Chikungunya

Background

• Aedes mosquito transmitted virus, originally found in West Africa but cases in the Americas beginning in 2013
• Frequently difficult clinically to differentiate from dengue fever

Geographic Distribution

Chikungunya geographic distribution

Countries and territories where chikungunya cases have been reported (as of 10/2014):

• AFRICA
  • Benin
  • Burundi
  • Cameroon
  • Central African Republic
  • Comoros
  • Democratic Republic of the Congo
  • Equatorial Guinea
  • Gabon
  • Guinea
  • Kenya
  • Madagascar
  • Malawi
  • Mauritius
  • Mayotte
  • Nigeria
  • Republic of Congo
  • Reunion
  • Senegal
  • Seychelles
  • Sierra Leone
  • South Africa
  • Sudan
  • Tanzania
  • Uganda
  • Zimbabwe
• EUROPE
  • Italy
  • France
• OCEANIA/PACIFIC ISLANDS
  • American Samoa
  • Federal States of Micronesia
  • New Caledonia
  • Papua New Guinea
  • Tonga
• ASIA
  • Bangladesh
  • Bhutan
  • Cambodia
  • China
  • India
  • Indonesia
  • Laos
  • Malaysia
  • Maldives
  • Myanmar (Burma)
  • Pakistan
  • Philippines
  • Saudi Arabia
  • Singapore
  • Sri Lanka
  • Taiwan
  • Thailand
  • Timor
  • Vietnam
  • Yemen
• AMERICAS
  • Anguilla
  • Antigua and Barbuda
  • Aruba
  • Bahamas
  • Barbados
  • Brazil
  • British Virgin Islands
  • Cayman Islands
  • Colombia
  • Costa Rica
  • Curacao
  • Dominica
  • Dominican Republic
  • El Salvador
  • French Guiana
  • Grenada
  • Guadeloupe
  • Guatemala
  • Guyana
  • Haiti
  • Jamaica
  • Martinique
  • Montserrat
  • Nicaragua
  • Panama
  • Puerto Rico
  • Saint Barthelemy
  • Saint Kitts and Nevis
  • Saint Martin
  • Sint Maarten
  • Saint Lucia
  • Saint Vincent and the Grenadines
  • Suriname
  • Trinidad and Tobago
  • Turks and Caicos Islands
  • United States
  • US Virgin Islands
  • Venezuela

Clinical Features

Acute

Chikungunya rash on foot

• Fever typically greater than 39deg
• Polyarthralgias, bilateral and symmetrical
• Rash- maculopapular
• Myalgias
• Nausea and vomiting
• Lymphocytopenia
• Elevated LFTs
• AKI
• 3-7d incubation period

Chronic

• May cause long-term symptoms, with long-term musculoskeletal pain from months to years post infection

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Travel-related skin conditions

• Papules
  • Insect bites
  • Scabies
  • Seabather's eruption
  • Cercarial dermatitis (Swimmer's Itch)
• Macular
  • Chikungunya
• Sub Q Swelling and Nodules
  • Myiasis
  • Tungiasis
  • Loa loa
  • African Trypanosomiasis
  • Onchocerciasis
• Ulcers
  • Tropical pyoderma
  • Leishmaniasis
  • Mycobacterium marinum
  • Buruli ulcer
  • Dracunculiasis (Guinea Worm disease)
• Linear and Migratory Lesions
  • Cutaneous larvae migrans
  • Photodermatitis

See also domestic U.S. ectoparasites

Workup

• CBC w diff, Cr, LFTs
• contact CDC for specialized testing; recommends tiger top tube

Management

Symptomatic treatment: acute symptoms usually resolve in 7-10d

Disposition

• Normally able to be treated as outpatient, unless complication

See Also

• Travel Medicine

Sources

CDC