Global emergence of the chikungunya epidemic: A narrative review of the virus-kidney relationship in Pakistan and beyond

Table 1 Clinical manifestations in Chikungunya virus infection

Organ/system	Typical	Atypical
Systemic	Fever	Lymphadenopathy
Musculoskeletal	Arthralgia, arthritis, myalgia, joint edema, tenosynovitis, backache, persistent or relapsing remitting polyarthralgias	Chronic inflammatory rheumatism, articular destruction
Dermatological	Macular or maculopapular rash, erythema	Bullous skin lesions, scaling, macular erythema, intertrigo, hypermelanosis, xerosis, excoriated papules, urticaria, and petechial spots
Neurological	Headache	Meningoencephalitis, acute flaccid paralysis, Guillain-Barré syndrome, myelitis, seizures, cranial nerve palsies, encephalopathy, sensorineural abnormalities, palsies, neuropathy
Hematological	Lymphopenia, thrombocytopenia	Hemorrhage
Ocular	Red eyes, iridocyclitis, retinitis, episcleritis, macular choroiditis, uveitis, retro-orbital pain, photosensitivity	Optic neuritis, retinitis, uveitis
Gastrointestinal		Nausea, vomiting, abdominal pain, anorexia, diarrhea
Cardiovascular		Myocarditis, pericarditis, heart failure, arrhythmias, cardiomyopathy
Hepatic		Fulminant hepatitis
Pulmonary		Respiratory failure, pneumonia
Renal		Nephritis, acute kidney injury

Table 2 Differential diagnosis of chikungunya fever

Infectious and immune-related causes
Other viral fevers
Dengue fever	Zika virus
Ross River virus	Enterovirus
Adenovirus	Other Alphaviruses
Rubella	Parvovirus B19
Ebola fever	Hanta virus infection
West Nile fever	Crimean-Congo fever
Bussuquara fever	Mayaro fever
Kyasanur forest disease	Lassa fever
Hepatitis B	Hepatitis C
Mumps	Herpesviruses
Parasitic infections
Falciparum malaria
Bacterial infections
Leptospirosis	Rickettsiae
Typhoid
Others
Still's disease or systemic lupus erythematosus	Acute leukemias