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

Geographic Distribution

Chikungunya geographic distribution

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

AFRICA	OCEANIA/PACIFIC ISLANDS	AMERICAS
Benin	American Samoa	Anguilla
Burundi	Federal States of Micronesia	Antigua and Barbuda
Cameroon	New Caledonia	Aruba
Central African Republic	Papua New Guinea	Bahamas
Comoros	Tonga	Barbados
Democratic Republic of the Congo	ASIA	Brazil
Equatorial Guinea	Bangladesh	British Virgin Islands
Gabon	Bhutan	Cayman Islands
Guinea	Cambodia	Colombia
Kenya	China	Costa Rica
Madagascar	India	Curacao
Malawi	Indonesia	Dominica
Mauritius	Laos	Dominican Republic
Mayotte	Malaysia	El Salvador
Nigeria	Maldives	French Guiana
Republic of Congo	Myanmar (Burma)	Grenada
Reunion	Pakistan	Guadeloupe
Senegal	Philippines	Guatemala
Seychelles	Saudi Arabia	Guyana
Sierra Leone	Singapore	Haiti
South Africa	Sri Lanka	Jamaica
Sudan	Taiwan	Martinique
Tanzania	Thailand	Montserrat
Uganda	Timor	Nicaragua
Zimbabwe	Vietnam	Panama
EUROPE	Yemen	Puerto Rico
Italy		Saint Barthelemy
France		Saint 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 Chikungunya rash on foot2 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 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 External Links Sources CDC