Notifiable condition. It is important to distinguish from dengue fever and Zika virus infection, which are transmitted by the same vector.
Most patients fully recover, but some develop chronic joint disease characterized by polyarthritis and systemic manifestations that may last for months or years and may resemble rheumatoid arthritis or a seronegative spondyloarthropathy.
Has a global distribution, thanks to a genetic change enabling the virus to be transmitted by Aedes albopictus (a more widespread Aedes vector), as well as Aedesaegypti. Locally acquired cases have been reported in the US and Europe.
Diagnosis is based on clinical manifestations and epidemiologic clues. Confirmation is via serologic detection of antibodies. Real-time reverse transcription polymerase chain reaction can be used to determine whether a patient is infected with chikungunya, Zika, or dengue virus in one test. Coinfection may occur.
There is no specific vaccine or treatment. Avoidance of mosquito bites is the best method of prevention.
Chikungunya virus (also known as CHIKV) is an alphavirus transmitted by the Aedes species of mosquitoes. Chikungunya means "that which bends up" in the Makonde language (spoken in a border area between Mozambique and Tanzania where the first outbreak was described), which refers to the arthritis that the infection can cause. Fever and joint aches are the most common manifestations of infection, which may resemble other viral illnesses, including dengue. The disease is usually self-limited, but some cases may evolve into a chronic condition with debilitating arthritis.
History and exam
Key diagnostic factors
- history of mosquito bites
- rash and other dermatological manifestations
Other diagnostic factors
- comorbid illness
- back pain
- neuropathic-type pain
- ocular manifestations
- sore throat
- gastrointestinal manifestations
- neurologic manifestations
- hemorrhagic manifestations
- 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)
1st investigations to order
- CBC with differential
- erythrocyte sedimentation rate
- basic metabolic panel
- molecular testing
Investigations to consider
- musculoskeletal imaging
- MRI brain
- cerebrospinal fluid analysis
- nerve conduction studies
- placental histology
- viral culture or mice inoculation
longer-term arthritis: symptoms of rheumatoid arthritis
longer-term arthritis: symptoms of spondyloarthropathy
longer-term arthritis: undifferentiated polyarthritis
Miguel G. Madariaga, MD, MSc, FACP
Infectious Diseases Consultant
Naples Community Hospital
MGM declares that he has no competing interests.
Jessica Fairley, MD
Assistant Professor of Medicine
Division of Infectious Diseases
JF declares that she has no competing interests.
Mala Chhabra, MBBS, MD
National Centre for Disease Control
MC declares that she has no competing interests.
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