Diffe

tion Differentiating Signs/Symptoms

Tes
on Residence in/travel from a Zika-affected region in the previous 2 weeks, or unprotected sexual contact with infected individual. Rev
tran
No signs of bleeding or hemorrhage. poly
Mild cases may be difficult to distinguish from dengue fever without specific diagnostic testing. reac
for Z
It is imperative to differentiate dengue fever from Zika virus infection in pregnancy as the latter is known to be associated with microcephaly in
newborns. [59] Sero
posi
of cr
with
antib
The
Orga
(WH
prod
help
diffe
betw
chik
Zika
infec
us Polyarthritis and carpal tunnel syndrome are common. Sero
chik
Absence of bleeding tendency and circulatory failure. [67] [68] posi
May be difficult to distinguish from dengue fever without specific diagnostic testing.
The
prod
help
diffe
betw
chik
Zika
infec
ases History of tick, flea, or mite bite. CBC
plate
Discrete maculopapular and erythematous rash, which mainly involves the soles of the feet, palms of the hands, and limbs in Rocky Mountain usua
spotted fever, and the trunk in other Rickettsial infections. how
Characteristic eschar is seen. [69] thro
Arthritis/arthralgia of large joints may occur. can
seve
Sero
imm
antib
Rick
infec

History of working or bathing in muddy or stagnant water or handling animals. CBC

Conjunctival injection. [70] Urin
hem
Seru
elev
BUN
Sero
(mic
aggl
for le
posi
Poly
reac
assa
 lepto
posi

n Koplik spots (i.e., red spots often with a bluish-white central dot on erythematous buccal mucosa). Sero
(me
Upper respiratory tract symptoms (e.g., cough, coryza) more common. IgM
Conjunctivitis. enzy
imm
Maculopapular rash, predominantly on the face and ears. assa
mea

Maculopapular rash, which usually begins on the face and spreads from the head to the feet. Sero
(ant
Lymphadenopathy (often posterior cervical). IgG)
Arthralgia. Vira
Conjunctivitis. reve
tran
poly
reac
PCR
posi

Long-standing fever (i.e., 1-2 weeks, rarely up to 5 weeks). CBC

lymp
Cervical or generalized lymphadenopathy. atyp
Pharyngitis. lymp

Variable skin rash that worsens with use of beta-lactam antibiotics. Eps
(EBV
antib
posi

Neck pain and/or stiffness. Bloo

posi
Photophobia. for N
Altered consciousness. men

Seizures.
Hemorrhagic rash.

n Travel history to endemic area. Bloo

cultu
Fever sometimes occurs in a stepwise fashion. for S
Constipation. ente
typh
Rose spots (blanching erythematous maculopapular lesions) are rare; usually seen on abdomen. Sero
test)
Relative bradycardia (although this is neither sensitive or specific for typhoid). posi
Splenomegaly.

tion Exposure to rodent excreta. Sero

IgG
Dyspnea or severe respiratory distress. Nom
hant
posi
 Conjunctival injection. Sero
ELIS
Jaundice. hem
Relative bradycardia. inhib
posi
incre
titers

Lymphadenopathy. Sero
Nile
Conjunctival injection. IgM
Encephalitis. spec
dete
Nile
in C

Travel history to endemic area. Giem

thick
Characteristic paroxysms of chills and rigors followed by fever and sweats may be described. bloo
Absence of rash. posi
mala
Rap
tests
para
enzy

History of tick bite or handling animals. Sero

er spec
Travel history to endemic area. dete
Hemorrhagic signs. Crim
virus
Disseminated intravascular coagulation.
May be difficult to distinguish from dengue fever without specific diagnostic testing.

Exposure to mouse excreta. Sero

spec
Travel history to endemic area. dete
Hemorrhagic signs. virus

Encephalopathy.
May be difficult to distinguish from dengue fever without specific diagnostic testing.

ction Travel history to endemic area. Sero

spec
Hemorrhagic signs. dete
May be difficult to distinguish from dengue fever without specific diagnostic testing. virus

Travel history to endemic area. Sero

spec
Hemorrhagic signs. dete
May be difficult to distinguish from dengue fever without specific diagnostic testing. Marb
posi

Travel history to endemic area. Sero

ers spec
dete
Hemorrhagic signs. Gua
Mac
May be difficult to distinguish from dengue fever without specific diagnostic testing. Cha
virus

Travel history to endemic area. Sero

spec
Hemorrhagic signs. dete
May be difficult to distinguish from dengue fever without specific diagnostic te Valle
posi

1st Tests To Order

Test Result

CBC leukopenia; thrombocytopenia; elevated

hematocrit
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liver function tests (LFTs) elevated

serum albumin level <3.5 g/dL

serology positive IgM and IgG in a single serum sample

(highly suggestive of infection); IgM or IgG
seroconversion in paired sera or a fourfold
IgG titer increase in paired sera (confirms
infection); IgM:IgG ratio <1.2 (suggests
secondary infection); negative result does not
exclude infection unless paired sera are
tested

reverse transcription-polymerase chain reaction (RT-PCR) positive

nonstructural protein 1 (NS1) detection positive

Other Tests to Consider

Test Result

coagulation studies variable

chest x-ray blunting of the costophrenic angles in erect
position (severe disease)

abdominal ultrasound may show ascites, abnormalities of

liver/gallbladder (severe disease)

Emerging Tests

Test Result

reverse transcription-insulated isothermal polymerase chain reaction positive

(RT-iiPCR)

sting.

Differential Diagnosis