Some particular characteristics of arthropod-borne viruses such as joint pain and edema (chikungunya), fever with hemorrhaging (dengue), or conjunctivitis (Zika) can serve as a guide as to what type of arthropod-borne virus is predominant; only a laboratory diagnosis can confirm a suspected coinfection. Potentiation can occur if multiple arthropod-borne viruses increase their in vivo viral replication. For example, dengue, chikungunya, and Zika virus can infect the same cells, causing similar disease symptoms and interfering with the immune response through similar pathways. In general, coinfections do not have a virologic or clinical impact and one virus overcomes the other, which results in symptoms consistent with a single infection. It is essential to take into account the local epidemiology or outbreaks that occur in the community when making diagnostic hypotheses. There are tests that can provide guidance regarding the possibility of coinfection. Serological tests for dengue currently represent a challenge, given that there could be a cross reaction with other arthropod-borne viruses (such as Zika virus). Therefore, symptoms are a valuable tool.
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