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Fig. 2 | BMC Infectious Diseases

Fig. 2

From: Co-distribution and co-infection of chikungunya and dengue viruses

Fig. 2

legend. Clinical symptoms typical of dengue (top) and chikungunya infections (bottom). The red line denotes the cumulative distributions (and 95 % CI at the 25th, 50th and 75th percentiles) for the incubation period of human infection (time between initial infection and symptoms onset) for both arboviruses as reported in a recent systematic review of Rudolph et al. [58]. Dengue virus infection (top): time course for the three phases of dengue infection (febrile, critical and recovery phase) are reproduced from WHO [92]. Boxes indicating typical signs/symptoms of dengue virus infection were reproduced from Whitehead et al. [91] unless otherwise indicated. Arrows indicate that signs/symptoms may occur earlier/later than illustrated (eg. headaches may occur earlier than 4.5 days post-infection). Notes: 1Onset of the critical phase usually coincides with defeverescence and is characterised by an increase in capillary permeability and significant plasma leakage lasting 1-2 days. Disease may resolve without entering the critical phase [93]. 2Mild haemorrhagic manifestations (mucosal bleeding/petechiae/bruising) may be observed from the febrile phase. Vaginal and intestinal bleeding may occur less commonly [92]. 3Platelet counts decline during the febrile phase (broken line), reaching lowest values at defeverescence. Thrombocytopenia, however, should not be used as an early indicator for development of severe disease (dengue haemorrhagic fever) as platelet counts in the early febrile phase do not vary markedly [93]. 4Hypovolemic shock typically lasts 1-2 days and can develop during late stages of the disease [91, 92]. 5During the recovery phase, reabsorption of extravascular compartment fluid occurs over 2-3 days [92]. Chikungunya virus infection (bottom): time course for the two phases of chikungunya infection (acute and chronic phase) and typical signs and symptoms are reproduced from Suhrbier et al. [90]. 6Viraemia typically lasts 5-7 days [90] and may precede the onset of symptoms. Viraemia in symptomatic patients typically peaks within the first three days [94] and has been reported to last for up to 11 days [95]. Viraemia has also been observed to persist in some patients for 2-3 days post- defervescence [95]

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