A 28-year-old woman from Kerala presents with fever, myalgia, and severe joint pain (polyarthralgia) affecting wrists, ankles, and knees for 5 days. She also reports a maculopapular rash on the trunk and extremities. Serology shows IgM antibodies against chikungunya virus. Regarding the clinical and laboratory features of chikungunya infection, all of the following are true EXCEPT:

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