Serological differential diagnosis in suspected cases of

dengue, chikungunya or Zika virus infections (DENV, CHIKV, ZIKV)

Direct
detection

Indications: (1) Symptoms of DENV, CHIKV or ZIKV infection

Fever, rash, joint pain or neurological symptoms 1
(2) Traveling history to endemic areas during pregnancy

Day 0

Serology

Fever onset
IgM
Viremia

IgG

Viral RNA

Parallel determination of antibodies against DENV, CHIKV and ZIKV using ELISA

Dengue Virus
NS1 ELISA

Anti-Dengue Virus
ELISA (IgG / IgM)

no evidence of
infection

Acute
dengue fever

Anti-Chikungunya Virus
ELISA (IgG / IgM)

DENV infection likely 3,4

Anti-Zika Virus
ELISA (IgG / IgM)

no evidence of
infection 2

CHIKV infection

ZIKV infection4

e. g. Guillain-Barr syndrome (GBS) 2 For further diagnosis, a follow-up sample can be taken after 1 2 weeks. If this is negative, an acute infection is very unlikely
to other flaviviruses cannot be excluded.

Possible serological constellations and their meaning in infections with flaviviruses (e. g. DENV, ZIKV, TBE virus, yellow fever virus, West Nile virus and others):

Cross-reactivity

IgM

IgG

IgG titer increase after 7 10 days

/ +*

Acute infection without prior contact with another flavivirus (primary infection)

Indication of

/ + **

Acute infection after past contact with another flavivirus (secondary infection)

Past infection or virus contact in the past, respectively

IgG antibodies usually occur together with IgM antibodies or shortly thereafter. In the case of contact with other flaviviruses in the past, the IgM response can occur delayed or
with reduced intensity, or not occur at all.
**

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EI_2668_I_UK_A01, 03/2016