Chikungunya in Adult
Alerts and Notices
SynopsisChikungunya is a mosquito-borne alphavirus of the Togaviridae family endemic in sub-Saharan Africa, Southeast Asia, Indonesia, the Philippines, India, and now, the Americas. The first local transmission in the Americas was reported in late 2013 on islands in the Caribbean. Many cases have since been reported in the Caribbean, especially the Dominican Republic, and throughout Central and parts of South America. The typical clinical presentation is fever and joint pain with many, but not all, patients developing a rash.
The incubation period of chikungunya is 1-14 days (usually 3-7 days). The initial symptoms consist of the abrupt onset of 3-7 days of flu-like illness with fever, chills, arthralgias, rash, myalgias, severe headache, retro-orbital pain, and photophobia. The fever is high and remitting (a fever that goes up and down without ever returning to normal). Arthralgias often precede the onset of fever in nearly three-fourths of cases. Pruritus may be noted. The rash of chikungunya may consist of widespread erythematous macules or macules and papules. 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 on 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. 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 (high blood pressure, diabetes, and heart disease) are at higher risk for severe or atypical disease.
Chikungunya is transmitted by the bite of infected mosquitoes, primarily Aedes aegypti and Aedes albopictus (which can also transmit dengue virus). Natural reservoirs include humans, primates, other mammals, and birds, but humans are the primary amplifying host (ie, humans can infect mosquitoes that bite them during the first week of illness). Person-to-person transmission of chikungunya has not been documented, although there have been reports of maternal-fetal 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. An experimental vaccine exists but is not yet available. There is no specific antiviral therapy; treatment is supportive.
Travelers to endemic areas are at higher risk for contracting chikungunya. In 2014, over 1600 travel-associated cases were reported throughout the United States, resulting in 11 locally transmitted cases (all in Florida). Travelers to areas with known ongoing outbreaks should use mosquito repellents, long-sleeved shirts, long pants, etc, to help prevent bites from these aggressive, day-biting mosquitoes.
A92.0 – Chikungunya virus disease
111864006 – Chikungunya fever
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.
- Bacterial sepsis
- Hemorrhagic viral fevers
- Other alphavirus infections
- Ross River virus
- Alkhurma virus
- Zika virus infection
- Postinfectious arthritis or other rheumatologic conditions
- Stevens-Johnson syndrome / toxic epidermal necrolysis
Patient Information for Chikungunya in Adult
OverviewChikungunya is a virus spread by mosquito bites. The virus infection was once considered a tropical disease, found mainly in Africa, India, and Southeast Asia. But in 2007, there was an outbreak in southern Europe. In 2013, patients were diagnosed with chikungunya in the Caribbean Islands. Since then, it has spread to Central and South America. In 2014, local cases were reported in Florida.
Symptoms begin 3-7 days after being bitten by an infected mosquito. However, the US Centers for Disease Control and Prevention (CDC) estimates that up to 28% of people with chikungunya virus infection don't have any symptoms.
Most people recover fully on their own in less than 3 weeks, but for some people, the virus can cause severe disease with joint pain that can last for months.
Who’s At RiskPeople who are at risk:
- Travelers to countries where infected mosquitoes have been reported
- Newborns and older persons (over age 65)
- People who are immunocompromised, or have diabetes, high blood pressure, or heart disease
- People exposed to mosquito bites
Signs & SymptomsThe symptoms of chikungunya include:
- Severe joint pain and swelling (hands and feet)
- Onset 3-7 days after mosquito bite
- Muscle aches, muscle pain, itchy rash, and joint swelling
- Eye pain and light sensitivity
Self-Care GuidelinesThere is no vaccine for chikungunya. If you have been diagnosed with the virus by a doctor and you are otherwise healthy, rest and drink lots of fluid. Over-the-counter pain relievers such as acetaminophen and ibuprofen will help with joint pain and fever.
Avoid mosquito bites to protect your community:
- Use air-conditioning or screens on windows and doors
- Use mosquito repellant containing DEET, picaridin (US),or icaridin (outside US)
- Wear long-sleeved shirts, pants, and socks
- Empty standing water from outdoor containers to kill mosquito eggs and larvae
When to Seek Medical CareIf you suspect you have chikungunya, see a medical professional. There may be serious complications, especially in older adults, newborns, and people with existing medical conditions.
TreatmentsYour doctor will order a blood test to look for signs of the chikungunya virus and other, similar infections.
There is currently no vaccine or anti-viral medication for chikungunya virus.
Your doctor may prescribe medicine to relieve joint pain. This pain usually goes away on its own in about 3 weeks. Tell your health care provider if the pain continues after a month.
Chikungunya in Adult