Chikungunya disease is transmitted by the Aedes mosquito. Chikungunya disease usually presents with acute fever. Chronic polyarthritis can persist and be disabling. Diagnosis is confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) or serology. Treatment is supportive care. Prevention is focused on avoiding mosquito bites.
Chikungunya disease is transmitted by the Aedes mosquito and is common in Africa, India, Pakistan, Nepal, Guam, Southeast Asia, New Guinea, China, Mexico, South and Central America, islands in the Caribbean, Indian Ocean and Pacific, and limited areas of Europe. Limited local transmission has been identified in Florida, Puerto Rico, and the US Virgin Islands. Chikungunya virus is an alphavirus in the Togavirus family.
Symptoms and Signs of Chikungunya Disease
Chikungunya disease is an acute febrile illness followed by more chronic polyarthritis that can persist for months or years and be severe and disabling. Other symptoms may include headache, muscle pain, joint swelling, or rash. Death is extremely rare.
Diagnosis of Chikungunya Disease
Chikungunya disease is suspected in patients who live in or have traveled to endemic areas if they develop sudden fever and arthralgias.
Chikungunya virus RNA can be detected using RT-PCR. Serologic testing for virus specific IgM can be done for those presenting more than 7 days following onset of symptoms.
Dengue and Zika viruses are transmitted by the same mosquitoes and have similar clinical features as chikungunya disease and should be considered (Centers for Disease Control and Prevention (CDC): Chikungunya Virus). It is important to rule out dengue virus infection, because proper clinical management of dengue can improve outcome.
Treatment of Chikungunya Disease
Supportive care
Treatment of chikungunya disease is symptomatic. Treatment for symptoms can include rest, fluids, and use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs can be used to help with acute fever and pain. However, in dengue-endemic areas, to reduce the risk of hemorrhage, acetaminophen is the preferred first-line treatment for fever and joint pain until dengue can be ruled out.Treatment of chikungunya disease is symptomatic. Treatment for symptoms can include rest, fluids, and use of analgesics and antipyretics. Nonsteroidal anti-inflammatory drugs can be used to help with acute fever and pain. However, in dengue-endemic areas, to reduce the risk of hemorrhage, acetaminophen is the preferred first-line treatment for fever and joint pain until dengue can be ruled out.
Prevention of Chikungunya Disease
Prevention of chikungunya disease involves avoiding mosquito bites and vaccination. In 2023, the U.S. Food and Drug Administration (FDA) approved the first vaccine for prevention of chikungunya disease. The chikungunya vaccine is approved for use in people age 18 years or older who are at increased risk of exposure to chikungunya virus due to travel abroad or laboratory work in the United States. Prevention of chikungunya disease involves avoiding mosquito bites and vaccination. In 2023, the U.S. Food and Drug Administration (FDA) approved the first vaccine for prevention of chikungunya disease. The chikungunya vaccine is approved for use in people age 18 years or older who are at increased risk of exposure to chikungunya virus due to travel abroad or laboratory work in the United States.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Centers for Disease Control and Prevention: Chikungunya Virus: For Healthcare Providers: Information on prevention, clinical presentation, diagnosis, and treatment
Pan American Health Organization/World Health Organization: Epidemiological Alert:Chikungunya increase in the Region of the Americas. 13 February 2023, Washington, D.C. PAHO/WHO 2023
Bartholomeeusen K, Daniel M, LaBeaud DA, et al: Chikungunya fever. Nat Rev Dis Primers 9(1):17, 2023. Published 2023 Apr 6. doi:10.1038/s41572-023-00429-2
