Differentiate Between Malaria, Dengue, and Chikungunya

Malaria, dengue, and chikungunya are three types of mosquito-borne diseases. All of these diseases are quite serious, and are accompanied by severe symptoms. Because the symptoms are so similar between each of the diseases, it can be quite difficult, if not impossible, to make a conclusive identification without laboratory testing. Although these diseases have almost identical manifestations, it is crucial to differentiate them for proper treatment.

Steps

Understanding Malaria

1. Know what causes malaria. Malaria is caused by plasmodium, a single-celled parasite often transmitted by infected mosquitoes.
   • The parasite is injected into a person’s circulatory system through the saliva of the mosquito. It then travels to the liver where it will mature and reproduce.
   • When the plasmodium matures, it will infect red blood cells until they burst. Then, newly developed plasmodium from the red blood cells will spread, and infect more red blood cells.
2. Know the signs and symptoms. In most cases, the manifestations of malaria will begin 8-25 days after the mosquito bite. However, those who have taken prophylaxis (medication to prevent infection) may have an extended incubation period.
   • When the infected red blood cells spread throughout the body, the cells will eventually die off.
   • This can lead to severe liver infection.
   • Sometimes the infected red blood cells become "stickier" than usual and clot easily, which can lead to stoppage of blood flow to the brain.
   • The severity of the signs and symptoms of malaria may depend upon three factors: the type of malaria, your immune system, and health of your spleen.
   • There are 5 types of malaria. These include P. Vivax, P. Malaria, P. Ovale, P. Falcifarum, and P. Knowlesi.
3. Pay attention for signs of spleen failure. The spleen is the graveyard of your red blood cells.
   • During a malaria infection, red blood cells rapidly die, and the spleen may not be able to keep up with the demand, leading to sepsis and organ failure.
   • Notice an enlarged spleen, which can happen when the spleen is overwhelmed by the amount of dead red blood cells and becomes unnaturally enlarged.
4. Take your temperature to identify a high fever. High fever is very common in malaria patients.
   • The temperature may reach as high as {{safesubst:#invoke:convert|convert}}.
   • Fever is a systemic immune response of the body, that works to suppress bacterial growth.
   • Fever is often accompanied by chills, which allow the muscles to burn calories and increase your body temperature. This may also include sweating.
5. Get a diagnosis. Because malaria has non-specific symptoms, it may be more difficult to diagnose when it occurs in an uncommon country, such as the US.
   • Your health and travel history will be assessed to determine if you have traveled to a malarial country.
   • Get a physical examination. Although the physical findings might not be specific, they will be used to make a preliminary diagnosis of malaria.
   • Get a blood film done. Your doctor will take a drop of blood and place it in a microscopic slide. The blood will be stained to make the blood cells visible under the microscope. Your doctor will analyze the film to see if there are visible plasmodium parasites. Two or more tests are required within a 36 hour period to confirm malaria.

Understanding Dengue

1. Know what causes dengue. There are four types of dengue viruses, all of which all of which are spread by mosquito. Humans are the primary host of the disease and it is a very common illness in tropical areas.
   • When a mosquito is infected by the virus, it will spread the virus through its saliva when it bites.
   • Dengue can also be transmitted from human to human. For example, infected blood used in a blood transfusion can cause dengue. Even organ donation and mother to child transmission are possible.
2. Recognize the signs and symptoms of dengue. The incubation period of dengue (period before which symptoms are visible) is about 3-14 days. Your symptoms may vary, depending upon the type of the virus and your level of immunity.
   • The virus will circulate around your body after infection, attacking white blood cells and other antibodies, which will compromise your immune system.
   • The virus will further replicate within the cell until the cell bursts and dies, releasing cytokines that initiate the inflammatory response of the body as it tries to ward off the virus.
   • The death of the white blood cells will trigger leakage of other fluids from the cells, leading to hypoproteinemia (low protein), hypoalbuminema (low albumin), pleural effusion (fluid in the lungs), ascites (fluid in the stomach area), hypotension (low blood pressure), shock, and eventually death.
3. Use a thermometer to identify fever. A high fever will take place as a result of the body’s effort to suppress the virus.
   • Like any other type of systemic infection, the body will increase its temperature to kill the virus.
4. Take note of an intense headache. Intense headache is reported by most dengue patients.
   • The exact reason for the headache is not known, but it is probably related to the high fever.
   • Increased body temperature can irritate the nerves of the head and cause a gnawing, radiating head pain.
5. Notice pain behind your eyes. Dengue-related eye pain is often exacerbated when there is bright light in the room.
   • The pain is characterized as dull and deep.
   • The eye pain is a side effect of the intense headache. Since nerve endings in the head share the same pathway, pain can be felt not just in the head, but also in the eyes.
6. Look out for any excessive bleeding. Widespread bleeding can occur, because the virus attacks your capillaries, the smallest blood vessels in the body.
   • When the capillaries burst, blood escapes to outside the blood stream.
   • Blood pressure decreases as blood leaves the body, eventually leading to internal bleeding, shock, and death.
   • During a severe case, bleeding is more common in the nose and gums, where small blood vessels are located.
   • Your pulse may also become weak due to the decreasing blood volume in your body.
7. Keep an eye out for rashes. As your fever decreases, skin rashes may start to appear.
   • The rash is reddish, and similar to a measles rash.
   • The rash is caused by the bursting of small capillaries.
8. Know how dengue is diagnosed. The diagnosis of dengue is done through performing a physical exam, taking the history of the illness, and doing laboratory tests.
   • Your doctor will try to identify your signs and symptoms. He will take into account whether or not you live in, or have recently visited, a common dengue area.
   • Your doctor will suspect dengue if there are warning signs such as abdominal pain, liver enlargement, mouth bleeding, low platelet and white blood cell counts, restlessness, and decreased pulse.
   • Your doctor may use an ELISA test to identify immunoglobins in your bloodstream that are unique to dengue infection.

Understanding Chikungunya

1. Understand what causes chikungunya. This virus is transmitted through mosquitoes and was recently declared as an emerging global health threat.
   • How the virus affects the body is not fully known, however, chikungunya and dengue have almost identical symptoms and disease processes.
   • Chikungunya infects the muscle cells of the body. From there, it reproduces until the cell dies, and then replicates and finds a new host cell to infect.
2. Recognize the signs and symptoms of chikungunya. The incubation period of the chikungunya is 1 to 12 days. Chikungunya usually attack the muscles, joints, skin, connective tissues, and even the central nervous system.
3. Notice rash and fever. Because chikungunya is a systemic infection, it is usually accompanied by fever and skin rash.
   • The skin rashes are almost identical to the rashes that are present in a case of dengue, and is a result of damage to the blood vessels.
   • Fever occurs as the body raises its temperature in an attempt to kill the infectious agent.
   • As a consequence of the fever, you may suffer from headache, nausea and vomiting.
4. Take note of any muscle or joint pain. Because the virus destroys cells in the muscles and joints, you will experience muscle weakness and joint pain.
   • Joint and muscle pain can be severe and acute.
5. Recognize a loss of taste. Partial loss of taste is reported by many chikungunya patients.
   • This happens because the virus attacks nerve endings on the tongue and desensitizes the taste buds.
6. Get a chikungunya diagnosis. Acquiring an accurate diagnosis is very important to get the right treatment.
   • A virus isolation is the most conclusive exam used to diagnose chikungunya. However, it takes 1 to 2 weeks before it is completed and should be done in a biosafety level 3 lab, which is not available in many developing countries where chikungunya is prevalent.
     • The technique involves acquiring a blood sample from the patient and then introducing the virus to it. The blood sample will then be observed for specific responses.
   • RT-PCR (Reverse Transcription Polymerase Chain Reaction) makes the genes of chikungunya more pronounced and shows evidence of the disease. The result can be obtained in 1-2 days.
   • An ELISA assay can be used to measure the levels of immunoglobin to identify the chikungunya virus. Results can be obtained within 2-3 days.

Differentiating Between Malaria, Dengue, and Chikungunya

1. Understand that the diseases are carried by different types of mosquitoes. Dengue and chikungunya are commonly transmitted by the Aedes aegypti.
   • However, malaria is transmitted by the anopheles mosquito.
2. Recognize that the infectious agents are different as well. Malaria is caused by anopheles, which is a protozoan.
   • Dengue and Chikungunya are both viral infections.
   • The former is caused by the dengue virus, while the latter is caused by Alphavirus.
3. Notice the differences in incubation periods. Dengue has a shorter incubation period, usually ranging from 3 to 4 days.
   • Chikungunya will take around 1 week before its signs are obvious.
   • Malaria will take at least 2 weeks to show symptoms.
4. Pay attention to differences in symptoms. The main differences between dengue and chikungunya lie in some of their signs and symptoms.
   • Most obviously, dengue is associated with low platelet count, high bleeding risk, and pain behind the eyes, whereas chikungunya does not exhibit these symptoms.
   • Both dengue and chikungunya display joint pain, however, chikungunya’s joint pain and inflammation are more intense and pronounced.
   • Malaria is best known for paroxysm, the cycle of chills/shivering, then fever/sweating. This cycle usually occurs every two days.
5. Get different diagnostic tests to differentiate the three diseases. Though signs and symptoms may serve as rough guidelines for diagnosis, laboratory and diagnostic exams are needed to confirm a specific disease.
   • Malaria is diagnosed via blood film.
   • Dengue and chikungunya are often diagnosed through ELISA.

Warnings

• If you are experiencing intense fever that comes and goes, as well as muscle and joint pain, do not ignore it. See your doctor if symptoms do not cease after 3 days.
• Dengue, malaria, and chikungunya can be fatal if medical intervention is not promptly delivered.

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