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

Clinical Features

Acute

Chikungunya rash on foot

• Fever typically greater than 39deg
• Polyarthralgias, bilateral and symmetrical
• Rash- maculopapular
• Myalgias
• Nausea and vomiting
• Lymphocytopenia
• Elevated LFTs
• AKI
• 3-7d incubation period

Chronic

• May cause long-term symptoms, with long-term musculoskeletal pain from months to years post infection with up to 60% of people reporting prolonged arthralgia three years following initial infection.

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Travel-related skin conditions

• Papules
  • Insect bites
  • Scabies
  • Seabather's eruption
  • Cercarial dermatitis (Swimmer's Itch)
• Macular
  • Chikungunya
• Sub Q Swelling and Nodules
  • Myiasis
  • Tungiasis
  • Loa loa
  • African Trypanosomiasis
  • Onchocerciasis
• Ulcers
  • Tropical pyoderma
  • Leishmaniasis
  • Mycobacterium marinum
  • Buruli ulcer
  • Dracunculiasis (Guinea Worm disease)
• Linear and Migratory Lesions
  • Cutaneous larvae migrans
  • Photodermatitis

See also domestic U.S. ectoparasites

Workup

• 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

• Travel Medicine

Sources

CDC