Protect yourself from Chikungunya, a viral disease transmitted by mosquitoes. Learn about symptoms, prevention, and treatment options.

Chikungunya

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Ismail Munir

Overview

Chikungunya is a viral disease transmitted by infected mosquitoes and characterized by fever, severe joint pain, and rash. 
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Chikungunya fever is a viral illness that causes fever and joint pain and is prevalent in tropical regions of Africa and Southeast Asia. The virus was first identified during an outbreak in Tanzania in 1953 and is transmitted through mosquitoes of the Aedes genus<a href="#accordion">[1]</a>. The disease has now become a concern in many countries, owing to the increased spread of the disease due to international travel. 
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The name &quot;Chikungunya&quot; comes from Swahili and Makonde and translates to &lsquo;to walk bent&rsquo;. It refers to the stooped-over posture that individuals with the disease exhibit due to severe chronic arthralgia. Chikungunya virus has caused numerous epidemics in Southern and Southeast Asia, with distinct strains and transmission cycles in different locations. The disease has also spread to several non-tropical and temperate areas, including the United States, and cases have been reported in multiple countries. Many travel-related cases of Chikungunya infection have been imported into the United States since 2006, and issues of locally transmitted infection have also been reported in Florida, Puerto Rico, and the Virgin Islands.

Pakistan reported its first human case of chikungunya in 2011<a href="#accordion">[9]</a>. Since then, multiple outbreaks have been recorded in the country. It continues to be a major cause of undiagnosed acute febrile illnesses. A recent study evaluated the epidemiology of the Chikungunya virus between 2016 and 2018 in Pakistan<a href="#accordion">[10]</a>. The researchers found 50% of the samples to be positive for the virus, with the highest cases among people between 21 to 40 years of age<a href="#accordion">[10]</a>.

Chikungunya is now a global public health concern. 
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There are no specific types of Chikungunya. 
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Signs and Symptoms

The symptoms of chikungunya usually appear between 3-7 days after a person has been bitten by an infected mosquito. The signs and symptoms of chikungunya include<a href="#accordion">[2]</a>: 
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<ul>
	<li>High Fever: The fever may range from 102-105&deg;F and may last for several days.</li>
	<li>Joint Pain: Chikungunya is characterized by severe joint pain that is often symmetrical and affects the small joints in the hands and feet. The pain can be debilitating and may last for several weeks, months, or even years.</li>
	<li>Muscle Pain: Muscles may become sore, tender, and achy, and may be accompanied by fatigue.</li>
	<li>Rash: A rash may develop on the trunk and limbs of the body. It can be maculopapular or diffuse and may be itchy.</li>
	<li>Headache: Many people with chikungunya experience severe headaches.</li>
	<li>Nausea And Vomiting: Some people with chikungunya may experience nausea and vomiting.</li>
	<li>Swollen Glands: Some people may develop swollen lymph nodes, particularly in the neck and armpits.</li>
</ul>

The signs and symptoms of Chikungunya overlap with those of <a href="https://merisehat.pk/disease/dengue">dengue </a>and Zika viruses. Therefore, cases can often be misdiagnosed. 
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Note: Seek a healthcare professional if you notice any of the above symptoms, especially if you&rsquo;ve recently traveled to an endemic region. 
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Causes

Chikungunya virus (CHIKV) is primarily transmitted to humans by the female Aedes aegypti and Aedes albopictus mosquitoes. Their biological characteristics make them highly invasive competent vectors, capable of causing outbreaks.

These mosquitoes prefer human blood, can establish populations outside of their native range, and have the ability to ingest and transmit the virus. Factors such as vector density, feeding probability, survivability, and extrinsic incubation period directly determine infectivity. Aedes aegypti has been present in the US for over 300 years, while Aedes albopictus has been present since 1985, and was able to spread CHIKV during the 2005-06 outbreak due to a mutation in its E1 membrane protein. The risk to public health from these mosquitoes is related to their focus on humans and their ability to travel with them<a href="#accordion">[4]</a>.

Chikungunya is primarily caused by two types of mosquitoes: 
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1. Aedes Aegypti: They are found in tropical and subtropical regions worldwide.

2. Aedes Albopictus: They are active during the daytime, with peak biting periods in the early morning and late afternoon. 
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Both Aedes aegypti and Aedes albopictus are known to transmit other viral diseases such as dengue fever and Zika virus.

Chikungunya is not contagious. However, if a mosquito bites an infected person, it can later transmit the virus to other healthy humans. 
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Diagnosis

There are no screening tests for Chikungunya. A clinical history may cause doctors to suspect a viral illness.

Diagnosis of chikungunya involves several approaches, including:

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Clinical Examination: A doctor will examine the patient for symptoms of chikungunya, including fever, joint pain, and rash.

Medical History: The doctor will ask the patient about their recent travel history, exposure to mosquito bites, and any other relevant medical history.

Laboratory Tests: Blood tests are used to diagnose chikungunya. These tests can detect the virus or the antibodies produced by the body in response to the virus. Tests that can be performed include:

1.&nbsp;Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Test: This test detects the presence of the chikungunya virus in the blood during the acute phase of the illness.

2.&nbsp;Enzyme-Linked Immunosorbent Assay (ELISA): This test detects antibodies produced by the body in response to the chikungunya virus.

3.&nbsp;Plaque Reduction Neutralization Test (PRNT): This test is used to confirm the diagnosis of chikungunya by measuring the levels of neutralizing antibodies against the virus. 
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Differential Diagnosis: Chikungunya can be easily confused with other mosquito-borne diseases, such as dengue and Zika. The doctor will consider other possible diagnoses based on the patient&#39;s symptoms, medical history, and laboratory test results.

As per the World Health Organization (WHO), an individual should have one or more of the following findings for a confirmed case of Chikungunya<a href="#accordion">[1]</a>.

<ul>
	<li>Viral RNA found through PCR test</li>
	<li>Viral isolation in cell culture</li>
	<li>Virus-specific IgM antibodies in samples 
	&nbsp;</li>
</ul>

Treatment

There is currently no specific antiviral treatment for chikungunya. Treatment is typically focused on relieving symptoms and reducing pain and inflammation. Here are some treatment options:

<ul>
	<li>Over-the-counter pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help relieve pain and reduce fever.</li>
	<li>Rest is important for allowing the body to recover from the infection. It is recommended that patients get plenty of rest and avoid strenuous activity.</li>
	<li>Drinking plenty of fluids helps avoid dehydration.</li>
	<li>Applying a cool compress or ice pack to the affected joints can help relieve pain and swelling.</li>
	<li>In severe cases, hospitalization may be necessary for intravenous fluids and pain management.</li>
	<li>In some cases, physical therapy may be recommended to help restore the range of motion and reduce joint stiffness. 
	&nbsp;</li>
</ul>

While the majority of people who contract chikungunya experience mild symptoms, some people may develop more severe complications. The most common complications of chikungunya include: 
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<ul>
	<li>Persistent Joint Pain: Joint pain is the most common symptom of chikungunya, and it can persist for months or even years after the initial infection.</li>
	<li>Chronic Arthritis: Some people may develop chronic arthritis as a result of chikungunya, which can cause long-term joint pain and inflammation. It affects 40% of people infected with the virus<a href="#accordion">[6]</a>.</li>
	<li>Neurological Complications: In rare cases, chikungunya can cause neurological complications, such as encephalitis or meningitis. Guillain-Barre syndrome has also been reported in rare cases. </li>
	<li>Cardiovascular Complications: Chikungunya has been associated with an increased risk of heart disease, including myocarditis and pericarditis.</li>
	<li>Eye Complications: Chikungunya can cause eye infections, such as uveitis, which can lead to vision loss.</li>
	<li>Hemorrhagic Fever: Although rare, some people may develop hemorrhagic fever as a result of chikungunya, which can cause bleeding and organ damage.</li>
	<li>Death: While death from chikungunya is rare, it can occur in people with weakened immune systems or other underlying health conditions. 
	&nbsp;</li>
</ul>

Pregnant women may spread the disease to the fetus. Newborns are at higher risk of complications, such as cognitive developmental delays and neurologic complications. 
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Several risk factors can increase the likelihood of contracting chikungunya. These include: 
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<ul>
	<li>Living Or Traveling To Areas With High Rates Of Chikungunya: Chikungunya is most commonly found in areas with tropical or subtropical climates, such as Africa, Asia, and the Caribbean. People who have recently traveled to areas with high rates of chikungunya may be at increased risk of contracting the virus. 
	&nbsp;</li>
	<li>Exposure To Mosquitoes: Chikungunya is transmitted to humans through the bite of infected female Aedes mosquitoes. Spending time outdoors, especially during the daytime when mosquitoes are most active, increases the risk of being bitten. 
	&nbsp;</li>
	<li>Lack Of Mosquito Control: Poor sanitation and inadequate mosquito control measures can increase the mosquito population and the risk of chikungunya transmission. 
	&nbsp;</li>
	<li>Weakened Immune System: People with weakened immune systems, such as the elderly or those with underlying health conditions, may be more susceptible to chikungunya and may be at greater risk of complications. 
	&nbsp;</li>
	<li>Lack Of Vaccination: Currently, there is no vaccine for chikungunya, so people who have not been previously infected with the virus are at risk of contracting it. 
	&nbsp;</li>
</ul>

Preventive measures for chikungunya primarily involve reducing the risk of mosquito bites and eliminating mosquito breeding sites. Here are some specific measures that can help prevent chikungunya: 
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<ul>
	<li>Mosquito Repellents: Applying an EPA-registered mosquito repellent to exposed skin and clothing. </li>
	<li>Protective Clothing: Wearing long-sleeved shirts and pants to cover exposed skin, especially during the daytime when mosquitoes are most active.</li>
	<li>Use Mosquito Nets: Sleeping under mosquito nets, especially in areas with a high risk of chikungunya transmission.</li>
	<li>Eliminate Standing Water: Removing any standing water in and around the home, including containers, tires, and other objects that can collect water.</li>
	<li>Use Screens: Using screens on doors and windows to prevent mosquitoes from entering the home.</li>
	<li>Keep Surroundings Clean: Keeping the surroundings clean and well-maintained to reduce mosquito breeding sites.</li>
	<li>Travel With Caution: People traveling to an area with a high risk of chikungunya should take precautions, such as using mosquito repellent, wearing protective clothing, and avoiding outdoor activities during the daytime. 
	&nbsp;</li>
</ul>
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Key Points

<ul>
	<li>Chikungunya is a viral disease that is transmitted by the Aedes mosquito, which also spreads other diseases like dengue and Zika.</li>
	<li>The disease was first identified in Tanzania in 1953 and has since spread to various parts of Africa, Asia, Europe, and the Americas.</li>
	<li>The symptoms of chikungunya typically include fever, joint pain, headache, muscle pain, fatigue, and rash.</li>
	<li>Chikungunya is rarely fatal, but it can cause severe joint pain that may last for months or even years, which can severely impact the quality of life.</li>
	<li>There is no specific treatment for chikungunya, and care is mostly supportive, aimed at relieving symptoms.</li>
	<li>Prevention measures include using mosquito repellents, wearing long-sleeved clothing, and eliminating mosquito breeding sites like standing water.</li>
	<li>Diagnosis of chikungunya can be confirmed through laboratory tests that detect the virus or its antibodies in the blood.</li>
	<li>Chikungunya can be misdiagnosed as dengue or other viral illnesses, as the symptoms are similar.</li>
	<li>The incubation period for chikungunya is typically 2-12 days, and symptoms can last for several weeks.</li>
	<li>The disease can also be transmitted from mother to baby during pregnancy or childbirth.</li>
	<li>Chikungunya is a preventable disease, and the best way to reduce the risk of infection is by controlling mosquito populations and avoiding mosquito bites. 
	&nbsp;</li>
</ul>

[1] Suganthini Krishnan Natesan MD. Chikungunya virus. Background, Pathophysiology, Etiology.

[2] Chikungunya: Symptoms, diagnosis, and treatment. Medical News Today.

[3] Prevention. Centers for Disease Control and Prevention.

[4] Ojeda Rodriguez JA, Haftel A, Walker, III JR. Chikungunya Fever. [Updated 2022 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[5] Chikungunya fact sheet. World Health Organization.

[6] What is Chikungunya fever, and should I be worried? Mayo Clinic.

[7] Chikungunya virus. healthdirect.

[8] Chikungunya: Transmission, treatment, and prevention. WebMD.

[9] Meraj L; Saleem J; Manzoor S; Ashfaq A; Khurram M. First report of Chikungunya fever in Rawalpindi, Pakistan. East Mediterr Health J. 2020;26(6):744–747.

[10] Badar N, Ikram A, Salman M, et al. Epidemiology of chikungunya virus isolates 2016–2018 in Pakistan. Journal of Medical Virology. 2021;93(11):6124-6131. doi:10.1002/jmv.26957.