Facilitator - WHO Western Pacific Region - World Health Organization

MODULE 5: Case classification & differential diagnosis
SESSION 5.2: DIFFERENTIAL DIAGNOSIS FOR DENGUE FEVER
SLIDE 6: Dengue mimics many clinical syndromes
•Facilitator
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explains:
•Dengue fever is non-specific and presents like many other diseases; therefore, before we go
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any further, we should consider the differential diagnosis for dengue fever.
•Clinical and laboratory pictures of dengue change as the disease progresses from the febrile
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phase to the critical phase and evolves into the recovery phase.
•Understanding the dynamic and systemic nature of dengue and its unique manifestations as
the disease progresses from one phase to another is crucial in order to differentiate dengue
from other diseases.
SLIDE 7: Conditions that mimic the febrile phase of dengue
•Facilitator
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explains:
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•Patients may present to clinicians at any phase of dengue illness.
•In the early febrile phase, it is not easy to differentiate dengue from other febrile illnesses as its
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clinical features mimic many other febrile illnesses.
•Collecting a thorough history is a very important, possibly the most important, step in making
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a differential diagnosis of acute, non-specific febrile illness.
•History of living in or travelling to hotspot dengue area, history of fogging or history of dengue
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cases in the family or neighbourhood
•History of trekking or contact with contaminated water source should alert one to the
possibility of leptospirosis, typhus (or other rickettsial disease) or meliodosis (especially if the
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patient has diabetes mellitus).
•History of travel to areas within Malaysia or other countries that are endemic for malaria or
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other tropical diseases
•History of exposure to bloodborne diseases (HIV, hepatitis B and C, syphilis)
•History of exposure to unhygienically prepared food or water should alert clinicians of typhoid
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and other waterborne diseases.
•History of recent contact with children who have had measles or rubella
•History of relapsing and remitting fever should alert one to a more chronic disease such as an
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autoimmune disease (e.g. systemic lupus erythematosus or SLE).
•Family history of any medical conditions, e.g. diabetes mellitus and autoimmune diseases, is
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also important.
•A comprehensive history of the patient’s co-morbidities (diabetes mellitus, hypertension,
ischemic heart disease, etc.) is essential not only to establish differential diagnosis but also to
manage a patient co-infected with dengue.
SLIDE 8: Conditions that mimic the critical phase of dengue
• •Facilitator explains the unique features of dengue during the critical phase.
• •As dengue disease progresses into the critical phase, it becomes easier and clearer to recognize;
attention should be paid on the development of “warning signs” (with or without shock) and
the typical laboratory changes that may occur.
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