Background: Dengue is a re-emerging infectious disease that poses substantial challenges to healthcare systems in endemic regions, such as West Africa. Owing to its nonspecific and overlapping clinical symptoms – including fever, rash, headache, joint pains, nausea, vomiting – many cases go unrecognized or are misdiagnosed. Consequently, patients are often inappropriately treated with antimalarial or antibiotic therapies. Such mismanagement not only affects patient outcomes but also contributes to the development of antimicrobial and antimalarial drug resistance within these populations. This literature review aimed to describe the patterns and impact of dengue diagnosis in West Africa. Methods: A comprehensive electronic database search of MEDLINE and Embase was conducted using keywords related to dengue, chikungunya, acute febrile illness, diagnostic strategies, and clinical management. Additional manual searches was performed through Google Scholar and relevant conference proceedings. Eligible studies included observational, real-world evidence, or interventional research conducted in West Africa involving adult patients diagnosed with dengue or chikungunya. Inclusion criteria required studies to report on diagnostic approaches and/or clinical management strategies. Due to the limited availability of data on chikungunya, this review focused exclusively on dengue. Results: Ten studies from Burkina Faso, Ivory Coast, Senegal, and Nigeria were included in this review. Rapid serologic testing (DENGUE NS1, IgG, IgM) was the most frequently used diagnostic tools, used in 60% of the studies. Clinical management of dengue primarily involved the administration of antipyretics, fluid therapy, and blood transfusions when necessary. In five studies, antimalarial treatments were systematically prescribed despite negative malaria results. Additionally, two studies reported the use of antibiotics without confirmed bacterial infection or supporting biological diagnosis, indicating inappropriate antibiotic use. Conclusions: Evidence on dengue diagnosis and related clinical management in West Africa remains limited. The available data indicate a widespread underuse of diagnosis tools and frequent misuse of antimalarial and antibiotic therapies in the management of dengue. Future studies should prioritize evaluating the impact of accurate differential diagnosis between dengue and malaria on patient care, particularly regarding the inappropriate use of antibiotics and antimalarials. Moreover, integrating routine diagnostic testing into standard clinical practice, as recommended by health authorities, could significantly improve current management. This would enable clinicians to more accurately diagnose dengue, malaria, other febrile illnesses, and potential co-infections, ultimately reducing the misuse of antimicrobial treatments.

Background: Dengue and chikungunya are endemic in West Africa, posing significant public health issues. The aim of this study was to evaluate the impact of differential and systematic diagnosis of dengue and chikungunya on patient management and on antibiotic use in Burkina Faso and Ivory Coast. Methods: A multicenter prospective cohort study was conducted in both countries involving patients with suspected dengue and/or chikungunya viremia. VIDAS^® diagnostic tests (bioMérieux SA, Marcy-l’Étoile, France) were provided to the intervention sites, while the control sites initially followed standard of care before testing at the end of the study. The primary outcome was defined as antibiotic prescription or non-initiation/discontinuation, and the secondary endpoints included hospital resource use, patient satisfaction, and health-related quality of life (HRQoL), analyzed through Chi-square and logistic regression using SAS software v9.4. Results: Out of 775 enrolled patients, 767 had corresponding VIDAS^® Dengue and VIDAS^® Chikungunya results, with 570 having recorded antibiotic therapy (initiated, non-initiated or discontinued). Both Burkina Faso and Ivory Coast observed an increase in antibiotic discontinuation (or non-initiation) rates at the intervention sites compared to control sites: increased from 60% to 78% in Burkina Faso and from 36% to 83% in Ivory Coast. Hospitalization rates within seven days following inclusion were also lower in intervention sites than in the control sites: Burkina Faso 41% as compared with 97% and Ivory Coast 24% as compared with 98%. Patient-reported antibiotic use within seven days post-inclusion was also significantly lower in intervention sites. Conclusions: The results showed a reduction in potential antibiotic overuse and hospital admissions (i.e., hospitalization rates within seven days) in both the Burkina Faso and Ivory Coast interventions sites. These findings emphasize the importance of enhanced diagnostic strategies for the improvement of patient outcomes and the fight against antibiotic resistance. This study also highlights the need for implementing systematic and differential diagnosis of dengue and chikungunya in West Africa where febrile infections are endemic. Further studies are warranted to explore the economic benefits of these diagnostic strategies.