Differential Diagnosis of Chikungunya, Dengue Viral Infection and Other Acute Febrile Illnesses in Children
The Pediatric Infectious Disease Journal,

Laoprasopwattana K et al. – During a chikungunya (CHIK) outbreak in a dengue viral infection (DVI)–endemic area, overdiagnosis of CHIK was common. Skin rash during fever and white blood cell count > 5000 cells/mm3 or specific antigen testing (if available) can be helpful in differentiating CHIK from DVI.

Methods
  • A prospective cohort study was conducted between April and July 2009 in children aged 1 month to 15 years who lived in a CHIK outbreak area in southern Thailand and who had fever <7 days with arthralgia/arthritis, myalgia or rash.
  • CHIK was confirmed by real-time polymerase chain reaction or the indirect immunofluorescence test.

Results
  • Fifty patients were suspected of having CHIK, of whom 32 were confirmed, 1 had coinfection with dengue viral infection (DVI), 10 had dengue alone and 7 had an acute febrile illness.
  • The specificity and positive predictive value of fever and arthralgia together to diagnose CHIK were 47.1% and 74.2%, and the corresponding values of the standard clinical triad (fever, arthralgia, rash) were 70.6% and 83.3%, respectively.

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