Summary
Definition
History and exam
Key diagnostic factors
- history of mosquito bites
- fever
- arthralgias/arthritis
- rash and other dermatological manifestations
Other diagnostic factors
- comorbid illness
- back pain
- neuropathic-type pain
- headache
- lymphadenopathy
- ocular manifestations
- photophobia
- sore throat
- gastrointestinal manifestations
- neurologic manifestations
- hemorrhagic manifestations
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)
Diagnostic tests
1st tests to order
- CBC with differential
- LFTs
- erythrocyte sedimentation rate
- CRP
- basic metabolic panel
- serology
- molecular testing
Tests to consider
- musculoskeletal imaging
- MRI brain
- cerebrospinal fluid analysis
- electromyogram
- nerve conduction studies
- electroencephalogram
- placental histology
Emerging tests
- viral culture or mice inoculation
Treatment algorithm
acute infection
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

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
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.
Differentials
- Dengue fever
- Zika virus infection
- Oropouche virus disease
More DifferentialsGuidelines
- Clinical testing and diagnosis for chikungunya virus disease
- Treatment and prevention of Chikungunya virus disease
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