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].