Chikungunya fever

Author: Vanessa Ngan, Staff Writer, 2008. Updated by Thomas Stewart. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell.


What is chikungunya fever?

Chikungunya is an arthropod-borne alphavirus transmitted by mosquitoes. It causes an acute febrile illness accompanied by a rash, joint pain and muscle pain.

Where does chikungunya virus come from?

Chikungunya virus (CHIK V) was first reported in Tanzania in 1952. Following the initial outbreaks in Africa and after more than three decades of quiescence, it made a resurgence and is currently endemic to several regions in Africa, India, South-East Asia, and the Western Pacific. Outbreaks have also become more frequent in the Indian Ocean and Pacific Island nations [1,2]. There have been no locally acquired cases in New Zealand or Australia; however, travellers can transport the virus after visiting endemic areas [3,4].  

How is chikungunya spread?

Chikungunya virus is transmitted to humans through the bite of an infected mosquito, mainly Aedes aegypti or A. albopictus. Mosquitos that are capable of spreading chikungunya virus exist in some parts of Australia but are not normally found in New Zealand [3,4].

Rarely, chikungunya spreads via the maternal-fetal route, through blood products, or organ transplantation [5].

What are the clinical features of chikungunya fever?

Chikungunya virus typically has an incubation period of 3–7 days (range 1–12 days) [6,7].

The first clinical manifestations are sudden-onset high fever and chills followed by severe polyarthralgia.

  • Classically, there is symmetrical involvement of several joints, especially the small joints of the hands and feet.
  • The arthralgia may persist for several months [6,7].
  • Other common non-specific symptoms include headache, myalgia, nausea, and lethargy.

Cutaneous manifestations of chikungunya

A wide range of mucocutaneous manifestations occurs, affecting up to 75% of patients with chikungunya during the disease course [6,7].

These have mainly been reported during chikungunya outbreaks in India.

  • An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on face, trunk and limbs. It is typically asymptomatic but may be pruritic [6–12].
  • The rash may result in post-inflammatory macules or diffuse pigmentation. This is most common on the face, characteristically affecting the nose [8–12].
  • Painful aphthous-like ulcers that predominantly involve the oral mucosa and groin are also common [8–12].

Other cutaneous features of chikungunya may include:

How is chikungunya fever diagnosed?

Chikungunya fever should be suspected in a patient with acute-onset fever and polyarthralgia when living in an endemic area, or following recent travel to an area where mosquito-borne transmission of chikungunya virus has been reported.

  • The diagnosis is confirmed by detection of viral RNA on polymerase chain reaction (PCR) testing or by positive viral serology.
  • Testing for dengue virus and zika virus should also be undertaken.

What is the treatment for chikungunya fever?

Chikungunya fever is usually self-limiting and no specific therapy is required or available.

How is chikungunya virus infection prevented?

No vaccine against chikungunya virus is currently available. Prevention relies primarily on avoidance of mosquitos (long-sleeved clothing, DEET insect repellents, insect screens and bed netting) [16].

What is the outcome of chikungunya fever?

The cutaneous manifestations of chikungunya typically resolve spontaneously within several weeks, without any need for specific dermatological treatment [8,9].

Patients with persistent arthralgias should be referred to a rheumatologist for additional workup and treatment [14].

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References

  1. Staples JE, Breiman RF, Powers AM. Chikungunya fever: An epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009; 49: 942–948. PubMed
  2. Panning M, Grywna K, van Esbroeck M, et al. Chikungunya fever in travelers returning to Europe from the Indian Ocean region. Emerg Infect Dis. 2008; 14: 416. PubMed
  3. Queensland Government. (2014). Chikungunya Virus. Available at http://conditions.health.qld.gov.au/HealthCondition/condition/14/217/24/Chikungunya-virus [Accessed on March 27 2018]
  4. New Zealand Government. Ministry of Health. (2014). Chikungunya virus. Available at https://www.health.govt.nz/our-work/diseases-and-conditions/chikungunya-virus [Accessed on March 27 2018]
  5. Staikowsky F, Talamin F, Grivad P, et al. Prospective study of Chikungunya virus acute infection in the Island of La Reunion during the 2005-2006 outbreak. PLoSOne. 2009; 28: e7603. PubMed
  6. Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. PubMed
  7. Lakshmi V, Neeraja M, Subbalaxmi MV, et al. Clinical features and molecular diagnosis of Chikungunya fever from South India. Clin Infect Dis. 2008; 46(9): 1436. PubMed
  8. Bandyopadhyay D & Ghosh SK. Mucocutaneous manifestation of chikungunya fever. Indian J Dermatol. 2010; 55: 84087. PubMed
  9. Kumar R, Sharma MK, Jain SK, et al. Cutaneous manifestations of chikungunya fever: Observations from an outbreak at a tertiary care hospital in Southeast Rajasthan, India. Indian Online J. 2017; 8: 336–42. PubMed
  10. Riyaz N, Riaz A, Rhima, et al. Cutaneous manifestations of chikungunya during a recent epidemic in Calicut, North Kerala, South India. Indian J Dermatol Venereol. 2010; 76: 671–76. PubMed
  11. Inamadar AC, Palit A, Sampagavi V, et al. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. International Journal of Dermatology 2008, 47, 154-9. PubMed
  12. Seetharam KA, Sridevi K, Vidyasagar P. Cutaneous manifestations of chikungunya fever. Indian Paediatrics. 2012; 49: 51-3. PubMed
  13. Simon F, Javelle E, Cabie A, et al. French guidelines for the management of chikungunya (acute and persistent presentations). Med Mal Infect. 2015; 45: 243–63. PubMed
  14. Javelle E, Ribera A, Degasne I, et al. Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012. PLoS Negl Trop Dis. 2015; 9: e0003603. PubMed

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