Zika virus infection differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Luke Rusowicz-Orazem, B.S.; Serge Korjian M.D.; Yamuna Kondapally, M.B.B.S[2]

Overview

The broad-ranging clinical symptoms associated with Zika virus infection commonly cause it to be misdiagnosed with multiple similar diseases that are also from the Flaviviridae virus family. Zika virus infection has similar clinical presentation to dengue fever, yellow fever, West Nile virus, and Japanese encephalitis. Zika virus infection is distinct in its milder clinical manifestations and shorter length of infection. The association between Zika virus infection and complications that include congenital anomalies and neurological syndromes is also distinctive. Of note, patients bitten by mosquitoes may be concomitantly infected with Zika virus and other mosquito-borne infections, and co-infection should always be considered.

Differentiating Zika Virus Infection from Other Diseases

Differentiating Zika Fever from Dengue Fever

The following table summarizes the distinguishing and common features between Zika fever and Dengue fever, both of which are transmitted by the Aedes mosquito:

Dengue Fever Zika Fever
Common Clinical Features Biphasic fever pattern, maculopapular rash, arthralgia, headache, and signs of hemorrhage Fever, maculopapular rash, conjunctivitis, and headache
Hemorrhage Common? Yes No
Symptom Severity May be severe Usually mild
Symptom Duration 2 to 7 days 4 to 7 days
Incubation Period 4 to 10 days 3 to 12 days
Endemicity Americas, Africa, Southeast Asia Americas, Africa, Southeast Asia
Vector Aedes mosquito Aedes mosquito
Laboratory Findings Leucopenia, rising hematocrit (suggestive of impending hemorrhage), thrombocytopenia, elevated liver function tests Leucopenia but normal hematocrit, platelet count, and liver function tests
Diagnosis RT-PCR or ELISA RT-PCR or ELISA
Treatment Supportive care, avoid aspirin and other NSAIDs Supportive care

References

  1. Zika virus. Center for Disease Control and Prevention for Medical Professionals. http://www.cdc.gov/zika/hc-providers/clinicalevaluation.html Accessed on December 10, 2015
  2. Outbreak of Exanthematous Illness Associated with Zika, Chikungunya, and Dengue Viruses, Salvador, Brazil. Emerging Infectious Diseases; Center for Disease Control. http://wwwnc.cdc.gov/eid/pdfs/vol21no12_pdf-version.pdf Accessed on December 16, 2015
  3. "Epidemiological Alert: Neurological Syndromes, Congenital Malformations, and Zika Virus Infection. Implications for Public Health in the Americas". Pan American Health Organization. Pan American Health Organization. December 1, 2015. Retrieved December 11, 2015.