Rift valley fever differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief:  Aakash Hans, MD[3]

## Overview[edit | edit source]

The majority of differential diagnoses for Rift valley fever arise from other diseases which are prevalent in travelers and present with fever. All these disease would share a similar history of recent travel to an endemic area, followed by development of fever and body aches. A few of these diseases are listed below.

## Differential Diagnosis[edit | edit source]

* Malaria
* The disease presents with fever like Rift valley fever, but the major difference is the pattern of fever in malaria. The fever recurs every 3-4 days in malaria while no such patterns are seen in RVF.
* Malaria is common in African countries, so paying attention to the time and onset of fevers can be useful in distinguishing between the two diseases.[1] The vast majority of cases of malaria occur in children under the age of 5 years.[2]
* Typhoid fever
* Typhoid usually has a pattern of step-ladder form of fever, meaning the temperature rises with each passing day.[3]
* The patient also complaints of bowel abnormalities along with fever. Individuals report either constipation or diarrhea along with fever.
* A rash is seen on the chest, known as rose-spots in patients with Typhoid.
* Crimean-Congo hemorrhagic fever
* It is a tick-borne viral disease of both wild animals and domestic animals, affecting humans.[4]
* The virus belongs to the Bunyaviridae family, which is commonly found in Africa.
* Risk factors include handling body fluids of infected humans or animals.
* Ebola virus disease
* It is caused by a virus belonging to the Filoviridae family.[5]
* It should be suspected in febrile indivisuals who have done the following within a time span 3 weeks before fever :
* Traveled to an area of a country where the disease had recently occurred.
* Have had contact with body fluids like blood and other secretions of animals or humans infected with the disease.
* Dengue
* Patients with dengue also complain of fever but have greater joint pains than in Rift valley fever.[6]
* A characteristic feature of dengue fever is retro-orbital pain.
* Dengue has a longer incubation period of 7 days, followed by a week of febrile phase, 1-2 days of the critical phase and 3-5 days of the recovery phase.
* Yellow fever
* It is a rare disease caused by mosquitos found in South America and Africa.[7]
* There are vaccines for travelers traveling to these areas.
* The disease is usually a self limiting febrile illness but may lead to cardiac, renal and hepatic complications.
* Lassa fever
* The disease is usually seen in West Africa.[8]
* It is transmitted by rats and risk factors include handling food materials infected with rat feces or contact with infected humans.
* The incubation period ranges from 2-21 days and most of the people do not report any symptoms.
* Common symptoms are fever, throat pain, headache, swelling of the face, vomiting and diarrhea.
* Chikungunya
* It is caused by the Aedes aegypti mosquito and is commonly seen in African and Asian countries.[9]
* The course of the disease is self limiting and involves fever, headaches and generalized body pain.
* Q fever
* Q fever is caused by infection by a bacteria called Coxiella burnetii.[10]
* The bacteria is usually found in domestic animals such as sheep, goats, cats and ticks also.
* Risk factors include drinking raw milk, breathing in contaminated dust or droplets.
* Acute infection is characterised by fever, pneumonia and hepatitis. Chronic infections presents with cardiac, musculoskeletal or vascular symptoms.
* Zika virus
* Patients exposed to the virus develop illness 3-12 days after being exposed.[11]
* Symptoms include headache,rash,fever and back pain.
* Symptoms last for the next 4-7 days with most of patients having a full recovery.
* Marburg virus disease
* Marburg virus is the pathogen responsible for the disease.[12]
* Infection in humans is caused due to exposure to mines and caves where Rousettus bats can be found.
* Once the virus is transmitted from animals to humans, further spread is usually human-to-human and results from contact with bodyfluids.
* Hypotension, metabolic disorders, immunosuppression and coagulopathy are the initial symptoms.

## References[edit | edit source]

1. ↑ Malaria Facts. CDC.gov accessed on 07/24/2014 [1]
2. ↑ Greenwood BM, Bojang K, Whitty CJ, Targett GA (2005). "Malaria". Lancet. 365: 1487–1498. PMID 15850634.CS1 maint: Multiple names: authors list (link)
3. ↑ Kotton C. Typhoid fever. MedlinePlus. URL: http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm. Accessed on: May 4, 2007.
4. ↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
5. ↑ "WHO Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting" (PDF).
6. ↑ https://www.cdc.gov/dengue/index.html
7. ↑ Anker M, Schaaf D; et al. (2000-01-07). "WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases" (PDF). WHO. p. 11. Retrieved 2007-06-11.CS1 maint: Explicit use of et al. (link)
8. ↑ Ogbu O, Ajuluchukwu E, Uneke CJ (2007). "Lassa fever in West African sub-region: an overview". Journal of vector borne diseases. 44 (1): 1–11. PMID 17378212
9. ↑ Preparedness and response for Chikungunya virus introduction in the Americas. Washington, DC: Pan American Health Organization CDC, Center for Disease Control and Prevention. 2011. ISBN 978-92-75-11632-6
10. ↑ https://www.cdc.gov/qfever/
11. ↑ Zika Virus Transmission. Centers for Disease Control and Prevention (August 27, 2016). http://www.cdc.gov/zika/transmission/index.html Accessed on September 14, 2016
12. ↑ http://www.who.int/mediacentre/factsheets/fs_marburg/en/

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