Chikungunya

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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
  • Chikungunya” is a Tanzanian derived word meaning “that which bends up”[1]

Geographic Distribution

Chikungunya geographic distribution

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

AFRICA OCEANIA/PACIFIC ISLANDS AMERICAS
Benin American Samoa Anguilla
Burundi Federal States of Micronesia Antigua and Barbuda
Cameroon New Caledonia Aruba
Central African Republic Papua New Guinea Bahamas
Comoros Tonga Barbados
Democratic Republic of the Congo ASIA Brazil
Equatorial Guinea Bangladesh British Virgin Islands
Gabon Bhutan Cayman Islands
Guinea Cambodia Colombia
Kenya China Costa Rica
Madagascar India Curacao
Malawi Indonesia Dominica
Mauritius Laos Dominican Republic
Mayotte Malaysia El Salvador
Nigeria Maldives French Guiana
Republic of Congo Myanmar (Burma) Grenada
Reunion Pakistan Guadeloupe
Senegal Philippines Guatemala
Seychelles Saudi Arabia Guyana
Sierra Leone Singapore Haiti
South Africa Sri Lanka Jamaica
Sudan Taiwan Martinique
Tanzania Thailand Montserrat
Uganda Timor Nicaragua
Zimbabwe Vietnam Panama
EUROPE Yemen Puerto Rico
Italy Saint Barthelemy
France 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 foot2
  • Fever typically greater than 39deg
  • Polyarthralgias, bilateral and symmetrical
  • Rash- maculopapular
  • Myalgias
  • Nausea and vomiting
  • Lymphocytopenia
  • Elevated LFTs
  • AKI
  • 3-7d incubation period
  • Possible "saddle-back fever"
    • Febrile again 1-2 days after afebrile period
    • Afebrile period typically 4-10 days

Chronic

  • May cause long-term symptoms, with long-term musculoskeletal pain from months to years post infection[2]

Differential Diagnosis

Fever in traveler

Travel-related skin conditions

Papules

Sub Q Swelling and Nodules

Ulcers

Linear and Migratory Lesions

Evaluation

  • 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

External Links

References

  1. Burt FJ, Rolph MS, Rulli NE, et al. Chikungunya: a re-emerging virus. Lancet. 2012;379:662-671
  2. Gérardin et al. "Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study." Arthritis research & therapy. Jan 9, 2013. 15(1). pmid=23302155. doi=10.1186/ar4137