CHIKUNGUNYA
CHIKUNGUNYA ICD10: A92
CLINICAL MANIFESTATION
The majority of people infected with chikungunya virus become symptomatic. The incubation period is typically 3 to 7 days (range, 1 to 12 days). The disease is most often characterized by acute onset of fever (typically >39°C [102°F]) and polyarthralgia. Joint symptoms are usually bilateral and symmetric, and can be severe and debilitating. Other symptoms may include headache, myalgia, arthritis, conjunctivitis, nausea/vomiting, or maculopapular rash. Clinical laboratory findings can include lymphopenia, thrombocytopenia, elevated creatinine, and elevated hepatic transaminases. RECOVERY PHASE Acute symptoms typically resolve within 7 to 10 days. Rare complications include uveitis, retinitis, myocarditis, hepatitis, nephritis, bullous skin lesions, hemorrhage, meningoencephalitis, myelitis, cranial nerve
palsies, and Guillain–Barré syndrome. Some patients might have relapse of rheumatologic symptoms (e.g., polyarthralgia, polyarthritis, tenosynovitis) in the months following acute illness. Variable proportions of patients with persistent joint pains for months to years. Mortality is rare and occurs mostly in older adults. DIFFERENTIAL DIAGNOSIS Varies based on place of residence, travel history, and exposures. Dengue and chikungunya viruses are transmitted by the same mosquitoes and have similar clinical features. The two viruses can circulate in the same area and can cause occasional co-infections in the same patient. MANAGEMENT There is no specific antiviral therapy for chikungunya virus infection. Treatment is for symptoms and can include rest, fluids, and use of nonsteroidal anti- inflammatory drugs (NSAIDs) to relieve acute pain and fever.