Chikungunya

Background

  • Aedes mosquito transmitted virus, originally found in West Africa but cases in the Americas beginning in 2013
  • Frequently difficult clinically to differentiate from dengue fever
  • Chikungunya” is a Tanzanian derived word meaning “that which bends up”[1]

Geographic Distribution

Countries and territories where chikungunya cases have been reported (as of 10/2014):

AFRICA OCEANIA/PACIFIC ISLANDS AMERICAS
BeninAmerican SamoaAnguilla
BurundiFederal States of MicronesiaAntigua and Barbuda
CameroonNew CaledoniaAruba
Central African RepublicPapua New GuineaBahamas
ComorosTongaBarbados
Democratic Republic of the CongoASIABrazil
Equatorial GuineaBangladeshBritish Virgin Islands
GabonBhutanCayman Islands
GuineaCambodiaColombia
KenyaChinaCosta Rica
MadagascarIndiaCuracao
MalawiIndonesiaDominica
MauritiusLaosDominican Republic
MayotteMalaysiaEl Salvador
NigeriaMaldivesFrench Guiana
Republic of CongoMyanmar (Burma)Grenada
ReunionPakistanGuadeloupe
SenegalPhilippinesGuatemala
SeychellesSaudi ArabiaGuyana
Sierra LeoneSingaporeHaiti
South AfricaSri LankaJamaica
SudanTaiwanMartinique
TanzaniaThailandMontserrat
UgandaTimorNicaragua
ZimbabweVietnamPanama
EUROPEYemenPuerto Rico
ItalySaint Barthelemy
FranceSaint Kitts and Nevis
Saint Martin
Sint Maarten
Saint Lucia
Saint Vincent and the Grenadines
Suriname
Trinidad and Tobago
Turks and Caicos Islands
United States
US Virgin Islands
Venezuela

Clinical Features

Acute

  • Fever typically greater than 39deg
  • Polyarthralgias, bilateral and symmetrical
  • Rash- maculopapular
  • Myalgias
  • Nausea and vomiting
  • Lymphocytopenia
  • Elevated LFTs
  • AKI
  • 3-7d incubation period
  • Possible "saddle-back fever"
    • Febrile again 1-2 days after afebrile period
    • Afebrile period typically 4-10 days

Chronic

  • May cause long-term symptoms, with long-term musculoskeletal pain from months to years post infection[2]

Differential Diagnosis

Fever in traveler

See also domestic U.S. ectoparasites

Evaluation

  • CBC w diff, Cr, LFTs
  • contact CDC for specialized testing; recommends tiger top tube

Management

Symptomatic treatment: acute symptoms usually resolve in 7-10d

Disposition

  • Normally able to be treated as outpatient, unless complication

See Also

References

  1. Burt FJ, Rolph MS, Rulli NE, et al. Chikungunya: a re-emerging virus. Lancet. 2012;379:662-671
  2. Gérardin et al. "Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study." Arthritis research & therapy. Jan 9, 2013. 15(1). pmid=23302155. doi=10.1186/ar4137
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.