Fever? Here’s how to find out if it’s flu or a more ominous infection

  • Sanchita Sharma, Hindustan Times, New Delhi
  • Updated: Jul 23, 2016 14:08 IST
Each monsoon brings with it a barrage of infections that threaten to lead up to mind-numbing hospital visits with heart-stopping bills and stony-faced clinicians sucking your blood out for endless tests. (Shutterstock)

Is your fever the ubiquitous seasonal flu or is it a symptom of the more ominous dengue, malaria, chikungunya or Japanese encephalitis? Each monsoon brings with it a barrage of infections that threaten to lead up to mind-numbing hospital visits with heart-stopping bills and stony-faced clinicians sucking your blood out for endless tests.

There’s no getting away from infection. It could be dengue, malaria, chikungunya, Japanese encephalitis if you’ve been travelling through the paddy belts of Assam and Bengal, or even Zika, if you’ve just been back from South America, or H1N1 or seasonal influenza if you’ve been taking public transport.

Read: Now you know when to get vaccinated for greater flu protection

Worse, it could be a combination of a couple of the above. Dengue and chikungunya are under-reported in India, reported a study in PLOS Neglected Tropical Diseases. Testing blood samples from 1,010 people across 50 locations in Chennai, home to over 6 million people, showed that nearly all of them had been exposed to dengue and 44% to chikungunya.  Yet almost none reported having been infected, either because they had very mild disease or weren’t diagnosed.

Missed diagnosis

The symptoms of most mosquito-borne diseases are similar, making diagnosis hard without tests that can leave you poorer by upwards of Rs 20,000 just to find out what is making you ill.

There are, however, minor differences in symptoms that can help your physician distinguish between the infections, so it’s important for you to red flag them to dodge misdiagnoses. Here’s how to spot ‘localising symptoms’ that indicate the underlying cause of the fever. A cough and runny nose with fever is most likely to be seasonal flu, while blotchy skin points to dengue and joint pain to chikungunya.

Dengue In nine in 10 cases, dengue causes fever, headache and muscle pain that subsides on its own within a week. All you need is paracetamol for fever and water to prevent dehydration. Differentiating symptoms are loss of appetite, nausea, severe pain behind the eyes that gets worse with the eye movement (retro-orbital pain), skin rash or blotchy skin (appears two to five days after fever begins), and rapidly falling platelets (white blood cells).

Bruising, bleeding from nose, gums or mouth, vomiting with traces of blood, dark stools or breathing difficulty are medical emergencies that need immediate hospitalisation. Never use aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) to lower the fever as these have blood-thinning properties and aggravate risk of bleeding (haemorrhagic syndrome).


Chikungunya outbreaks are limited to a handful of southern states, but infection spreads to most parts of India through infected travellers. Close to 30,000 confirmed cases were reported from 23 states and UTs in 2015, with Karnataka reporting close to a third of the cases. This year, the last count in April confirmed 6,235 cases.

Read: WHO’s goal to eliminate malaria by 2030 difficult but achievable

Signs include fever with severe pain and/or swelling in the joints (hands, feet, ankles and wrists), headache, muscular weakness and inability to walk. Though the joint pain may last for several weeks to months, the disease rarely needs hospitalisation.

Seasonal Influenza, swine flu

Unless a new flu virus is causing infection, infected people otherwise healthy usually have mild fever accompanied with cough, nasal congestion and body ache that lasts for five days to a week. Influenza usually causes death by aggravating existing diseases such as congestive heart failure, uncontrolled diabetes and lung diseases (pneumonia, chronic obstructive pulmonary disease).

This year in south Asia, milder forms of two influenza A viruses – “swine flu” 2009 (H1N1) pdm09-like virus and “Hong Kong flu” 2014 (H3N2)-like virus – are causing infection along with influenza B Brisbane/60/2008-like virus (B/Victoria lineage), says the World Health Organisation’s July 11 flu update.  Quadrivalent flu vaccines are recommended to protect against the flu in 2016.


Malaria is an acute parasitic infection caused by Plasmodium falciparum or Plasmodium vivax in India, which causes high fever with chills, nausea and headache. Most people recover within a week. Infection from the chloroquine-resistant P. falciparum parasite, which was causing disease only in the north-eastern states a decade ago, has higher rates of complications and causes 90% of malarial deaths. This deadly strain has now replaced the milder P. vivax malaria across India and now accounts for 66% of all malaria cases.

Zika, Japanese encephalitis

No Zika cases have been reported in India, which reported 180 Japanese encephalitis cases till June 30, almost exclusively from rural Assam, West Bengal, Tripura and Bihar. Worry about these only if you develop fever and headache after travelling in these parts.

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