Cynthia Goldsmith - CDC

Chikungunya

Article
Diseases & Conditions
Infectious Diseases
Contributed byMaulik P. Purohit MD MPHNov 15, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Arbovirus A Chikungunya Type
  • Chikungunya Fever
  • Chikungunya Hemorrhagic Fever

What is Chikungunya? (Definition/Background Information)

  • Chikungunya is a common infection, seen in Africa and Asia (endemic areas), transmitted by the bites of the Aedes aegypti and Aedes albopictus mosquito species that are infected with the CHIK virus. The disease can occur as an epidemic
  • The word Chikungunya in the Kimakonde language (mid-east African region) means "that which bends-up". The infection can cause severe joint pains, which forces the joints to bend-up, in order to decrease the discomfort
  • The Infection typically results in fever, tiredness, body aches, and joint pains. Some individuals have mild symptoms, while in others it may be severe
  • Most individuals recover completely from a Chikungunya disease, without any complications. The infection is not usually fatal

Who gets Chikungunya? (Age and Sex Distribution)

  • Chikungunya infection can affect individuals of all ages. Both males and females are susceptible
  • The infection is common in Africa and Asia (endemic areas); infections have been reported in Europe too, but not in the United States
  • The infection is not transmitted from a nursing mother to the baby, through breast milk

What are the Risk Factors for Chikungunya? (Predisposing Factors)

Risk factors of Chikungunya infection:

  • Living or staying in the endemic regions, especially at the time of an epidemic
  • Living in areas of high-density mosquito population, with recorded/known cases of the viral infection
  • Healthcare providers, who are treating Chikungunya cases in endemic areas

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chikungunya? (Etiology)

  • The Chikungunya disease is caused by the CHIK virus (CHIKV). This virus is found in Africa and Asia
  • The Aedes aegypti and Aedes albopictus mosquito species may get infected with the virus, either when it bites another human carrying the virus, or a monkey that might be a carrier (reservoir) of the virus

What are the Signs and Symptoms of Chikungunya?

The symptoms usually start 2-3 days after infection with the virus. Sometimes, this period can extend to 2 weeks. Mild symptoms may be observed in some individuals, while in others it may be severe. Following are the signs and symptoms of Chikungunya disease:

  • Fever up to 104 deg. F (sudden febrile episodes), which stops suddenly after 2 or 3 days
  • Feeling fatigued easily
  • Nausea and vomiting
  • Body aches including headaches, muscle aches
  • Difficulty sleeping (insomnia)
  • Skin rashes, on the chest, back, arms, and legs (macular rashes)
  • Joint pain, which can affect multiple joints (arthralgias); lasts upto months in some cases
  • Alteration of taste
  • Photophobia; the individual gets bothered by light easily
  • Inflammation of the eye, called iridocyclitis,causing blurred vision
  • Many a times, the signs and symptoms are confused with dengue fever

How is Chikungunya Diagnosed?

Following are the steps involved in diagnosing Chikungunya disease:

  • A thorough physical examination with medical history
  • Complete blood count
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein test
  • Blood tests are performed to detect the presence of antibodies to Chikungunya virus. This is done by ELISA method to detect IgM antibodies; the test can take 2-3 days

It is important to note that this test to detect antibodies, is not very specific. The presence of other viruses, such as o’nyong’ virus and Semliki virus, can give false positive results, leading to confusion in the diagnosis.

  • The antibodies can also be tested in CSF, through a lumbar puncture
  • Molecular tests, like RT-PCR, from a blood sample (usually takes 2-3 days)
  • Viral cultures may be performed (not very practical in many situations); though this test can take weeks for completion

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chikungunya?

Possible complications for Chikungunya disease include:

  • Prolonged illness with joint pains and lack of energy
  • Depression may occur, due to thisfeeling of lack of energy
  • In severe cases, the infection may cause death. However, serious complications due to Chikungunya disease are not very common

How is Chikungunya Treated?

There is no cure for the disease. There are no specific treatments for Chikungunya infection; the treatment is usually supportive.

  • Bed rest is very important; do not exert
  • To prevent dehydration, plenty of fluids should be taken, especially if vomiting is present
  • Analgesics for body pain and fever
  • Refrain from doing excessive exercise
  • Your healthcare provider may prescribe a drug, called chloroquine
  • Interferon therapy may be helpful

How can Chikungunya be Prevented?

The following standard precautions are helpful in preventing mosquito bites that cause Chikungunya disease:

  • Use of mosquito nets, while sleeping
  • Mesh-like screens on house windows/doors/ventilators
  • Using suitable clothing to cover your body, which can decrease exposure to mosquitoes
  • Use non-skin and skin, mosquito repellents
  • Decrease outdoor activity, especially during peak mosquito activity period

A vaccine for Chikungunya infection is under development, but not yet ready for routine clinical use.

What is the Prognosis of Chikungunya? (Outcomes/Resolutions)

  • With appropriate diagnosis and treatment, the prognosis for Chikungunya infection is excellent. There are no significant long-term effects, in such cases
  • The younger the individual’s age, faster is the complete recovery. Young patients recover within 2weeks; middle-age patients may take longer, upto 2 months. Older individuals may take much longer than 2 months
  • If the infection occurs in pregnant women, then in rare cases, adverse effect on the growing baby has been reported. However, such cases are few

Additional and Relevant Useful Information for Chikungunya:

Besides Chikungunya, the Aedes aegypti mosquito can also cause several diseases, like dengue, yellow fever, and other viral infections.

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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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