When dengue is not the answer: diagnostic anchoring bias in febrile illnesses in conflict-affected settings

Dengue is an increasingly prevalent arboviral infection in tropical regions, with expanding geographic distribution and rising reports of atypical and severe manifestations, including neurological involvement. In endemic and resource-limited settings, particularly those affected by conflict, the widespread availability of rapid diagnostic tests and overlapping clinical presentations with other infectious diseases have led to a growing concern: diagnostic anchoring bias toward dengue. This bias may contribute to misdiagnosis, delayed treatment of alternative life-threatening conditions, and distorted public health data. This commentary highlights key diagnostic pitfalls, including coinfections, incidental dengue positivity, and neurological mimics, and proposes a pragmatic clinical approach to improve diagnostic accuracy and patient outcomes.