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Chikungunya virus infection

Last reviewed: 1 Apr 2025
Last updated: 14 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • history of mosquito bites
  • fever
  • arthralgias/arthritis
  • rash and other dermatological manifestations
Full details

Other diagnostic factors

  • comorbid illness
  • back pain
  • neuropathic-type pain
  • headache
  • lymphadenopathy
  • ocular manifestations
  • photophobia
  • sore throat
  • gastrointestinal manifestations
  • neurologic manifestations
  • hemorrhagic manifestations
Full details

Risk factors

  • Aedes mosquito bites
  • travel to/residence in endemic area
  • outdoor exposure
  • environmental factors favoring breeding of mosquitoes
  • neonate with infected mother
  • low educational level
  • age >40 years
  • male sex
  • blood transfusion
  • blood group O positive
  • comorbid illnesses (risk of more severe disease)
  • neonate (risk of more severe disease)
Full details

Diagnostic tests

1st tests to order

  • CBC with differential
  • LFTs
  • erythrocyte sedimentation rate
  • CRP
  • basic metabolic panel
  • serology
  • molecular testing
Full details

Tests to consider

  • musculoskeletal imaging
  • MRI brain
  • cerebrospinal fluid analysis
  • electromyogram
  • nerve conduction studies
  • electroencephalogram
  • placental histology
Full details

Emerging tests

  • viral culture or mice inoculation

Treatment algorithm

ACUTE

acute infection

ONGOING

longer-term arthritis: symptoms of rheumatoid arthritis

longer-term arthritis: symptoms of spondyloarthropathy

longer-term arthritis: undifferentiated polyarthritis

Contributors

Authors

Miguel G. Madariaga, MD, MSc, FACP
Miguel G. Madariaga

Infectious Diseases Consultant

Naples Community Hospital

Naples

FL

Disclosures

MGM declares that he has no competing interests.

Peer reviewers

Jessica Fairley, MD

Assistant Professor of Medicine

Division of Infectious Diseases

Emory University

Atlanta

GA

Disclosures

JF declares that she has no competing interests.

Mala Chhabra, MBBS, MD

Joint Director

National Centre for Disease Control

Delhi

India

Disclosures

MC declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Clinical testing and diagnosis for chikungunya virus disease. May 2024 [internet publication].Full text

Brito CAA, Marques CDL, Falcão MB, et al. Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline. Rev Soc Bras Med Trop. 2020;53:e20190517.Full text  Abstract

Burt FJ, Rolph MS, Rulli NE, et al. Chikungunya: a re-emerging virus. Lancet. 2012 Feb 18;379(9816):662-71. Abstract

World Health Organization; Pan American Health Organization. Tool for the diagnosis and care of patients with suspected arboviral diseases. 2017 [internet publication].Full text

World Health Organization. Guidelines on clinical management of chikungunya fever. Dec 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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