dates of infections with any of the four serotypes of dengue.
It should be noted that this glycoprotein is produced by all flaviviruses. These antibodies may be detected after 4—5 days of onset of fever. It is not possible to detect serotypes of the virus with these tests. A sensitivity of IgGs may be detected in samples in the convalescence stage and persist throughout life. This test can only detect whether there is an infection with flaviviruses , and so the plaque reduction neutralisation test PRNT is more reliable, since the antibodies may give results of cross-reactivity in people previously infected with other flaviviruses.
This is reduced if the cross-reaction is caused by flaviviruses other than DENV for example, yellow fever or Japanese encephalitis. Mainly for the purposes of epidemiological monitoring, the serotype of the viruses in the acute phase of any of these diseases is determined using the reverse transcription polymerase chain reaction RT-PCR test. Serum or blood samples are used and it is specified that urine could be the ideal sample type.
However, the availability of this test is limited. Flow chart for the differential laboratory diagnosis of dengue, chikungunya and Zika. If the results are positive or inconclusive, a series of foetal ultrasounds and amniocenteses for PCR in amniotic fluid must be performed. If the results are negative, an ultrasound must be performed to look for microcephaly or intracranial calcifications.
In normal studies, routine prenatal care is continued. It is advisable to perform the test in pregnant women without symptoms. These diseases are generally self-limiting with no need for hospitalisation. Acetylsalicylic acid and other non-steroidal anti-inflammatory drugs NSAIDs are contraindicated in dengue and Zika, and should be used with caution to prevent bleeding events and Reye's syndrome in paediatric patients.
For Zika fever, the use of antihistamines is indicated to treat pruritus. Patients with dengue with warning signs, a state of shock or comorbidities should be referred for hospital management. Patients with severe dengue in the critical phase of the disease require emergency treatment and urgent transfer to a hospital.
Colloid solutions may be used in the event of shock with hypotension. It is advisable to assess the condition of the patient up to 48 h after the fever has disappeared. Blood transfusion is only indicated in cases with suspicious or massive bleeding.
Convalescence in this disease may be prolonged. It consists of anti-inflammatory drugs in conjunction with physiotherapy.
The measures recommended by the different international guidelines are aimed at preventing mosquitoes from biting and reproducing. Avoid their use in infants under 2 months of age. These should be used in strict compliance with the instructions on the label. Avoid standing water and mosquito-breeding areas. Place mosquito nets over windows, doors and beds. Domestic insecticides in aerosol form, mosquito coils and other insecticides in vapourisers within the home can also be used.
Treat clothing and equipment with permethrin. It is a recombinant, live-attenuated tetravalent virus vaccine. It is recommended for people 9—45 years of age who live in endemic areas. It has also managed to decrease the risk of hospitalisation and severe dengue in children between 9 and 16 years of age, but not younger children, who had a higher rate of hospitalisation due to dengue.
The authors declare that no experiments were performed on humans or animals for this study. The authors declare that no patient data appear in this article. The authors declare that they have no conflict of interests. ISSN: See more Follow us:. Previous article Next article. Issue 3. Pages July - September More article options. Clinical and differential diagnosis: Dengue, chikungunya and Zika.
Download PDF. Corresponding author. This item has received. Under a Creative Commons license. Article information. Table 1. Operational case definitions for dengue, chikungunya and Zika.. Table 2. Classification of dengue and levels of severity.. Table 3. Most common clinical manifestations of CHIK in children and adults..
Show more Show less. Therefore, it is important for clinicians to be familiar with the various clinical presentations and laboratory methods to make the differential diagnosis, start appropriate treatment, and prevent the associated complications. Palabras clave:. Full Text. Probable case Confirmed case Dengue Non-severe dengue: Any person of any age who resides in or comes from a region in which transmission of the disease is found and who has non-specific symptoms of fever plus two or more of the following criteria: nausea and vomiting, skin rash, discomfort and pain, positive tourniquet test, leukopenia or any warning signs.
Severe dengue: Any suspected case that has fever and any of the following criteria: severe extravasation of plasma dengue shock syndrome, accumulation of fluids with respiratory insufficiency or severe bleeding , severe organ compromise AST or ALT liver enzymes greater than or equal to , altered consciousness, or heart and other organs affected. Any probable case in which recent infection with dengue virus is confirmed through laboratory techniques, there is an epidemiological association with another confirmed case or no laboratory result is available.
Disease due to Zika virus Patient with pruritic maculopapular exanthema plus two of the following signs and symptoms: Headache, fever, conjunctivitis, myalgia, arthralgia or periarticular oedema. Case ruled out Any case in which evidence of the presence of any serological or virological marker for the virus by means of laboratory techniques endorsed by the Mexican Institute of Epidemiological Diagnosis and Reference InDRE is not demonstrated.
Dengue confirmed by laboratory. Severe bleeding. Tenosynovitis common. Back pain. Table 4. Figure 1. Infectio, 8 , pp. Dengue guidelines for diagnosis, treatment, prevention and control: new edition. Neurological syndrome, congenital malformations, and Zika virus infection. Implications for public health in the Americas—epidemiological alert. Bhatt, P. Gething, O.
Brady, et al. Nature, , pp. Statistically significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough for DF , nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than patients with DF or DHF. However, there was substantial overlap in most signs, symptoms and laboratory measurements. For continuous variables right 2 columns , the box shows the median values in white with the interquartile ranges, while the whiskers denote the central 95 th percentiles.
The red brackets to the left of the bars denote statistically significant comparisons between DF and chikungunya upper brackers , and DHF and chikungunya lower brackets. Five DF patients with no temperature measurement are excluded from the maximum temperature panel. The multivariate logistic regression analysis comparing DF versus chikungunya and DHF versus chikungunya at first presentation to hospital are shown in Tables 1a and 1b respectively. Bleeding, presence of fever and longer duration of illness at presentation were indicative of DHF, while a longer duration of fever and a higher platelet count increased the odds that the patient had chikungunya.
Over their entire hospital stay Table 2a , DF patients were more likely to have tachycardia, fever, and higher ALT, urea and albumin levels, while chikungunya patients were more likely to have higher maximum creatinine, minimum neutrophil proportion, minimum platelet count, maximum temperature, and maximum bilirubin levels. DHF cases were more likely to have bleeding, fever, and tachycardia, while chikungunya cases were more likely to have higher minimum serum protein Table 2b. The decision trees for determining DF versus chikungunya, and DHF versus chikungunya at first presentation to hospital are shown in Figure 2.
The trees could discriminate very well between chikungunya and dengue with a single laboratory variable: the platelet count. Without laboratory variables it is still possible to discriminate reasonably well for DHF using the rule, bleeding implies DHF. The tree we identified as best for distinguishing DF and chikungunya relied on the duration of illness and fever which was not very discriminating, indicating the difficulty in characterizing these two illnesses solely with signs or symptoms Figure 2A.
Models discriminate between dengue fever DF or dengue hemorrhagic fever DHF and chikungunya Chik for well-resourced laboratory data included and resource-limited laboratory data excluded settings. A and B discriminate between chikungunya and DF in a resource-limited and well-resourced setting respectively. C and D discriminate between chikungunya and DHF in a resource-limited and well-resourced setting respectively.
Chikungunya caused a slower drop in leukocyte count than dengue infections. Smaller differences were present for hematocrit and temperature. Chikungunya and dengue share overlapping geographic range and competent vectors [3] , [31] , with chikungunya occurring in epidemics in Africa, India, Sri Lanka and Southeast Asia [3] , and dengue in most tropical and subtropical regions of the world [32].
Both have caused autochthonous outbreaks in non-endemic areas, namely dengue in Hawaii and Texas-Mexico border [33] and metropolitan France [34] , and chikungunya in Italy [35] and metropolitan France [34]. Notably, serological surveys in Southeast Asia documented the presence of both dengue and chikungunya [36] ; and similar findings were present among German aid workers returning from Benin, Burkina Faso, Cameroon and Thailand [37].
Concurrent dengue and chikungunya may also occur, as proven by PCR in 10 of 38 patients in Madagascar [38] and in a traveller to Singapore [39]. While chikungunya has occurred in localized epidemics in in Africa, South and Southeast Asia since the 's, a molecular mutation AV resulting in more efficient viral replication and transmission in Aedes albopictus has enabled rapid expansion of its geographical range in the Indian Ocean since [40] — [42].
The overlapping geographic range and clinical manifestations of chikungunya and dengue, often in resource-limited countries, has made a diagnostic tool utilizing simple clinical criteria relevant and potentially useful. In our study, there was substantial overlap in the symptoms and signs for dengue and chikungunya infections although key significant differences existed. Many of these differences have substantial overlap and there is substantial variability between individuals with the same illness, rendering their utility in diagnostic differentiation limited Figure 1.
In addition, during the entire course of illness, thrombocytopenia and neutropenia were more likely to be present in dengue cases. To assist doctors in differentiating between these two infections for appropriate triaging for site of care and clinical management, diagnostic and prognostic algorithms that are highly sensitive with high negative predictive values are desirable.
Specifically, there is a need to identify patients with DHF as they require meticulous follow up and clinical management in hospital, while uncomplicated dengue and chikungunya can be managed on an outpatient basis. The decision trees shown in Figure 2 will provide doctors with the necessary tools to identify DF versus chikungunya and more importantly DHF versus chikungunya. These simple tools can also supplement other laboratory tools such as the rapid immunochromatographic NS-1 tests for dengue which are now available and can provide additional differentiation between these two diseases [43].
Using only clinical variables of fever, duration of fever and illness Figure 2A , likely to be only parameters available in resource-limited settings is not as discriminating as the single laboratory variable of platelet count Figure 2B for DF versus chikungunya Table 3. For both DF and DHF versus chikungunya, decision trees using clinical variables only performed less well compared with clinical and laboratory variables area under the receiver operating curve [AUC] for DF versus chikungunya, 0.
While it is useful to examine these variables at a static time point especially at hospital presentation, it may be helpful to understand the development of key clinical variables across time as the time of presentation to healthcare settings may vary in different settings.
From our time course analysis, it is evident that DF and DHF had significantly lower platelet count across the entire hospitalization while the mean platelet count in chikungunya was within the normal range. Notably, DF and DHF had significantly higher hematocrit and temperature in the first week of illness, as rising hematocrit represents plasma leakage, a hallmark of DHF [5] , [6]. Interestingly DF and DHF had significantly lower leukocyte count in the first week of illness, noted in similar work in Vietnam and Singapore [44] ; this recovered during the start of the second week.
There are some limitations to our study. The dengue virus predominant in was serotype 1, and our cohorts comprised adult patients. There is a need to validate our findings in different settings with different dengue serotypes and children for better generalization.
In addition, our dengue and chikungunya cohorts were from different time periods. Although the management protocol for dengue did not change substantially from to , our chikungunya cases occurred during the first ever large-scale outbreak in Singapore with heightened national alert for clinical case detection.
This would affect time from illness onset to presentation days since onset, Figure 1. The clinical and laboratory data for chikungunya were collected prospectively during the outbreak, while the data for dengue were retrospectively collected. However, all our dengue cases were managed by doctors experienced in dengue treatment in the Department of Infectious Diseases with a standardized care path, which mitigated somewhat potential data inaccuracy in a retrospective study.
The number of chikungunya and DHF cases in this study was relatively small, and although key variables could still be estimated accurately, future studies should be performed with larger datasets in different settings to validate these findings. In addition, while the WHO criteria was used to classify dengue cases, future studies should also consider the WHO criteria for severe dengue classification for comparison.
Dengue and chikungunya infections continue to co-exist in many tropical countries. Our study has shown that there is indeed substantial overlap in clinical presentation between these infections. At the same time, we have also shown that it is possible for clinicians to use simple clinical and laboratory variables to predict these infections for appropriate management. Abstract Background Dengue and chikungunya are co-circulating vector-borne diseases with substantial overlap in clinical presentations.
Findings At first presentation to hospital, significantly more chikungunya patients had myalgia or arthralgia, and fewer had a sore throat, cough for DF , nausea, vomiting, diarrhea, abdominal pain, anorexia or tachycardia than DF or DHF patients.
Interpretation There is substantial overlap in clinical presentation between dengue and chikungunya infections, but simple clinical and laboratory variables can predict these infections at presentation for appropriate management. Author Summary Dengue and chikungunya are mosquito-borne diseases that are found in similar geographical areas and present with similar symptoms.
Introduction Dengue and chikungunya are vector-borne diseases that have been circulating in the tropical regions of Africa and Asia for decades [1] , [2].
Methods We conducted a retrospective case-control study on patients confirmed with chikungunya infection on reverse transcription-polymerase chain reaction RT-PCR during the August outbreak, and hospitalized at Tan Tock Seng Hospital, Singapore, the national outbreak response center.
Statistical analyses We performed three analyses comparing dengue and chikungunya infections. Multivariate logistic regression The data exhibited separation [25] , [26] which prevented finite estimates of adjusted odds ratios and consequently had deleterious effects on Wald-derived confidence intervals [25]. Classification trees Predictive tools to distinguish between DF or DHF and chikungunya at presentation were constructed using classification and regression trees [27].
Time course analysis To quantify mean changes in temperature, serum hematocrit, platelet and leukocyte counts, while accounting for between patient variability, we used hierarchical modelling within the Bayesian framework. Results Differences in clinical expression between DF, DHF and chikungunya Differences between DF, DHF and chikungunya at presentation are shown in figure 1 results over the course of hospitalization are similar and not presented.
Dengue fever is a mosquito-borne disease. It is spread by numerous species of the Aedes mosquito. Dengue has become a global cause of concern ever since the commencement of the Second World War. Similarly, Chikungunya is an infection caused by the Chikungunya virus. This virus is transferred by two species of the same Aedes type mosquitoes. Chikungunya virus was first isolated by RW Ross in In India, Chikungunya was never a bigger cause of concern as compared to Dengue, especially in northern India.
However, since , there has been an increase in the cases of Chikungunya. First of all, mosquito bite is the main cause of Chikungunya and Dengue.
Both the diseases are caused by a female mosquito also commonly known by the name Aedes. These symptoms are often confused with viral fever and malaria. The key to avoiding both these dangerous diseases is prevention. And this is where Kala HIT will help you. Spray Kala HIT daily to keep the disease-carrying mosquitoes at bay. Despite being quite similar, both the diseases are very much different. Due to sharing quite similar signs, it becomes difficult in identifying the exact problem.
Some of the differences in both the viral infections are:. Spray Kala HIT daily to keep the disease-carrying mosquitos at bay. But in order to win this war on mosquito enemies, you need a killer.
The Kala HIT is one of the most amazing killer sprays in the market. As thousands and millions of mosquitoes are produced regularly it is impossible to stop this menace.
The only solution is to eliminate mosquitoes in every household with Kala HIT. It can reach all places where mosquitoes generally rest or hover around. Kill each one of them that causes diseases like Dengue and Chikungunya. Make sure to spray it every day and keep your family safe and healthy. Tips and tricks to make your home pest-free! Other common things between Dengue and Chikungunya are: Dengue and Chikungunya diseases are more common in the tropical and sub-tropical climates.
India is one such country where it rains and rains continuously for many months.
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