Arthropod-borne viruses (arboviruses) such as dengue, chikungunya and Zika viruses are transmitted by Aedes (Stegomyia) species mosquitoes. These mosquitoes can also transmit yellow fever virus in urban settings. Aedes-borne arboviruses currently pose a public health threat in areas where approximately 3.9 billion people live. Although Aedes aegypti and Aedes albopictus mosquitoes are more abundant in tropical and subtropical than in temperate climates, their geographic scope is expanding and so too the risk of introduction and spread of the viruses they transmit. The simultaneous circulation, frequency, and magnitude of outbreaks of these arboviruses are increasing globally, fuelled by the convergence of ecologic, economic and social factors, with consequent expansion of areas in which cases occur. This increasing incidence in endemic areas and occurrence of imported and autochthonous (sometimes referred to as indigenous) disease cases in new areas require clinician awareness to recognize disease and manage cases according to evidence-based guidance, a task complicated by the challenges in differentiating clinically between these infections, particularly in the early phases of illness.

In preparation for the 2022 Pan American Health Organization Guidelines for the Clinical Diagnosis and Treatment of Dengue, Chikungunya, and Zika, a systematic review was conducted using various electronic databases and manual searches (1). Among other research questions, the review aimed to determine which clinical findings and basic complementary studies can differentiate diseases caused by arboviruses from each other and from other febrile diseases. The synthesis and evidence profiles were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, with recommendations agreed upon by a panel of arbovirus experts. The methodology for these guidelines followed the WHO guideline development methods. Updated searches were not formally undertaken, as no recent large-scale studies were known to the panel; findings are incorporated here to aid end-users in refining their clinical judgements, but no formal recommendations have been made. For more detailed methodology information, please refer to the document (2).

The Tables 1.1 and 1.2 detail the clinical and laboratory findings that are potentially useful for guiding the diagnosis of suspected arbovirus infection based on the systematic review for the Pan American Health Organization guidelines. In a subsequent publication of the multicentre, prospective, observational study of early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America, platelet count, white blood cell count and a change in these counts from the previous day of illness, as well as bleeding, anorexia, and skin flushing were identified as significant predictors of dengue, while cough and rhinitis were negative predictors of dengue (3).

登革热、基孔肯雅热和寨卡病毒等虫媒病毒（arboviruses）由伊蚊属（Stegomyia亚属）蚊子传播。这些蚊子在城市环境中也可传播黄热病病毒。目前，伊蚊传播的虫媒病毒对约39亿人口居住的地区构成公共卫生威胁。尽管埃及伊蚊（Aedes aegypti）和白纹伊蚊（Aedes albopictus）在热带和亚热带地区比在温带气候地区更为常见，但它们的地理分布范围正在扩大，其传播病毒的传入和扩散风险也随之增加。在生态、经济和社会因素共同作用的推动下，这些虫媒病毒同时流行、暴发频率和规模在全球范围内不断增加，导致病例发生区域不断扩大。这种在流行区日益增长的发病率，以及在新地区出现输入性和本土性（有时称为本地）病例的情况，要求临床医生提高认识，以便根据循证指南识别疾病和管理病例。这一任务因临床区分这些感染（尤其在疾病早期）存在挑战而变得复杂。

为制定《2022年泛美卫生组织登革热、基孔肯雅热和寨卡病毒临床诊断与治疗指南》，我们利用多个电子数据库和手工检索进行了系统评价（1）。该评价旨在解决多个研究问题，其中包括确定哪些临床表现和基础辅助检查可用于区分不同虫媒病毒引起的疾病以及其他发热性疾病。评价结果的综合和证据概要采用GRADE（推荐分级的评估、制定与评价）方法制定，相关建议由虫媒病毒专家小组达成共识。该指南的方法学遵循世界卫生组织的指南制定方法。由于专家小组未获悉近期有大规模研究发表，因此未进行正式的更新检索；此处纳入评价结果旨在帮助最终用户完善其临床判断，但并未形成正式建议。更详细的方法学信息请参阅文献（2）。

表1.1和表1.2详述了基于泛美卫生组织指南系统评价得出的、可能有助于指导疑似虫媒病毒感染诊断的临床和实验室检查结果。在随后发表的一项针对亚洲和拉丁美洲登革热与其他发热性疾病早期诊断指标的多中心前瞻性观察性研究中发现，血小板计数、白细胞计数及其与前一天相比的变化，以及出血、厌食和面颈潮红是登革热的显著预测指标，而咳嗽和鼻炎则是登革热的阴性预测指标（3）。