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Chikungunya - Chem-Bio-Rad Suspicion
See also in: Overview
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Chikungunya - Chem-Bio-Rad Suspicion

See also in: Overview
Contributors: Neil Mendoza MD, Susan Burgin MD, David R. Lane MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Chikungunya (CHIK) fever is a mosquito-borne alphavirus of the Togaviridae family that is endemic in sub-Saharan Africa, Southeast Asia, Indonesia, the Philippines and India, with the first local transmission in the Americas being reported in late 2013 on islands in the Caribbean. Many cases have since been reported in the Caribbean, especially the Dominican Republic. The typical clinical presentation is fever and joint pain.

The incubation period of CHIK fever is 1-12 days (usually 2-3 days). The initial symptoms consist of the abrupt onset of 3-10 days of flu-like illness with fever, chills, arthralgias, rash, myalgias, severe headache, retro-orbital pain, and photophobia. Pruritus, nausea and vomiting, abdominal pain, and diarrhea may be noted. The severity of disease varies across a wide spectrum. Per the CDC, approximately 3%-28% of people infected with the virus will remain asymptomatic. In a 2016 report of 110 nonpregnant adults hospitalized due to chikungunya virus infection in Guadeloupe, 42 had a severe form of disease with a syndrome consistent with severe sepsis or septic shock. Severe illness and death have also been reported in a subset of patients during other outbreaks, including in Reunion Island.

Arthralgias are typically symmetrical, involve many joints, and are migratory. They primarily affect the small joints of the hands, wrists, ankles, and feet and may last for weeks to months. There is typically visible or palpable swelling of the joints. Flushing of the face and trunk is seen, and then macules and papules develop on the trunk and extremities and, occasionally, the palms, soles, and face. Buccal and palatal exanthems may be present. Lymphadenopathy and sore throat may be seen in some patients. Hypocalcemia and an elevated creatine kinase level may occur in some patients. Rarely, mucosal and gastrointestinal hemorrhage may occur. Mucosal involvement is more likely in children. Neonates, elderly individuals, and those with underlying medical conditions are at higher risk for severe or atypical disease.

CHIK fever is transmitted by the bite of infected mosquitoes, most commonly Aedes aegyptii and Aedes albopticus (which can also transmit dengue virus). Natural reservoirs include humans, primates, other mammals, and birds, but humans are the primary amplifying host (ie, can infect mosquitoes that bite them during the first week of illness). There is evidence of mother-to-child transmission in the perinatal period in mothers with acute infection, with subsequent high levels of morbidity for the neonate. There is no evidence supporting transmission via breastfeeding.

Avoidance of mosquito bites is the primary method of prevention. Wearing long sleeve shirts and pants, applying mosquito repellent to exposed skin, using bed nets and ensuring adequate screens on windows and doors, and minimizing potential local mosquito reservoirs such as standing water are considered standard forms of mosquito-bite reduction.

An experimental vaccine exists but is not yet available. There is no specific antiviral therapy; treatment is supportive.

Codes

ICD10CM:
A92.0 – Chikungunya virus disease

SNOMEDCT:
111864006 – Chikungunya fever

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Dengue fever is clinically similar; dengue virus infection more often causes neutropenia, thrombocytopenia, and hemorrhage, while chikungunya more commonly presents with severe arthralgia, acute fever, lymphopenia, and rash.

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Last Updated:05/13/2019
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Chikungunya - Chem-Bio-Rad Suspicion
See also in: Overview
A medical illustration showing key findings of Chikungunya (Acute Infection) : Abdominal pain, Diarrhea, Fever, Headache, Nausea/vomiting, Photophobia, Polyarthralgia, Retroorbital pain, South America, Widespread distribution, Myalgia, Maculopapular erythema, Mosquito bite
Copyright © 2022 VisualDx®. All rights reserved.