Differential Diagnosis for Aches in Bones and Joints without Fever, Similar to Dengue

• Single Most Likely Diagnosis
  • Chikungunya: This viral infection is known for causing severe joint pain and swelling, similar to dengue fever, but it often presents without fever or with a low-grade fever. The joint pain can be debilitating and long-lasting, making it a primary consideration for patients presenting with these symptoms.
• Other Likely Diagnoses
  • Zika Virus: Although primarily known for its association with birth defects, Zika virus infection can also cause arthralgia (joint pain), among other symptoms like rash and conjunctivitis. The absence of fever does not rule out Zika, as it often presents with mild or no fever.
  • Osteoarthritis or Rheumatoid Arthritis: While these are not infectious diseases, they can cause significant joint pain and could be considered in the differential, especially if the patient has a history of these conditions. However, the acute onset and severity might lean more towards an infectious or inflammatory cause.
  • Viral Myositis: Certain viral infections can cause inflammation of the muscles (myositis), leading to muscle and joint pain without fever. This could be a consideration, especially if the pain is more muscular than articular.
• Do Not Miss Diagnoses
  • Lyme Disease: Caused by the bacterium Borrelia burgdorferi, Lyme disease can present with joint pain and swelling, among other symptoms. It's crucial to consider this diagnosis, especially in patients who have been exposed to ticks, as untreated Lyme disease can lead to serious complications.
  • Septic Arthritis: Although typically presents with fever, in some cases, especially in the elderly or immunocompromised, septic arthritis can present without fever. This condition is a medical emergency requiring prompt diagnosis and treatment to prevent joint destruction.
• Rare Diagnoses
  • Ross River Virus: This is another viral infection that can cause severe joint pain and swelling, similar to chikungunya. It's more common in certain regions like Australia and the Pacific Islands but should be considered in travelers to these areas.
  • Sindbis Virus: Known to cause Pogosta disease, it presents with fever, rash, and severe joint pain. While less common, it's another viral cause of arthralgia that could be considered, especially in specific geographic locations or exposure histories.
  • Mayaro Virus: Similar to chikungunya, this virus causes fever, rash, and severe joint pain. It's found in the tropical regions of South America and should be considered in travelers to these areas who present with similar symptoms.