Keywords
Fever of unknown origin
Dengue
Chikungunya
clinicians
Democratic republic of the Congo
How to Cite
Abstract
Fever is one of the main reasons for consultation in medical facilities in tropical countries. In tropical countries, malaria has always been the most frequently considered diagnosis in cases of fever. However, with the changing epidemiology, the burden of malaria has decreased, and other pathologies causing fever have gained prominence. Thus, certain etiologies of fever have become more prominent, but unfortunately, their identification depends on high-performing laboratory facilities and knowledgeable clinicians. Among these etiologies, arboviral diseases such as dengue and chikungunya are widespread throughout the world, including in the Democratic Republic of Congo (DRC). This epidemiological development led to the definition of fevers of unknown origin (FUO) due to the lack of known etiology worldwide. Developed countries have reduced the prevalence of FUO through improvements in clinical and laboratory technology. In low-resource countries, FUO are more prevalent, leading clinicians to routinely prescribe antimalarials and antibiotics without knowing what they are treating because laboratory tests are negative, contrary to the recommendations of the World Health Organization. This practice facilitates the development of resistance. It is therefore necessary to reduce the burden of fevers of unknown origin through the strengthening of diagnostic capacities, the improvement of laboratory and clinical diagnostic facilities, and the continuous training of healthcare professionals. Greater awareness among clinicians of non-malarial causes of fever, particularly arboviral diseases such as dengue and chikungunya, could contribute to a more rational management of febrile patients and to more appropriate therapeutic prescribing.
References
1. Achee, N. L., Grieco, J. P., Vatandoost, H., Seixas, G., Pinto, J., Ching-Ng, L., Martins, A. J., Juntarajumnong, W., Corbel, V., Gouagna, C., David, J.-P., Logan, J. G., Orsborne, J., Marois, E., Devine, G. J., & Vontas, J. (2019). Alternative strategies for mosquito-borne arbovirus control. PLoS Neglected Tropical Diseases, 13(1), e0006822. https://doi.org/10.1371/journal.pntd.0006822
2. Adadja, J., Allafi, B. G., Falq, G., Munezero, C., Odjarado, F. K., Atade, W., Traore, N., & Berthelot, S. (2026). Prevalence and associated factors of self-medication among pregnant women in N’Djamena North District, Chad. The Pan African Medical Journal, 53, 39. https://doi.org/10.11604/pamj.2026.53.39.48580
3. Alabi, A., Musangomunei, F. P., Lotola-Mougeni, F., Bie-Ondo, J. C., Murphy, K., Essone, P. N., Kabwende, A. L., Mahmoudou, S., Macé, A., Harris, V., Ramharter, M., Grobusch, M. P., Yazdanbakhsh, M., Fernandez-Carballo, B. L., Escadafal, C., Kremsner, P. G., Dittrich, S., & Agnandji, S. T. (2025). Performance evaluation of a combination Plasmodium dual-antigen CRP rapid diagnostic test in Lambaréné, Gabon. Infection, 53(1), 285‑295. https://doi.org/10.1007/s15010-024-02366-y
4. Al-Mandhari, A., Al-Adawi, S., Al-Zakwani, I., Dorvlo, A., & Al-Shafaee, M. (2013). Reasons for Consultation among Patients attending Primary Healthcare Centres in Oman. Sultan Qaboos University Medical Journal, 13(2), 248‑255. https://doi.org/10.12816/0003230
5. Amoah, L. E., Cheng, N. I., Acquah, F. K., Adu-Amankwah, S., Bredu, D. G., Mensah, B. A., Anang, S.-F., Abban, B. C., Busayomi, A., Kwarpong, S. S., Tey, P. K., Cudjoe, E., Asamoah, A., Holden, T. M., Gerardin, J., Nonvignon, J., & Ahorlu, C. (2024). Diagnostic performance of an ultra-sensitive RDT and a conventional RDT in malaria mass testing, treatment and tracking interventions in southern Ghana. Parasites & Vectors, 17(1), 280. https://doi.org/10.1186/s13071-024-06354-x
6. Arnow, P. M., & Flaherty, J. P. (1997). Fever of unknown origin. Lancet, 350(9077), 575‑580. https://doi.org/10.1016/S0140-6736(97)07061-X
7. Arora, S. K., Nandan, D., Sharma, A., Benerjee, P., & Singh, D. P. (2021). Predictors of severe dengue amongst children as per the revised WHO classification. Journal of Vector Borne Diseases, 58(4), 329. https://doi.org/10.4103/0972-9062.318312
8. Basu, L., Bhowmik, B., Pal, A., Roy, P., Dey, B., Mondal, R., Roy, C., & Halder, L. (2025). Drug resistance and new strategies of prevention against malaria : An ongoing battle. Journal of Vector Borne Diseases, 62(1), 9. https://doi.org/10.4103/JVBD.JVBD_72_24
9. Bente, D. A., Forrester, N. L., Watts, D. M., McAuley, A. J., Whitehouse, C. A., & Bray, M. (2013). Crimean-Congo hemorrhagic fever : History, epidemiology, pathogenesis, clinical syndrome and genetic diversity. Antiviral Research, 100(1), 159‑189. https://doi.org/10.1016/j.antiviral.2013.07.006
10. Bohers, C., Vazeille, M., Bernaoui, L., Pascalin, L., Meignan, K., Mousson, L., Jakerian, G., Karch, A., de Lamballerie, X., & Failloux, A.-B. (2024). Aedes albopictus is a competent vector of five arboviruses affecting human health, greater Paris, France, 2023. Euro Surveillance: Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 29(20), 2400271. https://doi.org/10.2807/1560-7917.ES.2024.29.20.2400271
11. Boillat-Blanco, N., Mbarack, Z., Samaka, J., Mlaganile, T., Kazimoto, T., Mamin, A., Genton, B., Kaiser, L., & D’Acremont, V. (2021a). Causes of fever in Tanzanian adults attending outpatient clinics : A prospective cohort study. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 27(6), 913.e1-913.e7. https://doi.org/10.1016/j.cmi.2020.08.031
12. Boillat-Blanco, N., Mbarack, Z., Samaka, J., Mlaganile, T., Kazimoto, T., Mamin, A., Genton, B., Kaiser, L., & D’Acremont, V. (2021b). Causes of fever in Tanzanian adults attending outpatient clinics : A prospective cohort study. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 27(6), 913.e1-913.e7. https://doi.org/10.1016/j.cmi.2020.08.031
13. Bossi, P., Tegnell, A., Baka, A., Van Loock, F., Hendriks, J., Werner, A., Maidhof, H., Gouvras, G., & Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg. (2004). Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses. Euro Surveillance: Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 9(12), E11-12.
14. Bouquillard, E., & Combe, B. (2009). Rheumatoid arthritis after Chikungunya fever : A prospective follow-up study of 21 cases. Annals of the Rheumatic Diseases, 68(9), 1505‑1506. https://doi.org/10.1136/ard.2008.097626
15. Bourée, P. (2018). Nombreuses arboviroses. Medecine Et Sante Tropicales, 28(2), 130a‑1130. https://doi.org/10.1684/mst.2018.0786
16. Brézillon-Dubus, L., Dupuis, B., & Failloux, A.-B. (2025). [Dengue treatments and vaccines]. Medecine Sciences: M/S, 41(3), 260‑272. https://doi.org/10.1051/medsci/2025025
17. Burt, F. J., Chen, W., Miner, J. J., Lenschow, D. J., Merits, A., Schnettler, E., Kohl, A., Rudd, P. A., Taylor, A., Herrero, L. J., Zaid, A., Ng, L. F. P., & Mahalingam, S. (2017). Chikungunya virus : An update on the biology and pathogenesis of this emerging pathogen. The Lancet. Infectious Diseases, 17(4), e107‑e117. https://doi.org/10.1016/S1473-3099(16)30385-1
18. Cador-Rousseau, B., Cazalets-Lacoste, C., & Grosbois, B. (2002). Intermittent fever of neoplastic origin. La Revue Du Praticien, 52(2), 145‑148.
19. Caglioti, C., Lalle, E., Castilletti, C., Carletti, F., Capobianchi, M. R., & Bordi, L. (2013). Chikungunya virus infection : An overview. The New Microbiologica, 36(3), 211‑227.
20. CDC. (2025, novembre 19). Symptoms, Diagnosis, & Treatment. Chikungunya Virus. https://www.cdc.gov/chikungunya/symptoms-diagnosis-treatment/index.html
21. Cecilia, D., Kakade, M., Alagarasu, K., Patil, J., Salunke, A., Parashar, D., & Shah, P. S. (2015). Development of a multiplex real-time RT-PCR assay for simultaneous detection of dengue and chikungunya viruses. Archives of Virology, 160(1), 323‑327. https://doi.org/10.1007/s00705-014-2217-x
22. Chappuis, F., Alirol, E., d’Acremont, V., Bottieau, E., & Yansouni, C. P. (2013). Rapid diagnostic tests
for non-malarial febrile illness in the tropics. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 19(5), 422‑431. https://doi.org/10.1111/1469-0691.12154
23. Charan, K., Lakshmi Kandhan, V., Rishika, R. S., Kalimuthu, P., Pon Ruban, A. C., Karthikeyan, M. B., Sahoo, K. C., Ponnaiah, M., Chethrapilly Purushothaman, G. K., & Diwan, V. (2026). Primary caregivers’ practices and perceptions on antibiotic use and resistance : A one health qualitative study in rural South India. BMJ Open, 16(5), e112630. https://doi.org/10.1136/bmjopen-2025-112630
24. Chaterji, S., Allen, J. C., Chow, A., Leo, Y.-S., & Ooi, E.-E. (2011). Evaluation of the NS1 Rapid Test and the WHO Dengue Classification Schemes for Use as Bedside Diagnosis of Acute Dengue Fever in Adults. The American Journal of Tropical Medicine and Hygiene, 84(2), 224‑228. https://doi.org/10.4269/ajtmh.2011.10-0316
25. Chen, L. H., Fritzer, A., Hochreiter, R., Dubischar, K., & Meyer, S. (2024). From bench to clinic : The development of VLA1553/IXCHIQ, a live-attenuated chikungunya vaccine. Journal of Travel Medicine, 31(7), taae123. https://doi.org/10.1093/jtm/taae123
26. Coffey, L. L., Failloux, A.-B., & Weaver, S. C. (2014). Chikungunya virus-vector interactions. Viruses, 6(11), 4628‑4663. https://doi.org/10.3390/v6114628
27. Cui, Y., Liu, X., & Feng, S. (2025). Clinical Characteristics and Optimization of Empirical Antimicrobial Therapy for Febrile Neutropenia in Patients With Hematologic Malignancies. Infection and Drug Resistance, 18, 715‑729. https://doi.org/10.2147/IDR.S493670
28. Cunha, B. A. (1996). Fever of unknown origin. Infectious Disease Clinics of North America, 10(1), 111‑127. https://doi.org/10.1016/S0891-5520(05)70290-7
29. Cunha, B. A., Lortholary, O., & Cunha, C. B. (2015). Fever of Unknown Origin : A Clinical Approach. The American Journal of Medicine, 128(10), 1138.e1-1138.e15. https://doi.org/10.1016/j.amjmed.2015.06.001
30. D’Acremont, V., Kilowoko, M., Kyungu, E., Philipina, S., Sangu, W., Kahama-Maro, J., Lengeler, C., Cherpillod, P., Kaiser, L., & Genton, B. (2014). Beyond Malaria—Causes of Fever in Outpatient Tanzanian Children. New England Journal of Medicine, 370(9), 809‑817. https://doi.org/10.1056/NEJMoa1214482
31. De la Calle-Prieto, F., Arsuaga, M., Rodríguez-Sevilla, G., Paiz, N. S., & Díaz-Menéndez, M. (2024). The current status of arboviruses with major epidemiological significance in Europe. Enfermedades Infecciosas Y Microbiologia Clinica, 42(9), 516‑526. https://doi.org/10.1016/j.eimce.2024.09.008
32. De Filippis, V. R. (2022). Chikungunya Virus Vaccines : Platforms, Progress, and Challenges. Current Topics in Microbiology and Immunology, 435, 81‑106. https://doi.org/10.1007/82_2019_175
33. Dégallier, N., Hervé, J. P., Travassos da Rosa, A. P., & Sa, G. C. (1988). [Aedes aegypti (L.) : Importance of its bioecology in the transmission of dengue and other arboviruses. I]. Bulletin De La Societe De Pathologie Exotique Et De Ses Filiales, 81(1), 97‑110.
34. de Lima Cavalcanti, T. Y. V., Pereira, M. R., de Paula, S. O., & Franca, R. F. de O. (2022). A Review on Chikungunya Virus Epidemiology, Pathogenesis and Current Vaccine Development. Viruses, 14(5), 969.
35. https://doi.org/10.3390/v14050969Dengue. (2016, mai 20). Institut Pasteur. https://www.pasteur.fr/fr/centre-medical/fiches-maladies/dengue
36. Dengue – situation mondiale. (2023). https://www.who.int/fr/emergencies/disease-outbreak-news/item/2023-DON498
37. Dengue et dengue sévère. (2024). OMS. https://www.who.int/fr/news-room/fact-sheets/detail/dengue-and-severe-dengue
38. Durack, D. T., & Street, A. C. (1991). Fever of unknown origin—Reexamined and redefined. Current Clinical Topics in Infectious Diseases, 11, 35‑51.
39. E. Abou Warda, A., Molham, F., Salem, H. F., Mostafa-Hedeab, G., ALruwaili, B. F., Moharram,
A. N., Sebak, M., & Sarhan, R. M. (2022). Emergence of High Antimicrobial Resistance among Critically Ill Patients with Hospital-Acquired Infections in a Tertiary Care Hospital. Medicina, 58(11), 1597. https://doi.org/10.3390/medicina58111597
40. EDS 2023-2024 RDC. (2024). PNUD, Ecole de Santé publique de Kinshasa. https://drc.unfpa.org/sites/default/files/pub-pdf/2025-02/RDC%2C%20EDS%202023-2024.pdf
41. Elbahr, U., Erdem, H., Letaief, A., Grgić, S., Zambrano, L. I., Yahia, W. B., Rahimi, B. A., Baymakova, M., Khedr, R., Nsutebu, E., Şanlıdağ, G., Koç, M. M., Öncü, S., Poposki, K., Eser-Karlıdağ, G., & Sipahi, O. R. (2026). Follow-up, diagnosis, and outcomes of fever of unknown origin cases in whom no diagnosis was established after initial evaluation : An ID-IRI (Infectious Diseases - International Research Initiative) observational retrospective cohort study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-13431-2
42. Fatima, A., & Wang, J. (2015). Review : Progress in the diagnosis of dengue virus infections and importance of point of care test: a review. Pakistan Journal of Pharmaceutical Sciences, 28(1), 271‑280.
43. Faye, M., Makiala-Mandana, S., Diagne, M. M., Faye, O., Boehlken-Fascher, S., Kissenkoetter, J., Muyembe-Tamfum, J.-J., Ahuka-Mundeke, S., Mbala-Kingebeni, P., Okitale-Talunda, P., Mujinga, G. K., de La Vega, M.-A., Kobinger, G., Elijah, O. O., Bakarey, A. S., Kolawole, R. M., Ademowo, O. G., Diagne, C. T., Sall, A. A., … Weidmann, M. (2025). Field Evaluation of Mobile Molecular Differential Tests in DRC and Nigeria. Open Forum Infectious Diseases, 12(10), ofaf630. https://doi.org/10.1093/ofid/ofaf630
44. Fink, G., D’Acremont, V., Leslie, H. H., & Cohen, J. (2020). Antibiotic exposure among children younger than 5 years in low-income and middle-income countries : A cross-sectional study of nationally representative facility-based and household-based surveys. The Lancet. Infectious Diseases, 20(2), 179‑187. https://doi.org/10.1016/S1473-3099(19)30572-9
45. Fite, J., & Chandre, F. (2022). Les lâchers de moustiques modifiés pour lutter contre la dengue, le chikungunya ou la fièvre jaune.
46. Földes, F., Madai, M., Németh, V., Zana, B., Papp, H., Kemenesi, G., Bock-Marquette, I., Horváth, G., Herczeg, R., & Jakab, F. (2019). Serologic survey of the Crimean-Congo haemorrhagic fever virus infection among wild rodents in Hungary. Ticks and Tick-Borne Diseases, 10(6), 101258. https://doi.org/10.1016/j.ttbdis.2019.07.002
47. Fournier, L., Durand, G. A., Cochet, A., Brottet, E., Fiet, C., Mano, Q., Krug, C., Verdurme, L., Blanchot, T., Fournier, R., Investigation team, Paty, M.-C., Grard, G., Franke, F., & Calba, C. (2025). Multiple early local transmissions of chikungunya virus, Mainland France, from May 2025. Euro Surveillance: Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 30(32), 2500545. https://doi.org/10.2807/1560-7917.ES.2025.30.32.2500545
48. Gedefie, A., Debash, H., Kassaw, A. B., Mankelkl, G., Metaferia, Y., Belete, M. A., Desale, S., Sebsibe, S., Tilahun, M., Eshetu, B., Shibabaw, A., Kassa, Y., Ebrahim, H., Mulatie, Z., Alemayehu, E., Woretaw, L., Kebede, B., Temesgen, M. M., Msganew, N. K., & Tesfaye, M. (2025). Epidemiology of arboviruses in humans and livestock in Ethiopia : A systematic review and meta-analysis. BMC Infectious Diseases, 25(1), 458. https://doi.org/10.1186/s12879-025-10824-7
49. Giménez-Richarte, Á., Ortiz de Salazar, M. I., Giménez-Richarte, M.-P., Collado, M., Fernández, P. L., Clavijo, C., Navarro, L., Arbona, C., Marco, P., & Ramos-Rincon, J.-M. (2022). Transfusion-transmitted arboviruses : Update and systematic review. PLoS Neglected Tropical Diseases, 16(10), e0010843. https://doi.org/10.1371/journal.pntd.0010843
50. Girard, M., Nelson, C. B., Picot, V., & Gubler, D. J. (2020). Arboviruses : A global public health threat. Vaccine, 38(24), 3989‑3994. https://doi.org/10.1016/j.vaccine.2020.04.011
51. Halstead, S. B., Russell, P. K., & Brandt, W. E. (2019). NS1, Dengue’s Dagger. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/jiz083
52. Hildenwall, H., Amos, B., Mtove, G., Muro, F., Cederlund, K., & Reyburn, H. (2016). Causes of non-malarial febrile illness in outpatients in
Tanzania. Tropical Medicine & International Health, 21(1), 149‑156. https://doi.org/10.1111/tmi.12635
53. Hills, S. L., Wong, J. M., & Staples, J. E. (2023). Arboviral vaccines for use in pregnant travelers. Travel Medicine and Infectious Disease, 55, 102624. https://doi.org/10.1016/j.tmaid.2023.102624
54. Holder, B. M. A., & Ledbetter, C. (2011). Fever of unknown origin : An evidence-based approach. The Nurse Practitioner, 36(8), 46‑52. https://doi.org/10.1097/01.NPR.0000399714.32080.49
55. Horwood, P. F., & Buchy, P. (2015). Chikungunya. Revue Scientifique Et Technique, 34(2), 479‑489. https://doi.org/10.20506/rst.34.2.2373
56. Hot, A., Schmulewitz, L., Viard, J.-P., & Lortholary, O. (2007). Fever of unknown origin in HIV/AIDS patients. Infectious Disease Clinics of North America, 21(4), 1013‑1032, ix. https://doi.org/10.1016/j.idc.2007.08.003
57. Huang, Y.-J. S., Higgs, S., & Vanlandingham, D. L. (2019). Emergence and re-emergence of mosquito-borne arboviruses. Current Opinion in Virology, 34, 104‑109. https://doi.org/10.1016/j.coviro.2019.01.001
58. Institut Pasteur. (2025). Chikungunya : Symptômes, traitement, prévention—Institut Pasteur. https://www.pasteur.fr/fr/centre-medical/fiches-maladies/chikungunya
59. Institute of Tropical Medicine. (2026). Comportement piqueur | SurveillanceMoustiques. https://surveillancemoustiques.be/comportement-piqueur
60. Jourdain, F., Roiz, D., Perrin, Y., Grucker, K., Simard, F., & Paupy, C. (2015). Facteurs entomologiques d’émergence des arboviroses. Transfusion Clinique et Biologique, 22(3), 101‑106. https://doi.org/10.1016/j.tracli.2015.06.001
61. Kejariwal, D., Sarkar, N., Chakraborti, S. K., Agarwal, V., & Roy, S. (2001). Pyrexia of unknown origin : A prospective study of 100 cases. Journal of Postgraduate Medicine, 47(2), 104‑107.
62. Khongwichit, S., Chansaenroj, J., Chirathaworn, C., & Poovorawan, Y. (2021). Chikungunya virus infection : Molecular biology, clinical characteristics, and epidemiology in Asian countries. Journal of Biomedical Science, 28(1), 84. https://doi.org/10.1186/s12929-021-00778-8
63. Kularatne, S. A., & Dalugama, C. (2022). Dengue infection : Global importance, immunopathology and management. Clinical Medicine, 22(1), 9‑13. https://doi.org/10.7861/clinmed.2021-0791
64. Lacy, M. D., & Smego, R. A. (1996). Viral hemorrhagic fevers. Advances in Pediatric Infectious Diseases, 12, 21‑53.
65. Lignes directrices sur le paludisme. (2015). https://www.who.int/fr/teams/global-malaria-programme/guidelines-for-malaria
66. Linsuke, S., Nabazungu, G., Ilombe, G., Ahuka, S., Muyembe, J.-J., & Lutumba, P. (2020). Laboratoires médicaux et qualité des soins : La partie la plus négligée au niveau des hôpitaux ruraux de la République Démocratique du Congo. The Pan African Medical Journal, 35(22). https://doi.org/10.11604/pamj.2020.35.22.18755
67. Ly, H. (2024). Ixchiq (VLA1553) : The first FDA-approved vaccine to prevent disease caused by Chikungunya virus infection. Virulence, 15(1), 2301573. https://doi.org/10.1080/21505594.2023.2301573
68. Makashir, P., Shinde, U., Koithara, B., & Purandare, B. (2026). Brucella melitensis sacroiliitis as an unusual culprit for fever of unknown origin (FUO). BMJ Case Reports, 19(1), e269495. https://doi.org/10.1136/bcr-2025-269495
69. Makiala-Mandanda, S., Ahuka-Mundeke, S., Abbate, J. L., Pukuta-Simbu, E., Nsio-Mbeta, J., Berthet, N., Leroy, E. M., Becquart, P., & Muyembe-Tamfum, J.-J. (2018a). Identification of Dengue and Chikungunya Cases Among Suspected Cases of Yellow Fever in the Democratic Republic of the Congo. Vector Borne and Zoonotic Diseases, 18(7), 364‑370. https://doi.org/10.1089/vbz.2017.2176
70. Makiala-Mandanda, S., Ahuka-Mundeke, S., Abbate, J. L., Pukuta-Simbu, E., Nsio-Mbeta, J., Berthet, N., Leroy, E. M., Becquart, P., & Muyembe-Tamfum, J.-J. (2018b). Identification of Dengue and Chikungunya Cases Among Suspected
Cases of Yellow Fever in the Democratic Republic of the Congo. Vector Borne and Zoonotic Diseases, 18(7), 364‑370. https://doi.org/10.1089/vbz.2017.2176
71. Makiala-Mandanda, S., Ahuka-Mundeke, S., Abbate, J. L., Pukuta-Simbu, E., Nsio-Mbeta, J., Berthet, N., Leroy, E. M., Becquart, P., & Muyembe-Tamfum, J.-J. (2018c). Identification of Dengue and Chikungunya Cases Among Suspected Cases of Yellow Fever in the Democratic Republic of the Congo. Vector-Borne and Zoonotic Diseases, 18(7), 364‑370. https://doi.org/10.1089/vbz.2017.2176
72. Mardekian, S. K., & Roberts, A. L. (2015). Diagnostic Options and Challenges for Dengue and Chikungunya Viruses. BioMed Research International, 2015(1), 834371. https://doi.org/10.1155/2015/834371
73. Maure, C., Khazhidinov, K., Kang, H., Auzenbergs, M., Moyersoen, P., Abbas, K., Santos, G. M. L., Medina, L. M. H., Wartel, T. A., Kim, J. H., Clemens, J., & Sahastrabuddhe, S. (2024). Chikungunya vaccine development, challenges, and pathway toward public health impact. Vaccine, 42(26), 126483. https://doi.org/10.1016/j.vaccine.2024.126483
74. Mendoza, R. U., Valenzuela, S., & Dayrit, M. (2020). A Crisis of Confidence : The Case of Dengvaxia in the Philippines (SSRN Scholarly Paper No 3519736). Social Science Research Network. https://doi.org/10.2139/ssrn.3519736
75. Metz, S. W., & Pijlman, G. P. (2011). Arbovirus vaccines; opportunities for the baculovirus-insect cell expression system. Journal of Invertebrate Pathology, 107 Suppl, S16-30. https://doi.org/10.1016/j.jip.2011.05.002
76. Mori, A., Pomari, E., Deiana, M., Perandin, F., Caldrer, S., Formenti, F., Mistretta, M., Orza, P., Ragusa, A., & Piubelli, C. (2021). Molecular techniques for the genomic viral RNA detection of West Nile, Dengue, Zika and Chikungunya arboviruses : A narrative review. Expert Review of Molecular Diagnostics, 21(6), 591‑612. https://doi.org/10.1080/14737159.2021.1924059
77. Mozahheb Yousefi, K., Aminian, S., Ebrahimi, M., Minaeian, S., & Laali, A. (2025). Diagnosis and Management of Dengue Fever in a Nonendemic Country : Lessons From an Acute Febrile Illness in Iran During the COVID-19 Outbreak. Case Reports in Infectious Diseases, 2025, 5742576. https://doi.org/10.1155/crdi/5742576
78. Musumeci, S., Kruse, A., Chappuis, F., Ostergaard Jensen, T., & Alcoba, G. (2024). Neglected etiologies of prolonged febrile illnesses in tropical and subtropical regions : A systematic review. PLOS Neglected Tropical Diseases, 18(6), e0011978. https://doi.org/10.1371/journal.pntd.0011978
79. Nalca, A., Fellows, P. F., & Whitehouse, C. A. (2003). Vaccines and animal models for arboviral encephalitides. Antiviral Research, 60(3), 153‑174. https://doi.org/10.1016/j.antiviral.2003.08.001
80. Nanaware, N., Banerjee, A., Mullick Bagchi, S., Bagchi, P., & Mukherjee, A. (2021). Dengue Virus Infection : A Tale of Viral Exploitations and Host Responses. Viruses, 13(10), 1967. https://doi.org/10.3390/v13101967
81. Nguyen, T. K., Nguyen, Y. H., Nguyen, H. T., Khong, Q. M., & Tran, N. K. (2022). Etiologies of fever of unknown origin in HIV/AIDS patients, Hanoi, Vietnam. BMC Infectious Diseases, 22(1), 61. https://doi.org/10.1186/s12879-022-07049-3
82. Nnadi, N. O., Ikurayeke, J., Amaechi, I. G., Dienye, N. P., & Olaniyan, F. A. (2026). Socio-Demographic, Economic Factors, and Antibiotic Self-Medication among Residents of Rivers State in South-South, Nigeria. West African Journal of Medicine, 43(1), 14‑21.
83. Ong, E. P., Obeles, A. J. T., Ong, B. A. G., & Tantengco, O. A. G. (2022). Perspectives and lessons from the Philippines’ decades-long battle with dengue. The Lancet Regional Health: Western Pacific, 24, 100505. https://doi.org/10.1016/j.lanwpc.2022.100505
84. Opoku Afriyie, S., Addison, T. K., Gebre, Y., Mutala, A.-H., Antwi, K. B., Abbas, D. A., Addo, K. A., Tweneboah, A., Ayisi-Boateng, N. K., Koepfli, C., & Badu, K. (2023). Accuracy of diagnosis among clinical malaria patients : Comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections. Malaria Journal, 22(1), 76. https://doi.org/10.1186/s12936-023-04506-5
85. Pang, M., Sun, X.-Z., He, T., Yang, H., & Chen, J. (2025). Clinical Manifestation of Arboviruses in Paediatrics. Reviews in Medical Virology, 35(2), e70016. https://doi.org/10.1002/rmv.70016
86. Paronyan, L., Zardaryan, E., Bakunts, V., Gevorgyan, Z., Asoyan, V., Apresyan, H., Hovhannisyan, A., Palayan, K., Bautista, C. T., Kuchuloria, T., & Rivard, R. G. (2016). A retrospective chart review study to describe selected zoonotic and arboviral etiologies in hospitalized febrile patients in the Republic of Armenia. BMC Infectious Diseases, 16(1), 445. https://doi.org/10.1186/s12879-016-1764-z
87. Pereira, C. A. de M., Mendes, R. P. G., Silva, P. G. da, Chaves, E. J. F., & Pena, L. J. (2025). Vaccines Against Urban Epidemic Arboviruses : The State of the Art. Viruses, 17(3), 382. https://doi.org/10.3390/v17030382
88. Petersdorf, R. G., & Beeson, P. B. (s. d.). Fever of unkwown origin. Consulté 8 juin 2026, à l’adresse https://journals.lww.com/md-journal/citation/1961/02000/fever_of_unexplained_origin__report_on_100_cases.1.aspx
89. Petersdorf, R. G., & Beeson, P. B. (1961). Fever of unexplained origin : Report on 100 cases. Medicine, 40, 1‑30. https://doi.org/10.1097/00005792-196102000-00001
90. Pialoux, G., Gaüzère, B.-A., Jauréguiberry, S., & Strobel, M. (2007). Chikungunya, an epidemic arbovirosis. The Lancet. Infectious Diseases, 7(5), 319‑327. https://doi.org/10.1016/S1473-3099(07)70107-X
91. Pialoux, G., Gaüzère, B.-A., & Strobel, M. (2006). Chikungunya virus infection : Review through an epidemic. Medecine Et Maladies Infectieuses, 36(5), 253‑263. https://doi.org/10.1016/j.medmal.2006.04.002
92. Pinheiro-Michelsen, J. R., Souza, R. da S. O., Santana, I. V. R., da Silva, P. de S., Mendez, E. C., Luiz, W. B., & Amorim, J. H. (2020). Anti-dengue Vaccines : From Development to Clinical Trials. Frontiers in Immunology, 11, 1252. https://doi.org/10.3389/fimmu.2020.01252
93. Postigo-Hidalgo, I., Magassouba, N., Krüger, N., Guilavogui, M. L., Kruger, D. H., Klempa, B., & Drexler, J. F. (2025). Elucidating Infectious Causes of Fever of Unknown Origin : A Laboratory-Based Observational Study of Patients with Suspected Ebola Virus Disease, Guinea, 2014. The Journal of Infectious Diseases, 232(1), 101‑112. https://doi.org/10.1093/infdis/jiae637
94. Proesmans, S., Katshongo, F., Milambu, J., Fungula, B., Muhindo Mavoko, H., Ahuka-Mundeke, S., Inocêncio da Luz, R., Van Esbroeck, M., Ariën, K. K., Cnops, L., De Smet, B., Lutumba, P., Van Geertruyden, J.-P., & Vanlerberghe, V. (2019). Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo : A cross-sectional study. PLoS Neglected Tropical Diseases, 13(9), e0007047. https://doi.org/10.1371/journal.pntd.0007047
95. Queyriaux, B., Simon, F., Oliver, M., & Boutin, J.-P. (2008). Chikungunya and other arboviroses in tropical areas. Médecine tropicale : revue du Corps de santé colonial, 68, 478‑481.
96. Rachdi, I., Aydi, Z., Daoud, F., Fekih, Y., Zoubeidi, H., Ben Dhaou, B., & Boussema, F. (2019). Étiologies des fièvres prolongées inexpliquées du sujet âgé dans une cohorte tunisienne. NPG Neurologie - Psychiatrie - Gériatrie, 19(114), 340‑348. https://doi.org/10.1016/j.npg.2019.100793
97. Robinson, M. L., & Durbin, A. P. (2017). Dengue vaccines : Implications for dengue control. Current Opinion in Infectious Diseases, 30(5), 449‑454. https://doi.org/10.1097/QCO.0000000000000394
98. Salimi, H., Cain, M. D., & Klein, R. S. (2016). Encephalitic Arboviruses : Emergence, Clinical Presentation, and Neuropathogenesis. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 13(3), 514‑534. https://doi.org/10.1007/s13311-016-0443-5
99. Salzberger, B., Müller-Schilling, M., & Fleck, M. (2013). Fieber ungeklärter Ursache. Zeitschrift für Rheumatologie, 72(3), 255‑266. https://doi.org/10.1007/s00393-013-1164-3
100. Santana, L. F. e, Rodrigues, M. de S., Silva, M. P. de A., Brito, R. J. V. C. de, Nicacio, J. M., Duarte, R. M. S. de C., & Gomes, O. V. (2019). Fever of
unknown origin – a literature review. Revista Da Associação Médica Brasileira, 65, 1109‑1115. https://doi.org/https://doi.org/10.1590/1806-9282.65.8.1109
101. Schaller, A., Moulin, E., Cherpillod, P., Kaiser, L., De Valliére, S., & Boillat-Blanco, N. (2016). Arboviroses émergentes : Quelle démarche diagnostique chez les voyageurs ? Rev Med Suisse, 517, 889‑894.
102. Sepkowitz, K. A. (1999). FUO and AIDS. Current Clinical Topics in Infectious Diseases, 19, 1‑15.Shayan, S., Bokaean, M., Shahrivar, M. R., & Chinikar, S. (2015). Crimean-Congo Hemorrhagic Fever. Laboratory Medicine, 46(3), 180‑189. https://doi.org/10.1309/LMN1P2FRZ7BKZSCO
103. Silva, L. A., & Dermody, T. S. (2017). Chikungunya virus : Epidemiology, replication, disease mechanisms, and prospective intervention strategies. The Journal of Clinical Investigation, 127(3), 737‑749. https://doi.org/10.1172/JCI84417
104. Simpson, D. I. (1972a). Arbovirus diseases. British Medical Bulletin, 28(1), 10‑15. https://doi.org/10.1093/oxfordjournals.bmb.a070876
105. Simpson, D. I. (1972b). Arbovirus diseases. British Medical Bulletin, 28(1), 10‑15. https://doi.org/10.1093/oxfordjournals.bmb.a070876
106. Sinha, S., Singh, K., Ravi Kumar, Y. S., Roy, R., Phadnis, S., Meena, V., Bhattacharyya, S., & Verma, B. (2024). Dengue virus pathogenesis and host molecular machineries. Journal of Biomedical Science, 31(1), 43. https://doi.org/10.1186/s12929-024-01030-9
107. Stanley, J., Chongkolwatana, V., Duong, P. T., Kitpoka, P., Stramer, S. L., Dung, N. T. T., Grimm, K. E., Pojanasingchod, A., Suksomboonvong, P., & Galel, S. A. (2021). Detection of dengue, chikungunya, and Zika RNA in blood donors from Southeast Asia. Transfusion, 61(1), 134‑143. https://doi.org/10.1111/trf.16110
108. Togami, E., Chiew, M., Lowbridge, C., Biaukula, V., Bell, L., Yajima, A., Eshofonie, A., Saulo, D., Hien, D. T. H., Otsu, S., Dai, T. C., Ngon, M. S., Lee, C.-K., Tsuyuoka, R., Tuseo, L., Khalakdina, A., Kab, V., Abeyasinghe, R. R., Yadav, R. P., … Olowokure, B. (2023). Epidemiology of dengue reported in the World Health Organization’s Western Pacific Region, 2013-2019. Western Pacific Surveillance and Response Journal: WPSAR, 14(1), 1‑16. https://doi.org/10.5365/wpsar.2023.14.1.973
109. Tumbarello, M., Giuliano, G., Criscuolo, M., Del Principe, M. I., Papayannidis, C., Fracchiolla, N. S., Dargenio, M., Cefalo, M., Nadali, G., Candoni, A., Buquicchio, C., Marchesi, F., Picardi, M., Lessi, F., Piedimonte, M., Prezioso, L., Piccini, M., Cattaneo, C., Busca, A., … Pagano, L. (2025). Clinical impact of ceftazidime/avibactam on the treatment of suspected or proven infections in a large cohort of patients with haematological malignancies : A multicentre observational real-world study. The Journal of Antimicrobial Chemotherapy, 80(2), 386‑398. https://doi.org/10.1093/jac/dkae416
110. Umar, K., Sutradhar, T., Prakash, P., Bavanilatha, M., Hemamalani, A. U., Prakashini, R. S., Thangam, T., & Parthasarathy, K. (2025). Dengue virus : Structure, genome, evolution and challenges to control and prevent transmission. Antonie Van Leeuwenhoek, 118(9), 139. https://doi.org/10.1007/s10482-025-02153-1
111. Unger, M., Karanikas, G., Kerschbaumer, A., Winkler, S., & Aletaha, D. (2016). Fever of unknown origin (FUO) revised. Wiener Klinische Wochenschrift, 128(21), 796‑801. https://doi.org/10.1007/s00508-016-1083-9
112. Vairo, F., Haider, N., Kock, R., Ntoumi, F., Ippolito, G., & Zumla, A. (2019). Chikungunya : Epidemiology, Pathogenesis, Clinical Features, Management, and Prevention. Infectious Disease Clinics of North America, 33(4), 1003‑1025. https://doi.org/10.1016/j.idc.2019.08.006
113. Vieira, D. S., Zambenedetti, M. R., Requião, L., Borghetti, I. A., Luna, L. K. de S., Santos, A. de O. dos, Taborda, R. L. M., Pereira, D. B., Krieger, M. A., Salcedo, J. M. V., & Rampazzo, R. de C. P. (2019). Epidemiological profile of Zika, Dengue and Chikungunya virus infections identified by medical and molecular evaluations in Rondonia, Brazil. Revista Do Instituto de Medicina Tropical de São Paulo, 61, e40. https://doi.org/https://doi.org/10.1590/S1678-9946201961040
114. Wang, W.-H., Urbina, A. N., Chang, M. R., Assavalapsakul, W., Lu, P.-L., Chen, Y.-H., &
Wang, S.-F. (2020). Dengue hemorrhagic fever—A systemic literature review of current perspectives on pathogenesis, prevention and control. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 53(6), 963‑978. https://doi.org/10.1016/j.jmii.2020.03.007
115. Weber, W. C., Streblow, D. N., & Coffey, L. L. (2024). Chikungunya Virus Vaccines : A Review of IXCHIQ and PXVX0317 from Pre-Clinical Evaluation to Licensure. BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy, 38(6), 727‑742. https://doi.org/10.1007/s40259-024-00677-y
116. Wei, Y.-L., Wu, Z., Li, R.-L., & Tang, F. (2025). Review of selected mosquito-borne diseases : Arboviruses (dengue, chikungunya, Zika, West Nile, Japanese encephalitis, yellow fever) and parasitic diseases (malaria, lymphatic Filariasis). Frontiers in Public Health, 13, 1712094. https://doi.org/10.3389/fpubh.2025.1712094
117. WHO. (2025). Chikungunya. https://www.who.int/fr/news-room/fact-sheets/detail/chikungunya
118. Wu, P., Yu, X., Wang, P., & Cheng, G. (2019). Arbovirus lifecycle in mosquito : Acquisition, propagation and transmission. Expert Reviews in Molecular Medicine, 21, e1. https://doi.org/10.1017/erm.2018.6
119. Young, P. R. (2018). Arboviruses : A Family on the Move. Advances in Experimental Medicine and Biology, 1062, 1‑10. https://doi.org/10.1007/978-981-10-8727-1_1
120. Yu, X., Wang, S., Du, N., Zhao, H., & Chen, H. (2024). Diagnostic efficacy and necessity of 18F-FDG PET/CT in fever of unknown origin : Insights from a retrospective cohort study. Frontiers in Medicine, 11, 1511710. https://doi.org/10.3389/fmed.2024.1511710
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2026 Mushindua et al.