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Chikungunya
2012-01-09 Chikungunya on the right feet at The Philippines
Presentation
- Given the wide variety of presentations, chikungunya fever-related uveitis should be included in the differential diagnosis of all at-risk patients presenting with acute ocular inflammation, particularly those traveling from endemic regions.[ncbi.nlm.nih.gov]
- With this exponential rise in these illness, now we are beginning to notice uncommon presentations of these common illnesses.[ncbi.nlm.nih.gov]
- The present era of international travel poses a new diagnostic and epidemiologic challenge that demands increased awareness to the possibility of an exotic tropical infectious disease.[ncbi.nlm.nih.gov]
- RESULTS: Abnormal neurological examination with fever was typical presentation in all 13 babies with/without seizures/peri-oral rashes; 12 had persistent neurological abnormalities at discharge.[ncbi.nlm.nih.gov]
- We present the case of a 69-year-old woman presenting with an acute unilateral optic neuropathy as a delayed complication of Chikungunya virus (CHIKV) infection contracted during a recent trip to the West Indies.[ncbi.nlm.nih.gov]
Entire Body System
Fever
- Chikungunya and dengue fevers The clinical manifestations of chikungunya fever have to be distinguished from dengue fever.[web.archive.org]
- Of 652 patients included in the surveillance of yellow fever in DRC from January 2003 to January 2012, 453 patients that tested negative for yellow fever virus (YFV) immunoglobulin M (IgM) antibodies were selected for the study.[ncbi.nlm.nih.gov]
- Situation updates - Chikungunya 15 July 2009 Chikungunya Fever in South-East Asia Find all updates 10 June 2009 Chikungunya Fever in South-East Asia Find all updates 23 October 2007 Chikungunya Fever in the Province of Ravenna, Italy Find all updates[web.archive.org]
- Because CHIK fever epidemics are sustained by human-mosquito-human transmission, the epidemic cycle is similar to those of dengue and urban yellow fever.[cdc.gov]
Chills
- The initial manifestations of this virus are sudden onset high fever, headache, chills, rashes, myalgia and intense joint pain.[ncbi.nlm.nih.gov]
- It comes on like the flu — fever, chills, headache, aching joints — and typically lingers for a week. Many patients later develop severe joint pain that can recur for months or years.[sciencenews.org]
- Symptoms It is generally characterized by abrupt onset of fever, chills which is accompanied by joint pain.[aimu.us]
- Fever, chills, headache and muscle pain. Joint swelling, stiffness and pain, especially in the mornings. A rash, usually on the trunk or limbs. This usually lasts for 7 - 10 days. A feeling of tiredness or weakness.[health.nsw.gov.au]
- Other symptoms include headache, muscle aches, weakness, chills, and gastrointestinal symptoms. Approximately half of infected persons develop a rash on the trunk and limbs.[tripprep.com]
Infectious Mononucleosis
- Chikungunya virus infection may resemble the following: Dengue fever Zika virus Malaria Infectious mononucleosis HIV infection Group A Streptococcus Meningococcal infection Ross river virus Parvovirus Rubella Other viruses, including enterovirus, adenovirus[emedicinehealth.com]
Plethora
- A plethora of ocular manifestations have been described ranging from a non-specific conjunctivitis to exudative retinal detachment. Ocular chikungunya seems to respond well to corticosteroid therapy, and outcomes are usually better if treated early.[ncbi.nlm.nih.gov]
Gastrointestinal
Abdominal Distension
- Both infants presented on day 3 with abdominal distension, reduced perfusion pressure, and hypotension; acrocyanosis progressing to ischemic digits; and respiratory distress. Both died within 24-48 hours of presentation.[ncbi.nlm.nih.gov]
Cardiovascular
Acrocyanosis
- Both infants presented on day 3 with abdominal distension, reduced perfusion pressure, and hypotension; acrocyanosis progressing to ischemic digits; and respiratory distress. Both died within 24-48 hours of presentation.[ncbi.nlm.nih.gov]
Jaw & Teeth
Bleeding Gums
- Some cases brought on nosebleeds and bleeding gums. While joint and muscle pain may continue, there are few other long-term effects. These symptoms can sometimes last for months or years after infection.[passporthealthusa.com]
- Haemorrhagic manifestations (petechiae, purpura, bleeding gums, nosebleeds, haematemesis, and melena) Footnote 1 have been documented, but only in Asia Footnote 10.[phac-aspc.gc.ca]
- gums (uncommon) Symptoms of chikungunya can be severe and disabling in some people.[emedicinehealth.com]
- Bleeding gums and nosebleeds have often been described in connection with the disease, mainly in Asia.[pasteur.fr]
Ears
Tinnitus
- The results of tinnitus evaluation showed low-pitched tinnitus and it was persistent causing significant handicap to him based on self report tinnitus handicap questionnaire results.[ncbi.nlm.nih.gov]
Eyes
Scotoma
- At 5-month follow-up, there was a persistent right RAPD and marked optic atrophy with a corresponding inferior scotoma in the visual field.[ncbi.nlm.nih.gov]
Musculoskeletal
Arthralgia
- (A) Percentage of patients with arthralgia among participating patients, (B) localization of arthralgia among patients with arthralgia, (C) number of arthralgia sites among the 76 patients answering at every time point and having arthralgia, (D) complete[doi.org]
- OBJECTIVE: We present a case of Chikungunya virus (CHIKV)-induced arthritis and review the literature surrounding Chikungunya-induced arthritis/arthralgias and associated musculoskeletal (MSK) manifestations.[ncbi.nlm.nih.gov]
- The median duration of the arthralgia was 75 days, and the joint pain lasted for 2 months in 8 patients and 6 months in 3 patients. Persistent arthralgia was not significantly associated with an age of 35 years (p 0.13) or patient sex (p 0.69).[ncbi.nlm.nih.gov]
- The disease is characteristically manifested as fever, arthralgia, and/or rash. Various neurological manifestations like meningoencephalitis, myelitis, and myeloneuropathy have been mentioned in various reports.[ncbi.nlm.nih.gov]
- We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities.[ncbi.nlm.nih.gov]
Skin
Maculopapular Rash
- We present three Israeli travelers who developed fever, maculopapular rash and long-standing arthralgias while visiting northern Indian states not known to be involved in the chikungunya fever epidemic.[ncbi.nlm.nih.gov]
- The classic tetrad of symptoms for CHIKV is fever, symmetric polyarthralgia, maculopapular rash, and nonpurulent conjunctivitis. Although the majority (3 of 4) of infected people will be symptomatic, the viral illness generally runs a benign course.[ncbi.nlm.nih.gov]
- INTRODUCTION: Chikungunya fever often presents with severe arthritis/arthralgias, high fever, myalgias, headache, and maculopapular rash (Chow et al., 2011 [1]; Das et al., 2010 [2]; Mizuno et al., 2011 [3]; Powers, 2010 [4]; Sissoko et al., 2010 [5];[ncbi.nlm.nih.gov]
- rash, thrombocytopenia and leukopenia.[doi.org]
- Although 4 out of 5 people infected with Zika virus never develop symptoms, when symptoms do occur they may include fever, arthralgia, maculopapular rash, and conjunctivitis. Zika is categorized in flaviviruses.[raredr.com]
Exanthema
- A rash manifesting as macular or maculopapular exanthema and/or erythema was observed in 15 patients (75%). Generalized pruritus occurred in 5 patients (25%) and conjunctivitis occurred in 4 patients (20%).[doi.org]
- Neonatal CHIKV infection was symptomatic after 4 days in one in two cases, with fever, pain, prostration, poor feeding, diffuse pain, distal joint edema, and miscellaneous skin alterations (petechiae, exanthema).[doi.org]
- Most likely, these results are due to a broad/inclusive case definition (fever or exanthema plus another symptom) used by the surveillance system, which could be caused by various infectious and non-infectious conditions.[nature.com]
Neurologic
Headache
- We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities.[ncbi.nlm.nih.gov]
- But it causes a high fever, headache, nausea and extreme joint pain — which can linger for months. And there's no cure or vaccine.[web.archive.org]
- Myalgia, severe headache, and lymphadenopathy are frequently associated. Chronically the disease may cause recurrent, long-term polyarthralgia, arthritis, fatigue, and depression.[orpha.net]
- Chikungunya fever is a mosquito-borne viral disease with symptoms such as fever, joint pain, muscle pain, headache and nose and gum bleeding. Chikungunya is present in parts of Africa, Southeast Asia and on the Indian sub-continent.[web.archive.org]
- Article Figures/Media Metrics Chikungunya virus infection is a rapid-onset, febrile disease with intense asthenia, arthralgia, myalgia, headache, and rash.[doi.org]
Neck Stiffness
- On April 29, he had onset of illness with fever, chills, joint pain (in the wrists and ankles), and neck stiffness; a rash appeared a few days later.[cdc.gov]
Dysarthria
- Here we report a case of post chikungunya reversible demyelinating encephalitis who presented with vertigo, dysarthria and ataxia. There was complete clinical as well as radiological improvement with steroids.[ncbi.nlm.nih.gov]
Workup
- Following a broad workup that included laboratory testing for dengue and malaria, our patient was diagnosed with Chikungunya virus, which was then reported to the Centers for Disease Control and Prevention for initiation of infection control.[ncbi.nlm.nih.gov]
- Extensive workup was negative with the exception of positive chikungunya virus immunoglobulin G and immunoglobulin M titers.[ncbi.nlm.nih.gov]
- Patients with persistent arthralgia should be referred to a rheumatologist for additional workup and treatment [14]. See smartphone apps to check your skin. [Sponsored content] Related information References Staples JE, Breiman RF, Powers AM.[dermnetnz.org]
Treatment
- Chronic arthritis is one of the serious complications of CHIK infection, which is characterized by swelling and acute pain that poorly responds to treatment with analgesics.[ncbi.nlm.nih.gov]
- However, they have different downstream patient-to-patient transmission potentials, and require very different patient treatments.[ncbi.nlm.nih.gov]
- Treatment of chikungunya arthritis usually involves non-steroidal anti-inflammatory drugs.[ncbi.nlm.nih.gov]
- Initially, she responded to corticosteroid treatment but developed recurrent inflammation 3 months after completing the initial treatment.[ncbi.nlm.nih.gov]
- However, it is fundamental that studies of CHIK treatment be further developed.[ncbi.nlm.nih.gov]
Prognosis
- This could possibly correlate with a prognosis, in terms of fever duration, possibility for chronic joint pain, and infectiousness to mosquitoes.[bcm.edu]
- What should you tell the family about the patient’s prognosis? The overall prognosis with chikungunya fever is good. Mortality and complication rate is relatively low except in the elderly with multiple co-morbid conditions.[infectiousdiseaseadvisor.com]
- Such good prognosis as seen in the aforementioned cases may not be representative of the true clinical progression, and may be biased due to the early age of the patients 28.[f1000research.com]
- What Is the Prognosis for a Chikungunya Virus Infection? In general, chikungunya virus is self-limiting, and most cases resolve on their own in seven to 10 days. After effects may include joint pain ( arthritis ) that persists.[emedicinehealth.com]
- […] infection of neonates born to viremic mothers and exposed to the virus during birth can reach 50%, leading to severe disease and encephalopathy, resulting in long-term neurological sequelae and poor outcome. 62 In general, CHIKV infection has a good prognosis[elsevier.es]
Etiology
- Abstract For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done.[ncbi.nlm.nih.gov]
- Search terms included Chikungunya virus, etiology, and fever. Searches were limited to humans and English language publications. Additional relevant articles were obtained from the reference lists. 2013 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
- Overall, 57% of participants tested positive by IgM for one of these seven etiological agents.[doi.org]
- However, the etiologic spectrum largely depends on destination-specific epidemiologic variations, and travelers may serve as sentinels for the emergence and dissemination of pathogens that affect local populations.[doi.org]
- […] months. [1] Also, other additional lab values can include lymphopenia (low white blood cell count), thrombocytopenia (low blood platelet count), elevated creatinine, and elevated hepatic transaminases. [2] Radiological findings are typically normal. [3] Etiology[physio-pedia.com]
Epidemiology
- Report for 2017 Publication Communicable disease threats report, 17-23 March 2019, week 12 News Health risks during the Carnival season in Brazil News Epidemiological update: Chikungunya – Europe - 2017 News Epidemiological update: Chikungunya – Europe[ecdc.europa.eu]
- The present era of international travel poses a new diagnostic and epidemiologic challenge that demands increased awareness to the possibility of an exotic tropical infectious disease.[ncbi.nlm.nih.gov]
- There is an urgent need for further epidemiological and clinical studies to better understand the impact of CHIK in endemic areas in LAC.[ncbi.nlm.nih.gov]
- Mobilization of various stakeholders will lead to enhanced epidemiological and entomological surveillance that will allow for improved risk assessment in each area.[ncbi.nlm.nih.gov]
- There is limited information regarding the epidemiology and clinical information of imported CHIK in Japan.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution
Pathophysiology
- The possible pathophysiology of chikungunya virus causing ANSD and vestibular symptoms needs to be explored further in future studies.[ncbi.nlm.nih.gov]
- Given its public health and pathophysiological importance, we also investigated CHIKV infection in the pregnant host.[doi.org]
- BMC Infectious Diseases is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology[biomedcentral.com]
- Original Editors - Kristin Dierker & Kalie Reams from Bellarmine University's Pathophysiology of Complex Patient Problems project.[physio-pedia.com]
- The pathophysiology of human CHIKV infection has long been a mystery. Some hypotheses were first proposed based on data from other alphaviruses.[doi.org]
Prevention
- […] staying in the affected areas in order to prevent becoming infected with the virus.[ecdc.europa.eu]
- Prevention and control No vaccine is available against this virus infection. Prevention is entirely dependent upon taking steps to avoid mosquito bites and elimination of mosquito breeding sites.[web.archive.org]
- Anthony Fauci The most effective way to prevent Chikungunya infection is to prevent mosquito bites. And as there is no specific treatment once a person is infected, a vaccine represents the best hope of controlling the infection.[web.archive.org]
- No vaccine exists to prevent chikungunya virus infection or disease. Prevent chikungunya virus infection by avoiding mosquito bites (see below). The mosquitoes that spread the chikungunya virus bite mostly during the daytime.[web.archive.org]
- We currently have no specific treatment, vaccine, or preventive drug for chikungunya.[doi.org]