Chikungunya: Causes, Symptoms, Diagnosis and Treatment

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Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It is caused by the chikungunya virus and is characterized by sudden fever and joint pain that can be severe and debilitating.

The name “chikungunya” derives from a word in the Kimakonde language that translates to “that which bends ups,” referring to the contorted appearance of sufferers with joint pain.right up arrow The disease was first described during an outbreak in southern Tanzania in 1952.
    Although chikungunya had previously been detected in countries in Africa, Asia, Europe, and the Indian and Pacific Ocean regions, local transmission of the virus was first detected in the Caribbean in 2013. Since then, the virus has spread throughout most of the Americas, including the United States.


    Signs and Symptoms of Chikungunya

    The first sign of chikungunya will typically be a fever, followed by a rash. After the bite of an infected mosquito, onset of illness usually occurs 4 to 8 days later (but the range can be 2 to 12 days).

    Symptoms include:

    • Sudden onset of high fever (typically above 102 degrees F)
    • Joint pains
    • Headache
    • Myalgia
    • Arthritis
    • Conjunctivitis
    • Nausea
    • Vomiting
    • Maculopapular rash (characterized by a flat red area on the skin covered with elevated bumps)
    While the majority of people infected with the virus will have symptoms, 3 to 28 percent of people infected with chikungunya will remain asymptomatic, according to the Centers for Disease Control and Prevention.


    Causes and Risk Factors of Chikungunya

    Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It is caused by the chikungunya virus (CHIKV).

    An infected person cannot directly transmit the virus to another person. The disease is spread when a mosquito feeds on a person with the virus circulating in their blood. The mosquito can pick up the virus and spread it to another person through its bite.

    According to the CDC, no infants have been found to have been infected with chikungunya virus through breastfeeding.

    Chikungunya virus is most often spread to people by Aedes aegypti and Aedes albopictus mosquitoes. These are the same mosquitoes that transmit dengue virus.

    CHIKV epidemics in Africa and Asia have been primarily associated with the urban mosquito A. aegypti. But since an outbreak on RĂ©union in 2005, A. albopictus has been introduced as a second major spreader of CHIKV.

    A. albopictus is more widely distributed and has the ability to survive in temperate climates. This is unlike A. aegypti, which live predominantly in tropical and subtropical areas.

    Proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.

    How Is Chikungunya Diagnosed?

    If you have recently returned from an area with known virus transmission and are experiencing high fever and joint pain, your doctor might recommend a series of blood tests to detect the presence of chikungunya virus or antibodies.

    Several methods can be used for diagnosis of chikungunya virus infection.

    Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies.

    Chikungunya virus antibodies normally develop toward the end of the first week of illness. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months.

    The virus may be directly detected in the blood during the first few days of infection as well. Samples collected during the first week of illness are tested by both serological and virological methods.
    Blood tests can also look for similar viruses like dengue and Zika, which have similar symptoms.

    Test results are normally available 4 to 14 days after a specimen is received by the lab.

    Prognosis of Chikungunya

    Most patients recover fully from the infection, but in some cases joint pain may persist for several months, or even years.

    According to the CDC, some patients will have a relapse of rheumatologic symptoms such as polyarthralgia, polyarthritis, tenosynovitis, or Raynaud's syndrome in the months after acute illness. Studies have reported that anywhere from 5 to 80 percent of patients may experience persistent joint pain, as well as prolonged fatigue, for months or years after their illness.

    Once an individual is recovered, they are likely to be immune from future infections.

    Severe cases and deaths from chikungunya are very rare and are almost always related to other existing health problems. People at risk for more severe disease include newborn babies infected around the time of birth, adults over the age of 65, and people with medical conditions such as high blood pressure, diabetes, or heart disease.

    Duration of Chikungunya

    According to the CDC, fevers typically last from several days to a week. The fever can also be biphasic, meaning it may come in two stages.right up arrow
    Treatment and Medication Options for Chikungunya
    There is no specific antiviral drug for chikungunya, so treatment involves relieving the symptoms. Treatment includes:

    • Antipyretics to reduce fever
    • Analgesics for pain relief and to reduce fever
    • Drinking plenty of fluids
    • Rest
    Given the similarity of symptoms between chikungunya and dengue, in areas where both viruses circulate, suspected chikungunya patients should avoid using aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) until a dengue diagnosis is ruled out (this is because these medicines can increase the risk of bleeding with dengue).

    Once a diagnosis is established, patients with persistent joint pain can use nonsteroidal anti-inflammatory drugs and corticosteroids, including topical preparations. Physical therapy may help lessen the symptoms.

    Prevention of Chikungunya

    There is no vaccine or preventive drug for chikungunya, so the best way to avoid infection is to prevent mosquito bites. But there are potential vaccines being evaluated in clinical testing.

    Basic precautions should be taken by people traveling to high risk areas, including:

    • Wearing long sleeves, long pants, and other clothing that minimizes skin exposure
    • Using insect repellents on skin or clothing
    Making sure indoor spaces have adequate screens to keep mosquitoes out
    Using insecticide-treated mosquito nets over your bed if you sleep in the daytime
    Wearing mosquito netting over your face and neck, in addition to using gloves or repellents, if you spend a lot of time outdoors in areas with mosquitoes
    Avoiding travel to areas experiencing a chikungunya outbreak

    Using mosquito coils and insecticide vaporizers during the day time

    Reducing the number of places that mosquitos breed around your home can cut down the population significantly. Some simple actions include:

    • Emptying water from containers, such as the saucers under potted plants, vases, buckets, and rain gutters
    • Covering water containers that cannot be emptied, such as tanks or reservoirs that provide household water
    • Getting rid of old tires that may be left outside
    • Keeping garbage in closed plastic bags and other closed containers
    • If you have been diagnosed with chikungunya, you should take care to prevent mosquito bites during the first week of your illness, when the virus can be passed to a mosquito and then to another person.

    7 Natural Ways to Prevent Mosquito Bites

    When it comes to fending off itchy mosquito bites, synthetic repellents are not your only option. Find out what else works to ward off pesky mosquitoes.
    Complications of Chikungunya
    Serious complications are not common, but occasionally infection can lead to serious problems of the skin, eyes, kidneys, heart, or nervous system.

    Rare but serious complications include:

    • Myocarditis
    • Ocular disease (uveitis, retinitis)
    • Hepatitis
    • Acute renal disease
    • Severe bullous lesions
    Neurologic disease such as meningoencephalitis, Guillain-Barré syndrome, myelitis, or cranial nerve palsies

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