Table 3. Proposed RVF clinical case definition summarised from results of systematic review and meta-analysis.

Patients’ classical presentation

1. General febrile/influenza-like syndrome Common: fever, headache, arthralgia, myalgia, chills, malaise, backache, fatigue, lethargy, rash. Rare: weight loss, prostration, nasal congestion, dehydration, joint stiffness, sore throat

2. Hepatic syndrome Common: elevated ALT, elevated AST, elevated LDH, jaundice, right hypochondriac tenderness, hepatomegaly, liver failure, splenomegaly Rare: ascites, elevated gamma glutamyl transferase (GGT)

And/or any of the following forms

3. Gastrointestinal syndrome Common: epigastric discomfort, vomiting, nausea, anorexia, abdominal pain, diarrhoea, constipation. Rare: coated tongue, dysphagia, odynophagia

4. Renal syndrome Common: renal failure, elevated creatinine Rare: elevated creatine phosphokinase (CPK)

5. Neurological syndrome Common: dizziness, delirium, insomnia, CNS symptoms/encephalitis, hyperaesthesia, coma, vertigo, meningismus, confusion, disorientation, hallucinations, ataxia, choreiform movements, hemiparesis, locked-in-syndrome Rare: drowsiness, hypersalivation, neck pain, lack of gustatory discrimination, asthenia, visual hallucinations, irritability, decerebrate posturing, neck stiffness, tremors, amnesia

6. Haemorrhagic syndrome Common: pallor, haemorrhagic disease, epistaxis, haematemesis, melena, shock, bleeding gums, sub-conjunctival haemorrhage, petechiae, haematochezia, uterovaginal bleeding, ecchymoses, macular/purpura rash, haemoptysis, thrombocytopenia, anaemia (low Hb) Rare: hypotension, haemorrhagic meningo-encephalitis, disseminated intravascular coagulation, haematuria, rectal bleeding, bleeding from puncture sites

7. Visual syndrome Common: injected conjunctiva, eye pain, retro-orbital pain, blurred or partial blindness, photophobia, retinitis Rare: red eye, retinal haemorrhage, complete blindness

8. Obstetric syndrome Rare: abortion / miscarriage, pre-term delivery

9. Cardio-pulmonary syndrome Common: syncope, throat swelling, cough Rare: chest pain, dyspnoea, hiccup, myocarditis, pneumonia

10. Death—common

Legend: Common–two or more studies reported on the sign/symptom and a pooled prevalence estimate could be calculated using random effects meta-analysis; Rare–a single study reported on the sign/symptom and a pooled prevalence estimate could not be calculated using random effects meta-analysis.