Diagnosis in most cases can be made from clinical presentation with certainty; if the clinician has a strong suspicion. Differentials include papular urticaria, chickenpox, mosquito bite etc. Rarity of cases and lack of suspicion as well as uneventful recovery are the most important causes of missing a case clinically. Though laboratory confirmation depends on direct isolation of virus in cell cultures, Indirect fluorescent assays (IFA), RT-PCR or serum neutralization techniques are also useful. Clinical presentation is quite characteristic to raise the suspicion of the condition and remains the sole diagnostic modality in resource constrained areas. Previous outbreaks in Kerala and.
