Rift valley fever differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Aakash Hans, MD[3]

Overview

The majority of differential diagnoses for Rift valley fever arise from other diseases which are prevalent in travelers and present with fever. All these disease would share a similar history of recent travel to an endemic area, followed by development of fever and body aches. A few of these diseases are listed below.

Differential Diagnosis

  • Malaria
    • The disease presents with fever like Rift valley fever, but the major difference is the pattern of fever in malaria. The fever recurs every 3-4 days in malaria while no such patterns are seen in RVF.
    • Malaria is common in African countries, so paying attention to the time and onset of fevers can be useful in distinguishing between the two diseases.[1] The vast majority of cases of malaria occur in children under the age of 5 years.[2]
  • Typhoid fever
    • Typhoid usually has a pattern of step-ladder form of fever, meaning the temperature rises with each passing day.[3]
    • The patient also complaints of bowel abnormalities along with fever. Individuals report either constipation or diarrhea along with fever.
    • A rash is seen on the chest, known as rose-spots in patients with Typhoid.
  • Crimean-Congo hemorrhagic fever
    • It is a tick-borne viral disease of both wild animals and domestic animals, affecting humans.[4]
    • The virus belongs to the Bunyaviridae family, which is commonly found in Africa.
    • Risk factors include handling body fluids of infected humans or animals.
  • Ebola virus disease
    • It is caused by a virus belonging to the Filoviridae family.[5]
    • It should be suspected in febrile indivisuals who have done the following within a time span 3 weeks before fever :
      • Traveled to an area of a country where the disease had recently occurred.
      • Have had contact with body fluids like blood and other secretions of animals or humans infected with the disease.
  • Dengue
    • Patients with dengue also complain of fever but have greater joint pains than in Rift valley fever.[6]
    • A characteristic feature of dengue fever is retro-orbital pain.
    • Dengue has a longer incubation period of 7 days, followed by a week of febrile phase, 1-2 days of the critical phase and 3-5 days of the recovery phase.
  • Yellow fever
    • It is a rare disease caused by mosquitos found in South America and Africa.[7]
    • There are vaccines for travelers traveling to these areas.
    • The disease is usually a self limiting febrile illness but may lead to cardiac, renal and hepatic complications.
  • Lassa fever
    • The disease is usually seen in West Africa.[8]
    • It is transmitted by rats and risk factors include handling food materials infected with rat feces or contact with infected humans.
    • The incubation period ranges from 2-21 days and most of the people do not report any symptoms.
    • Common symptoms are fever, throat pain, headache, swelling of the face, vomiting and diarrhea.
  • Chikungunya
    • It is caused by the Aedes aegypti mosquito and is commonly seen in African and Asian countries.[9]
    • The course of the disease is self limiting and involves fever, headaches and generalized body pain.
  • Q fever
    • Q fever is caused by infection by a bacteria called Coxiella burnetii.[10]
    • The bacteria is usually found in domestic animals such as sheep, goats, cats and ticks also.
    • Risk factors include drinking raw milk, breathing in contaminated dust or droplets.
    • Acute infection is characterised by fever, pneumonia and hepatitis. Chronic infections presents with cardiac, musculoskeletal or vascular symptoms.
  • Zika virus
    • Patients exposed to the virus develop illness 3-12 days after being exposed.[11]
    • Symptoms include headache,rash,fever and back pain.
    • Symptoms last for the next 4-7 days with most of patients having a full recovery.
  • Marburg virus disease

References

  1. Malaria Facts. CDC.gov accessed on 07/24/2014 [1]
  2. Greenwood BM, Bojang K, Whitty CJ, Targett GA (2005). "Malaria". Lancet. 365: 1487–1498. PMID 15850634.
  3. Kotton C. Typhoid fever. MedlinePlus. URL: http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm. Accessed on: May 4, 2007.
  4. Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
  5. "WHO Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting" (PDF).
  6. https://www.cdc.gov/dengue/index.html
  7. Anker M, Schaaf D; et al. (2000-01-07). "WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases" (PDF). WHO. p. 11. Retrieved 2007-06-11.
  8. Ogbu O, Ajuluchukwu E, Uneke CJ (2007). "Lassa fever in West African sub-region: an overview". Journal of vector borne diseases. 44 (1): 1–11. PMID 17378212
  9. Preparedness and response for Chikungunya virus introduction in the Americas. Washington, DC: Pan American Health Organization CDC, Center for Disease Control and Prevention. 2011. ISBN 978-92-75-11632-6
  10. https://www.cdc.gov/qfever/
  11. Zika Virus Transmission. Centers for Disease Control and Prevention (August 27, 2016). http://www.cdc.gov/zika/transmission/index.html Accessed on September 14, 2016
  12. http://www.who.int/mediacentre/factsheets/fs_marburg/en/

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