Chikungunya Fever

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Chikungunya (CHIK-V) Fever 

• An acute febrile illness associated with polyarthralgias, caused by the infection of the arthropod-borne alpha-virus, Chikunguyna virus (CHIK-V).    
• The virus is transmitted to humans primarily through the bite of an infected mosquito
• The term Chikungunya is derived from the Makinde word meaning “that which bends up” 
• The first discovery of the CHIK-V was in 1952 in Tanzania, Africa with the first outbreak noted in 1999 in Malaysia affecting 27 people .
• The virus re-emerged in 2004 in countries of the Indian Ocean and has since then, spread to new locations leading to millions of cases throughout countries globally.
  

Aetiology

• The Aedes Aegypti and Aedes Albopictus mosquitos are the main vectors of the virus.
• The human being becomes the reservoir of infection and transmitted from human to human via the infected mosquito.
• These mosquitos bite mainly in the daytime and are also known to transmit the dengue virus 

Risk Factors 

• There has been increased prevalence in densely populated, urbanized areas, since humans are the only reservoir of the virus.
• Poor living conditions and maintenance of peridomestic environment including pooling of water in water recipients or tyres and inappropriate waste disposal.These are all sources of Aedes mosquito species.
• Migration and Travelling; the CDC estimated approximately 9 million people travel between the United States and the Caribbean each year, increasing the risk of transmission

Clinical Features 

• The incubation period for Chikunguyna fever is noted to be between 3-7 days starting with fevers greater than 38.9°C which can last up to 2 weeks and are biphasic in nature 
• Following the fever, majority of infected people develop severe polyarthralgias which are usually symmetric
• Pains are most commonly in the wrists, elbows, fingers, knees and ankles but are not limited to these.
• Pain and Joint swelling are often incapacitating and result in severe disabilities which can last for months.
• The development of a maculopapular rash is often associated
• Additionally, the individual may experience cervical lymphadenopathy, headaches, fatigue, nausea, vomiting, conjunctivitis and myalgia.
• In the acute stage of infection, blood tests may reveal abnormalities such as leukopenia, thrombocytopenia, hypocalcemia and moderate increase in liver function test results
• Asymptomatic cases have also been reported

Musculoskeletal Implications 

• In the chronic phase of the infection, individuals may experience musculoskeletal symptoms for several weeks to months
• Joint manifestations such as joint effusions, hygromas, bursitis and axial pain can be identified in areas with previously occurring injuries
• Carpal Tunnel syndrome and Raynaud phenomenon in chronic phase have been noted 
• Carpal or Cubital Tunnel syndromes are often a result of hypertrophic tenosynovitis of the anterior wrist

Other Complications

• Cardiac complications were also reported in a number persons infected with the chikunguyna virus resulting in cases of myocarditis and cardiomyopathy. In many cases, these conditions have been noted to resolve spontaneously 
• Chikungunya fever is rarely fatal however there are cases of death has been reported resulting from severe complications or by a weakened immune system

References

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