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Differential Diagnosis of Dengue with Rash

Illness History Exam Test Occurs most commonly in children, 5 to Fever, facial erythema or “slapped • None: clinical diagnosis 15 years, during winter and spring. If cheek” rash in first 1–4 days, • Anti-Parvovirus B19 IgM antibody: history of exposure to person with cold- followed by a generalized lacy rash positive like symptoms, patient would have been that lasts 4–10 days and can be Erythema infected 4–14 days before onset of pruritic. Arthritis involving hands, Infectiosum symptoms. Family gives history of feet or knees can be present, (Fifth disease) fever, headache, runny nose, and rash. especially in adults. Patient might complain of arthralgia.

Occurs most commonly in infants and High fever, generalized rose-pink • None: clinical diagnosis children, 1 to 5 years. Family gives macular rash on trunk and proximal • Serum for anti-human herpes virus history of high fever for 3–5 days, then extremities, cervical or occipital types 6 or 7 antibodies: positive abrupt appearance of rash at lymphadenopathy, red papules and Roseola defervescence which lasts for 1–3 days. erosions of soft palate, and Infantum Might have history of seizure with fever periorbital or eyelid edema. Patient (Sixth disease) or mild upper respiratory symptoms, can develop encephalopathy or including runny nose and sore throat. aseptic meningitis.

Occurs most commonly in young Fever, lymphadenopathy, periorbital • Monospot test: positive detects EBV children and adolescents. Family gives edema, hepatosplenomegaly, and heterophile IgM antibody history of fever, sore throat, malaise morbilliform rash, initially on trunk • EBV viral capsid antigen: IgM positive and headache, then rash at day 4–6 of and upper extremities which later in primary infection until 4–6 weeks, illness. extends to entire body. Genital IgG appears in acute phase, peaks at Epstein-Barr ulceration can be noted. 2–4 weeks, and then persists for life. Virus (EBV) Infection • EBV nuclear antigen: antibody negative in primary infections • CBC: atypical lymphocytes ≥ 10% • Liver function test: elevated AST and ALT

Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases