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==Overview==
==Overview==
Chikungunya which follows a bite of an infected mosquito [[Aedes aegypti]] or [[Aedes albopictus]] carrying chikungunya [[virus]], can either present as an asymptomatic or as a symptomatic disease.  The most common symptoms of the symptomatic disease include [[fever]], [[arthralgia]] or [[polyarthritis]], and [[maculopapular rash]].
==History and Symptoms==
==History and Symptoms==
[[Image:Aedes aegypti biting human.jpg|thumb|left|200px|The ''Aedes aegypti'' mosquito]]
While few infected with chikungunya virus become asymptomatic (around 3-28%),<ref name="pmid18156079">{{cite journal| author=Queyriaux B, Simon F, Grandadam M, Michel R, Tolou H, Boutin JP| title=Clinical burden of chikungunya virus infection. | journal=Lancet Infect Dis | year= 2008 | volume= 8 | issue= 1 | pages= 2-3 | pmid=18156079 | doi=10.1016/S1473-3099(07)70294-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18156079  }} </ref><ref name="pmid20207883">{{cite journal| author=Moro ML, Gagliotti C, Silvi G, Angelini R, Sambri V, Rezza G et al.| title=Chikungunya virus in North-Eastern Italy: a seroprevalence survey. | journal=Am J Trop Med Hyg | year= 2010 | volume= 82 | issue= 3 | pages= 508-11 | pmid=20207883 | doi=10.4269/ajtmh.2010.09-0322 | pmc=PMC2829919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20207883  }} </ref> most of the individuals will develop some symptoms after an incubation period of 3-7 days (range: 1-12 days).  The symptoms of the disease can manifest as any of the following clinical forms.<ref name=PAHO2011>{{cite book | last = | first = | title = Preparedness and response for Chikungunya virus introduction in the Americas | publisher = Pan American Health Organization CDC, Center for Disease Control and Prevention | location = Washington, DC | year = 2011 | isbn = 978-92-75-11632-6 }}</ref>
The symptoms of Chikungunya include fever which can reach 39°C, (102.2°F) a [[petechial]] or [[maculopapular rash|maculopapular]] [[rash]] usually involving the limbs and trunk, and [[arthralgia]] or arthritis affecting multiple joints which can be debilitating. The symptoms could also include [[headache]], conjunctival injection, and slight [[photophobia]]. In the present epidemic in the states of Andhra Pradesh and Tamil Nadu, India, high fever and crippling joint pain are the prevalent complaint. The fever typically lasts for two days and abruptly comes down. However, other symptoms, namely joint pain, intense headache, [[insomnia]] and an extreme degree of prostration last for a variable period, usually for about 5 to 7 days. But, patients have complained joint pains for much longer time periods depending on age of the patient. With younger patients recovering within 5 to 15 days and middle aged recovering in 1 to 2.5 months and more for old people. It has been observed that the severity of the disease as well as its duration is less in younger patients and pregnant women. No untoward effects of pregnancy is noticed following the infection.
 
===Acute Disease===
The following are the acute symptoms that usually last for 3–10 days.<ref name="pmid17479933">{{cite journal| author=Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP et al.| title=Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 11 | pages= 1401-7 | pmid=17479933 | doi=10.1086/517537 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17479933  }} </ref><ref name="pmid17433130">{{cite journal| author=Staikowsky F, Le Roux K, Schuffenecker I, Laurent P, Grivard P, Develay A et al.| title=Retrospective survey of Chikungunya disease in Réunion Island hospital staff. | journal=Epidemiol Infect | year= 2008 | volume= 136 | issue= 2 | pages= 196-206 | pmid=17433130 | doi=10.1017/S0950268807008424 | pmc=PMC2870803 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17433130  }} </ref><ref name="pmid17554689">{{cite journal| author=Taubitz W, Cramer JP, Kapaun A, Pfeffer M, Drosten C, Dobler G et al.| title=Chikungunya fever in travelers: clinical presentation and course. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 1 | pages= e1-4 | pmid=17554689 | doi=10.1086/518701 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17554689  }} </ref>
 
*[[High fever]]: High fever is the most characteristic acute symptom.  It is usually
**Sudden in onset.
**Lasts from several days up to a week.
**Typically >39°C [102°F].
**Continuous or intermittent.
**May be associated with relative [[bradycardia]].
*[[Arthralgia]] or [[polyarthritis]]: [[Arthralgia]] or [[polyarthritis]] is another characteristic acute symptom of the disease that follows fever.  Polyarthritis is usually
**Symmetrical.
**Affects 10 or >10 joint groups.
**Most commonly involves the hands and feet, but can also affect the proximal joints.
**Associated with [[tenosynovitis]].
**Severe and debilitating, confining the patients to bed and thus affecting their normal day to day activities.
*[[Rash]]: Half the patients are affected by rash that usually occurs 2-5 days after the onset of fever. The rashes are
**Typically [[maculopapular]].
**Involve the trunk and extremities, and can also include the palms, soles, and face.
**Can also manifest as diffuse [[erythema]] that blanches with pressure.
**[[Vesicular and bullous lesions|Vesiculobullous]] lesions, the most common skin presentation in infants.
* Other symptoms may include [[headache]], [[myalgia]], [[conjunctivitis]], [[nausea]], [[vomiting]], and diffuse [[back pain]].
 
===Subacute and Chronic Disease===
Subacute and chronic disease can manifest as any of the following after an acute stage.


[[Dermatology|Dermatological]] manifestations observed in a recent outbreak of Chikungunya fever in Southern India (Dr. Arun Inamadar, Dr. Aparna Palit, Dr.V.V. Sampagavi, Dr. Raghunath S, Dr. N.S. Deshmukh), Western India (Surat) (Western India reported by Dr. Buddhadev) and Eastern India (Puri) (Dr. Milon Mitra et al) includes the following:
*Swollen and stiff joints
* [[Maculopapular rash]]
*Swollen joints with fine [[desquamation]]
* Nasal blotchy [[erythema]]
*[[Hyperpigmentation]]
* [[Freckle]]-like pigmentation over centro-facial area
*[[Tenosynovitis]]
* [[Flagellate]] pigmentation on face and extremities
*[[Hygroma]] at the joints
* Lichenoid eruption and hyperpigmentation in photodistributed areas
 
* Multiple aphthous-like [[ulcer]]s over [[scrotum]], crural areas and [[axilla]].
===Atypical Manifestations===
* Lympoedema in acral distribution (bilateral/unilateral)
Besides the typical symptoms, the disease can atypically present with any of the following clinical manifestations due to the virus itself, immunological response to the virus, or drug toxicity.<ref name="pmid19716149">{{cite journal| author=Rajapakse S, Rodrigo C, Rajapakse A| title=Atypical manifestations of chikungunya infection. | journal=Trans R Soc Trop Med Hyg | year= 2010 | volume= 104 | issue= 2 | pages= 89-96 | pmid=19716149 | doi=10.1016/j.trstmh.2009.07.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19716149  }} </ref>
* Multiple ecchymotic spots (Children)
 
* Vesiculobullous [[lesion]]s (infants)
*[[Neurological]]:
* Subungual [[hemorrhage]]
**[[Encephalitis]]
* Photo [[Urticaria]]
**[[Encephalopathy]]
* Acral [[Urticaria]]
**[[Guillain-Barré syndrome]]
* Cephalgia
**[[Meningoencephalitis]]
* Lumbago
**[[Neuropathy]]
* Vomiting
**[[Seizures]]
* Epistaxis and haemetemesis
*[[Ocular]]:
Histopathologically, pigmentary changes, maculopapular rash, lichenoid rash, aphthous-like ulcers show lymphocytic infiltration around dermal blood vessels (Inamadar et al).
**[[Episcleritis]]
Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.
**[[Iridocyclitis]]
**[[Optic neuritis]]
**[[Retinitis]]
*[[Cardiovascular]]:
**[[Arrhythmias]]
**[[Heart failure]]
**[[Hemodynamic instability]]
**[[Ischemic heart disease]]
**[[Myocarditis]]
**[[Pericarditis]]
*[[Skin]]:
**Penoscrotal [[ulcers]]
**[[Photosensitivity|Photosensitive hyperpigmentation]]
**[[Vesicular and bullous lesions|Vesiculobullous dermatosis]]
*[[Renal]]:
**[[Acute renal failure]]
**[[Nephritis]]
*[[Neonatal]] infection due to vertical transmission:
**[[Perinatal mortality|Ante-partum fetal deaths]]
**[[Disseminated intravascular coagulation]]
**[[Meningoencephalitis]]
*Other possible associations:
**[[Hepatitis]]
**[[Hypoadrenalism]]
**[[Pancreatitis]]
**[[Pneumonia]]
**[[Respiratory failure]]
**[[Syndrome of inappropriate antidiuretic hormone]]


==References==
==References==
{{Reflist|2}}
==External Links==
* [http://www.cdc.gov/Chikungunya/index.html CDC Chikungunya virus]


{{Reflist|2}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Viral diseases]]
[[Category:Togaviruses]]
[[Category:Tropical disease]]
 
{{WH}}
{{WS}}

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Alonso Alvarado, M.D. [3]; Vendhan Ramanujam M.B.B.S [4]

Overview

Chikungunya which follows a bite of an infected mosquito Aedes aegypti or Aedes albopictus carrying chikungunya virus, can either present as an asymptomatic or as a symptomatic disease. The most common symptoms of the symptomatic disease include fever, arthralgia or polyarthritis, and maculopapular rash.

History and Symptoms

While few infected with chikungunya virus become asymptomatic (around 3-28%),[1][2] most of the individuals will develop some symptoms after an incubation period of 3-7 days (range: 1-12 days). The symptoms of the disease can manifest as any of the following clinical forms.[3]

Acute Disease

The following are the acute symptoms that usually last for 3–10 days.[4][5][6]

  • High fever: High fever is the most characteristic acute symptom. It is usually
    • Sudden in onset.
    • Lasts from several days up to a week.
    • Typically >39°C [102°F].
    • Continuous or intermittent.
    • May be associated with relative bradycardia.
  • Arthralgia or polyarthritis: Arthralgia or polyarthritis is another characteristic acute symptom of the disease that follows fever. Polyarthritis is usually
    • Symmetrical.
    • Affects 10 or >10 joint groups.
    • Most commonly involves the hands and feet, but can also affect the proximal joints.
    • Associated with tenosynovitis.
    • Severe and debilitating, confining the patients to bed and thus affecting their normal day to day activities.
  • Rash: Half the patients are affected by rash that usually occurs 2-5 days after the onset of fever. The rashes are
    • Typically maculopapular.
    • Involve the trunk and extremities, and can also include the palms, soles, and face.
    • Can also manifest as diffuse erythema that blanches with pressure.
    • Vesiculobullous lesions, the most common skin presentation in infants.
  • Other symptoms may include headache, myalgia, conjunctivitis, nausea, vomiting, and diffuse back pain.

Subacute and Chronic Disease

Subacute and chronic disease can manifest as any of the following after an acute stage.

Atypical Manifestations

Besides the typical symptoms, the disease can atypically present with any of the following clinical manifestations due to the virus itself, immunological response to the virus, or drug toxicity.[7]

References

  1. ↑ Queyriaux B, Simon F, Grandadam M, Michel R, Tolou H, Boutin JP (2008). "Clinical burden of chikungunya virus infection". Lancet Infect Dis. 8 (1): 2–3. doi:10.1016/S1473-3099(07)70294-3. PMID 18156079.
  2. ↑ Moro ML, Gagliotti C, Silvi G, Angelini R, Sambri V, Rezza G; et al. (2010). "Chikungunya virus in North-Eastern Italy: a seroprevalence survey". Am J Trop Med Hyg. 82 (3): 508–11. doi:10.4269/ajtmh.2010.09-0322. PMC 2829919. PMID 20207883.
  3. ↑ Preparedness and response for Chikungunya virus introduction in the Americas. Washington, DC: Pan American Health Organization CDC, Center for Disease Control and Prevention. 2011. ISBN 978-92-75-11632-6.
  4. ↑ Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP; et al. (2007). "Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients". Clin Infect Dis. 44 (11): 1401–7. doi:10.1086/517537. PMID 17479933.
  5. ↑ Staikowsky F, Le Roux K, Schuffenecker I, Laurent P, Grivard P, Develay A; et al. (2008). "Retrospective survey of Chikungunya disease in Réunion Island hospital staff". Epidemiol Infect. 136 (2): 196–206. doi:10.1017/S0950268807008424. PMC 2870803. PMID 17433130.
  6. ↑ Taubitz W, Cramer JP, Kapaun A, Pfeffer M, Drosten C, Dobler G; et al. (2007). "Chikungunya fever in travelers: clinical presentation and course". Clin Infect Dis. 45 (1): e1–4. doi:10.1086/518701. PMID 17554689.
  7. ↑ Rajapakse S, Rodrigo C, Rajapakse A (2010). "Atypical manifestations of chikungunya infection". Trans R Soc Trop Med Hyg. 104 (2): 89–96. doi:10.1016/j.trstmh.2009.07.031. PMID 19716149.

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