Tomato flu B08.4

First described in the Kollam district of Kerala state (southern India). As early as 2007, approximately 2,000 cases of tomato influenza were recorded in India.

From May-July 2022, a total of more than 82 affected children <5 years of age were reported by local government hospitals in India.

Tomato flu could be a "parainfectious" after-effect of chikungunya or dengue fever. A (primary) infection by an as yet unknown virus is also suspected (Chavda VP et al. 2022). New viral variant of Coxsackie virus is also discussed as a trigger. Similar to influenza or the common cold, infection appears to occur via droplet infection. Smear infection via contaminated objects and surfaces is also conceivable.

So far, children up to nine years of age have been most affected, but 1- to 5-year-olds are particularly likely to fall ill.

The main symptoms are similar to those of chikungunya fe ver with nonspecific symptoms including high fever, fatigue, headache, aching limbs, joint swelling, and vomiting and diarrhea (Cunha RVD et al. 2017).

Diagnosis of exclusion, if above mentioned infections could be excluded.

Dengue fever: tomato fever is discussed as "paraviral exanthem" in dengue fever

Chikungunya fever: tomato fever is discussed as "paraviral exanthem" in chikungunya fever

Zika fever:

Zoster: segmental spread!

Herpes simplex virus infection: no tendency to endemic course.

Coxsackie infection(hand-foot-and-mouth disease): important differential diagnosis.

Monkeypox infection: mostly men with same-sex sexual contacts (MSM).

Course of disease usually self-limiting!

Isolation, physical rest, sufficient fluid intake, symptomatic analgesic and antipyretic therapy with e.g. paracetamol.

Isolation of confirmed or suspected cases for 5-7 days from symptom onset.

Tomato flu got its name from the characteristic exanthema with the appearance of reddish, painful vesicles and blisters that spread over the entire body and can grow to the size of a tomato.

1. Chavda VP et al (2022) Tomato flu outbreak in India. Lancet Respir Med S 2213-2600(22)00300-9.
2. Cunha RVD et al (2017) Chikungunya virus: clinical aspects and treatment-a review. Mem Inst Oswaldo Cruz 112:523-531.
3. Jacob J (2022) How Kerala is battling "tomato flu" outbreak. https://www.indiatoday.in/india-today-insight/story/how-kerala-is-battling-tomato-flu-outbreak-1949473-05-15
4. Tang JW et al (2022) Kerala Tomato Flu - A Manifestation of Hand Foot and Mouth Disease. Pediatr Infect Dis J doi: 10.1097/INF.00000000003668.