Maculopapular rash 3 days after fever onset, often starting on extremities.
Other symptoms: Abdominal pain, diarrhea, vomiting, generalized lymphadenopathy, red eyes, conjunctivitis, anterior uveitis.
Rare manifestations: Vesiculobullous and mucocutaneous lesions, encephalitis (especially in newborns from maternal-fetal transmission), sepsis, renal issues.
Ocular issues: Red eyes, conjunctivitis, anterior uveitis, retinitis.
Evaluation
Clinical Findings: Fever and polyarthralgia in a person recently returning from an affected region.
Differentiation from Dengue: CHIKV more likely to cause severe arthralgia, arthritis, rash, lymphopenia; DENV more likely to cause neutropenia, thrombocytopenia, hemorrhage, shock, death.
Diagnostic Methods:
RT-PCR: Best during acute infection (first five days).
Serology (ELISA, IFA): Detection of anti-chikungunya antibodies (IgM and IgG).
CDC and WHO Recommendations: Gather serology for CHIKV, DENV, and Zika virus for all patients with suspicious symptoms.
Treatment / Management
Symptomatic Relief: Hydration, rest, pain/fever relief with acetaminophen.
Initial Care: Avoid aspirin and NSAIDs during the first 48 hours to prevent platelet dysfunction, especially with possible DENV coinfection.
Chronic Symptoms: May respond to hydroxychloroquine with corticosteroids or other DMARDs.
Research: Promising results for specific antivirals, but none approved for human use.
Prevention:
Avoidance of mosquito bites with repellents (DEET), protective clothing, bed nets, reduction of water puddles.
Use of insecticides, though resistance is a growing concern.
Vaccines: Under research, none approved for use.
Differential Diagnosis
Acute Manifestations:
Malaria
Yellow fever
Leptospirosis
Measles
Mononucleosis
African tick bite fever
Chronic Arthralgia:
Seronegative rheumatoid arthritis
Reiter arthritis
Rheumatoid arthritis
Hepatitis C
Systemic lupus erythematosus
Prognosis
Low Case Fatality Ratio: Significant chronic polyarthralgia, defined as joint pains lasting longer than 6 weeks.
Post-Chikungunya Arthritis: Reported in 26-40% of cases, causing substantial morbidity.
Complications
Chronic Arthritis: Most common and severe complication.
Ocular Manifestations: Conjunctivitis, optic neuritis, iridocyclitis, episcleritis, retinitis, uveitis, typically benign and self-limited.
Consultations
Rheumatologists: For chronic arthritis due to swelling, recurrent pain, treatment challenges, and similarity to rheumatic arthritis.
Deterrence and Patient Education
Awareness: Understanding mosquito transmission, symptoms, and prevention.
