Viral
Arboviral infections, which frequently cause fever in India, include
viruses like dengue, chikungunya, Japanese Encephalitis (JEV) and the
tick borne Kyasanur forest disease (KFD). It is essential to prioritize
ruling out dengue fever, as was done at an outside clinic in this case,
because of its potential severity, as early supportive care can greatly
improve patient outcomes. Dengue fever typically arises within a few
days after a mosquito bite, presenting with nonspecific symptoms such as
fever, headache, and in severe cases petechial rash. The rash and lack
of neurological findings make JEV less likely, while chikungunya remains
on the cards and is therefore important to rule out given the protracted
clinical course that is characterized by While chikungunya remains on
the cards and is therefore important to rule out given the protracted
clinical course that is characterized by, the post-acute stage of
chikungunya, occurring from the fourth week to the end of the third
month, includes persistent inflammatory symptoms such as inflammatory
arthralgia, arthritis, tenosynovitis, and bursitis, and may exacerbate
pre-existing degenerative or traumatic joint conditions, leading to
local issues such as reactionary edema, entrapment syndromes, joint
stiffness, or neuropathic pain, while the chronic stage, starting after
the third month and lasting from a few months to several years, is
defined by the persistence of these symptoms, including painful
flare-ups in overused joints[5]. KFD named after a forest in the
neighboring state of Karnataka is transmitted mainly by hard ticks
belonging to the genus Haemaphysalis, which transmit the
infection among wild non-human primates such as red-faced bonnet monkeys
(Macaca radiata) and black-faced langurs (Semnopithecus entellus)
[6]. Though the lack of hemorrhagic symptoms and the low annual
incidence of around 400 cases a year [7] make it less likely. Cases
of Zika, while they do present with a similar rash and fever, have not
been reported in the state since 2021 [8].