chikungunya; Sepik fever
Jump to navigation
Jump to search
Etiology
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
- incubation period 48-72 hours[16]
Genetics
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]
- 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]
- leukopenia, thrombocytopenia, & elevated aminotransferase levels
- chikungunya virus RNA by RT-PCR
- uses nested primer pairs to amplify several Chikungunya- specific genes from whole blood
- results available in 1-2 days
- testing reliable for only 1 week after onset of symptoms[13]
- virus isolation: chikungunya virus culture
- most definitive diagnosis
- takes 1-2 weeks for completion
- must be carried out in Biosafety level 3 laboratories
- involves exposing specific cell lines to whole blood & identifying chikungunya virus-specific responses
- chikungunya virus serology
- requires a larger amount of blood than the other methods
- uses an ELISA assay to measure Chikungunya-specific IgM levels
- results available in 2-3 days
- results positive for up to 2-3 months[13]
- false positives can occur with infection via other related viruses such as O'nyong'nyong virus & Semliki Forest Virus
- available from the University of Malaya in Kuala Lumpur, Malaysia Differential diagosis:
- dengue incubation time 4-10 days
- frontal headache, retro-orbital pain, myalgia
- severe lumbosacral pain is characteristic
- arthritis is more severe & synovitis is more likely with chikungunya[13]
- 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
More general terms
Additional terms
References
- ↑ 1.0 1.1 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 - ↑ Wikipedia: Chikungunya http://en.wikipedia.org/wiki/Chikungunya
- ↑ Communicable Diseases: Chikungunya Fever Laboratory Diagnosis of Chikungunya Fevers World Health Organization http://www.searo.who.int/EN/Section10/Section2246_12902.htm
- ↑ Chhabra M et al Chikungunya fever: a re-emerging viral infection. Indian J Med Microbiol. 2008 Jan-Mar;26(1):5-12 PMID: https://pubmed.ncbi.nlm.nih.gov/18227590
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/17698645
- ↑ 6.0 6.1 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
- ↑ Centers for Disease Control and Prevention Geographic Distribution of Chikungunya Virus. Jan 21, 2014. http://www.cdc.gov/chikungunya/map/index.html
- ↑ 8.0 8.1 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
- ↑ 9.0 9.1 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25132507 <Internet> 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25132506 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961290-3/fulltext - ↑ 10.0 10.1 Hamer DH, Chen LH Chikungunya: Establishing a New Home in the Western Hemisphere. Ann Intern Med. Published online 23 September 2014 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25244354 <Internet> http://annals.org/article.aspx?articleid=1906848
- ↑ 11.0 11.1 11.2 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 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25901430 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1415172
- ↑ 12.0 12.1 Gerardin P et al Chikungunya virus-associated encephalitis: A cohort study on La Reunion Island, 2005-2009. Neurology. Nov 25, 2015 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26609145 <Internet> http://www.neurology.org/content/early/2015/11/25/WNL.0000000000002234.short?rss=1
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Pathak H, Mohsn MC, Ravindran C Chikungunya arthritis. Clin Med (Lond). 2019 Sep;19(5):381-385 PMID: https://pubmed.ncbi.nlm.nih.gov/31530685 PMCID: PMC6771335 Free PMC article
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/31705850 PMCID: PMC7385732 Free PMC article
- ↑ 16.0 16.1 16.2 16.3 Bronze MS Fast Five Quiz: Dengue Medscape. August 22, 2022 https://reference.medscape.com/viewarticle/995704
- ↑ 17.0 17.1 Harris E FDA Approves First Chikungunya Vaccine. JAMA. Published online November 29, 2023. PMID: https://pubmed.ncbi.nlm.nih.gov/38019496 https://jamanetwork.com/journals/jama/fullarticle/2812514
- ↑ Centers for Disease Control and Prevention (CDC) Chikungunya virus. http://www.cdc.gov/chikungunya/