TY - JOUR
T1 - Symptom overlap in chikungunya and dengue
T2 - A diagnostic challenge during outbreaks
AU - Brancini, Marini Lino
AU - Sene, Felipe Costa Trida
AU - Pereira dos Santos, Tamires Fernanda
AU - Candial, Thayrane de Souza
AU - Vero, Alice Tobal
AU - Abbas, Tamires Nasie
AU - Olgêncio, Elen Márcia de Oliveira
AU - Milhim, Bruno Henrique Gonçalves de Aguiar
AU - Pelegrini, Letícia Olmos
AU - Mendes, Lina de Moura
AU - Queiroz, Flavia
AU - Salomão, Maria Lucia Machado
AU - Henrique, Tiago
AU - Vasilakis, Nikos
AU - Nogueira, Maurício Lacerda
AU - Estofolete, Cássia Fernanda
N1 - Publisher Copyright:
© 2026 Elsevier B.V.
PY - 2026/6
Y1 - 2026/6
N2 - Distinguishing dengue from chikungunya at presentation is difficult in co-circulation settings due to substantial symptom overlap. In November 2023, São José do Rio Preto, São Paulo, Brazil, a dengue-endemic city, faced its first recognized chikungunya outbreak, challenging frontline triage and surveillance. We conducted a hospital-based retrospective cross-sectional study (November 2023–August 2024), integrating clinical variables with RT-qPCR confirmation to compare syndromic profiles and severity markers between dengue and chikungunya. Neurological cases were captured through active surveillance and are reported as an additional descriptive analysis (CDC neuroinvasive disease criteria), because they did not meet the serum RT-qPCR inclusion criterion for the comparative analysis. Among 1819 patients analyzed, 223 were dengue-positive and 144 chikungunya-positive. Fourteen manifestations overlapped. Compared with chikungunya, dengue more frequently presented fever, headache, vomiting, ocular pain, thrombocytopenia, and leukopenia, whereas chikungunya more often presented rash and joint pain. Warning signs were more frequent in dengue. Despite some discriminating features, clinical overlap predominated and limited diagnostic accuracy; virological confirmation by specific tests remains essential where arboviruses co-circulate.
AB - Distinguishing dengue from chikungunya at presentation is difficult in co-circulation settings due to substantial symptom overlap. In November 2023, São José do Rio Preto, São Paulo, Brazil, a dengue-endemic city, faced its first recognized chikungunya outbreak, challenging frontline triage and surveillance. We conducted a hospital-based retrospective cross-sectional study (November 2023–August 2024), integrating clinical variables with RT-qPCR confirmation to compare syndromic profiles and severity markers between dengue and chikungunya. Neurological cases were captured through active surveillance and are reported as an additional descriptive analysis (CDC neuroinvasive disease criteria), because they did not meet the serum RT-qPCR inclusion criterion for the comparative analysis. Among 1819 patients analyzed, 223 were dengue-positive and 144 chikungunya-positive. Fourteen manifestations overlapped. Compared with chikungunya, dengue more frequently presented fever, headache, vomiting, ocular pain, thrombocytopenia, and leukopenia, whereas chikungunya more often presented rash and joint pain. Warning signs were more frequent in dengue. Despite some discriminating features, clinical overlap predominated and limited diagnostic accuracy; virological confirmation by specific tests remains essential where arboviruses co-circulate.
KW - Chikungunya fever
KW - Dengue virus
KW - Neurological manifestations
KW - Severe dengue
UR - https://www.scopus.com/pages/publications/105033498854
UR - https://www.scopus.com/pages/publications/105033498854#tab=citedBy
U2 - 10.1016/j.actatropica.2026.108053
DO - 10.1016/j.actatropica.2026.108053
M3 - Article
C2 - 41825613
AN - SCOPUS:105033498854
SN - 0001-706X
VL - 278
JO - Acta Tropica
JF - Acta Tropica
M1 - 108053
ER -