Contents

Search

chikungunya; Sepik fever

Etiology: - viral infection with chikungunya virus Epidemiology: - transmitted to humans by virus-carrying Aedes mosquitoes - epidemics in Africa & Asia - travelers to the Caribbean [6,11] - Southeast Asia, India, Sub-Saharan Africa [[7] - identified in 17 countries or territories in the Caribbean & South America [8] (June 2014) - local transmission of the virus first hit the Western Hemisphere in December 2013 - first likely transmission within U.S. reported by CDC in July 2014 [CDC] - Southern Florida is endemic area [13] - incubation period 48-72 hours [16] Genetics: - see chikungunya virus Clinical manifestations: - causes symptoms similar to dengue fever - abrupt onset of fever > 30 C - acute febrile phase lasting 2-5 days, followed by a prolonged arthralgic phases - high fever often recurrent after an afebrile period "saddle back fever" - bilateral symmetrical arthralgia - arthralgia more severe than with dengue [13] - may persist for weeks or months, or in some cases years - more significant polyarthralgia with migratory arthralgias - arthralgias of the hands, wrist & ankles [13] - usually involves >= 10 joints - maculopapular rash on trunk & limbs (50%) [10,13] - mucosal ulcers [11] - headache - encephalitis [12] - ocular inflammation from Chikungunya may present as iridocyclitis; retinal lesions as well - idiopathic pedal edema is observed in many patients, not related to cardiovascular, renal or hepatic disease Laboratory: - complete blood count - thrombocytopenia much less common than dengue [13] - chikungunya virus RNA by RT-PCR a) uses nested primer pairs to amplify several Chikungunya- specific genes from whole blood b) results available in 1-2 days c) testing reliable for only 1 week after onset of symptoms [13] - virus isolation: chikungunya virus culture a) most definitive diagnosis b) takes 1-2 weeks for completion c) must be carried out in Biosafety level 3 laboratories d) involves exposing specific cell lines to whole blood & identifying chikungunya virus-specific responses - chikungunya virus serology a) requires a larger amount of blood than the other methods b) uses an ELISA assay to measure Chikungunya-specific IgM levels c) results available in 2-3 days d) results positive for up to 2-3 months [13] e) false positives can occur with infection via other related viruses such as O'nyong'nyong virus & Semliki Forest Virus f) available from the University of Malaya in Kuala Lumpur, Malaysia Differential diagosis: - dengue incubation time 4-10 days - Zika incubation is 3-14 days [16] - rash of dengue not as prominent as Chikungunya or Zika - myalgia of dengue more prominent than Chikungunya or Zika - arthralgia of dengue less prominent than Chikungunya or Zika - bleeding not a feature of Chikungunya or Zika - shock not a feature of Chikungunya or Zika - conjunctivitis not a feature of dengue or Chikungunya [16] Management: - no established effective therapy - chloroquine phosphate 250 mg/day has been used with some success - hyperimmune serum may be of benefit [1] - chikungunya vaccine immunogenic & safe in phase 1 trial [9] - FDA Approves 1st chikungunya vaccine [17] - prognosis: - younger patients recover within 5-15 days - middle-aged patients recover in 1-2.5 months - recovery is longer for the elderly

Related

chikungunya virus

General

viral infection

References

  1. Couderc T et al Prophylaxis and therapy for chikungunya virus infection. J Infect Dis 2009 Jul 2; http://dx.doi.org/10.1086/600381 - Michault A and Staikowsky F. Chikungunya: First steps toward specific treatment and prophylaxis. J Infect Dis 2009 Jul 2; http://dx.doi.org/10.1086/600382
  2. Wikipedia: Chikungunya http://en.wikipedia.org/wiki/Chikungunya
  3. Communicable Diseases: Chikungunya Fever Laboratory Diagnosis of Chikungunya Fevers World Health Organization http://www.searo.who.int/EN/Section10/Section2246_12902.htm
  4. Chhabra M et al Chikungunya fever: a re-emerging viral infection. Indian J Med Microbiol. 2008 Jan-Mar;26(1):5-12 PMID: 18227590
  5. Powers AM & Logue CH Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus Published online ahead of print on 31 May 2007 as DOI 10.1099/vir.0.82858-0. http://www.sgm.ac.uk/jgvdirect/82858/82858ft.pdf J Gen Virol. 2007 Sep;88(Pt 9):2363-77 PMID: 17698645
  6. Centers for Disease Control and Prevention Notice to Public Health Officials and Clinicians: Recognizing, Managing, and Reporting Chikungunya Virus Infections in Travelers Returning from the Caribbean. CDC Health Advisory. Dec 13, 2013 http://emergency.cdc.gov/HAN/han00358.asp
  7. Centers for Disease Control and Prevention Geographic Distribution of Chikungunya Virus. Jan 21, 2014. http://www.cdc.gov/chikungunya/map/index.html
  8. Fischer M and Staples EJ Centers for Disease Control and Prevention Notes from the Field: Chikungunya Virus Spreads in the Americas - Caribbean and South America, 2013-2014. MMWR. June 6, 2014 / 63(22);500-501 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6322a5.htm
  9. Chang LJ et al. Safety and tolerability of chikungunya virus-like particle vaccine in healthy adults: A phase 1 dose-escalation trial. Lancet 2014 Aug 15 PMID: 25132507 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961185-5/fulltext - Powers AM. Chikungunya virus control: Is a vaccine on the horizon? Lancet 2014 Aug 15 PMID: 25132506 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961290-3/fulltext
  10. Hamer DH, Chen LH Chikungunya: Establishing a New Home in the Western Hemisphere. Ann Intern Med. Published online 23 September 2014 PMID: 25244354 http://annals.org/article.aspx?articleid=1906848
  11. Hyle EP, Alame D Case records of the Massachusetts General Hospital. Case 13-2015. A 27-year-old woman with arthralgias and a rash. N Engl J Med 2015; 372:1657-1664April 23, 2015 PMID: 25901430 http://www.nejm.org/doi/full/10.1056/NEJMcpc1415172
  12. Gerardin P et al Chikungunya virus-associated encephalitis: A cohort study on La Reunion Island, 2005-2009. Neurology. Nov 25, 2015 PMID: 26609145 http://www.neurology.org/content/early/2015/11/25/WNL.0000000000002234.short?rss=1
  13. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
  14. Pathak H, Mohsn MC, Ravindran C Chikungunya arthritis. Clin Med (Lond). 2019 Sep;19(5):381-385 PMID: 31530685 PMCID: PMC6771335 Free PMC article
  15. Amaral JK et al Chronic Chikungunya Arthritis and Rheumatoid Arthritis: What They Have in Common. Am J Med. 2020 Mar;133(3):e91-e97 PMID: 31705850 PMCID: PMC7385732 Free PMC article
  16. Bronze MS Fast Five Quiz: Dengue Medscape. August 22, 2022 https://reference.medscape.com/viewarticle/995704
  17. Harris E FDA Approves First Chikungunya Vaccine. JAMA. Published online November 29, 2023. PMID: 38019496 https://jamanetwork.com/journals/jama/fullarticle/2812514
  18. Centers for Disease Control and Prevention (CDC) Chikungunya virus. http://www.cdc.gov/chikungunya/