Table 3.
Differentiating features of Zika, Dengue, and Chikungunya
| Features | Dengue | Zika | Chikungunya |
|---|---|---|---|
| Incubation period | 3-14 days | 3-12 days | 1-12 days |
| Etiology | RNA virus belongs to the genus Flavivirus of family Flaviviridae. (4 different serological types exists - DENV 1, 2, 3 and 4) Mostly, Infection with one serotype Leads to lifelong immunity against the same type. However, occasionally, exposure of the individual to a second type of dengue virus Leads to a very severe form of illness (dengue shock syndrome and dengue hemorrhagic fever) | RNA virus belongs to the genus Flavivirusof family Flaviviridae. Lifelong immunity after infection with one type has not been reported in Zika virus infections | RNA virus of genus Alphavirusof the family Togaviridae |
| Fever (duration) | Higher (≥40°) +++ Lasts for 4-7 days |
Lower (≤38.5) ++ Lasts for 1-2 days |
High fever++Lasts for 2-3 days |
| Rash (maculopapular exanthema) | Moderately elevated + |
Elevated +++ |
Moderately elevated ++ |
| Headaches | Frequent and high intensity +++ | Frequent and moderate intensity + | Frequent and moderate intensity + |
| Arthralgia | Mild | Mild/moderate | Frequent and in multiple joints +++ |
| Nausea and vomiting | Seen | Unusual | Unusual |
| Blood dyscrasias (shock and thrombocytopenia) | +++ | +/_ | +/_ |
| Non-purulent conjunctivitis | + | +++ | ++ |
| Peripheral edema | _ | + | _ |
| lymphadenopathy | ++ | + | ++ |
| Neurological complications | Encephalitis | Guillain-Barré syndrome and encephalitis | Guillain-Barré syndrome and encephalitis (especially in neonates) |
| Course of disease | Mostly, dengue infection is benign and limited to fever during the acute phase followed by a Gradual return to normal. Occasionally, after exposure to secondary serological type of dengue, there are three distinct phases of disease: an acute febrile phase, a critical (plasma leak) phase where hematologic abnormalities, shock and death can occur, and a recovery phase | Usually self-limiting (2-7 days) | The illness is usually self-limiting and resolves with time. However, preexisting signs of chronic joint disease and other causes of chronic rheumatism predispose patients to chronicity of chikungunya infection |
| Hospitalization | Secondary dengue infection often requires hospitalization and 2.5% of infected individuals will develop a lethal illness | Most cases are managed on an outpatient basis | Patients with severe chikungunya fever requiring hospitalization tend to be older and have comorbidities such as cardiovascular, neurologic, and respiratory disorders or diabetes |
| Role of NSAIDS | NSAIDS can increase risk of bleeding | Acceptable to use in Zika virus infection as long as dengue has been excluded | Taking nonsteroidal anti-inflammatory drugs may reducethe symptoms of fever and pain |
| Neutropenia | ++ | Not demonstrable | + |
| Lymphopenia | ++ | Not demonstrable | +++ |
NSAIDS=Nonsteroidal anti-inflammatory drugs. +: Mild, ++: Moderate, +++: Severe, +/-: May or may not be present