Treatment for Chikungunya Virus Infection
The treatment for chikungunya is primarily supportive care focused on symptom management, as there is currently no specific antiviral treatment or approved vaccine available. 1
Acute Phase Management (First 5-7 days)
Pain and Fever Control
- Acetaminophen (paracetamol) is the preferred first-line agent for fever and pain control 1
- Adult dosing: 500-1000mg every 6 hours (maximum 4g/day)
- Pediatric dosing: 10-15mg/kg every 6 hours
- Avoid NSAIDs and aspirin during the acute febrile phase due to:
- Potential bleeding risk
- Difficulty distinguishing from dengue fever which has similar initial symptoms 1
Hydration and Rest
- Maintain adequate hydration with oral fluids
- Bed rest is recommended during the acute phase
Post-Acute Phase Management (After 7 days)
For Persistent Joint Pain
- NSAIDs may be introduced after the acute febrile phase has resolved
- For severe or persistent arthralgia:
- Short courses of corticosteroids may be considered
- Methotrexate should be considered if inflammatory polyarthritis persists beyond 3 months 2
- Typically starting at 7.5-15mg weekly with folic acid supplementation
For Chronic Symptoms
- Physical therapy for persistent joint pain and stiffness
- Graduated exercise program to improve mobility and strength
Special Populations
Pregnant Women
- Acetaminophen is the only recommended analgesic
- Close monitoring for vertical transmission and fetal complications
Elderly and Those with Comorbidities
- More intensive monitoring required as they are at higher risk for severe disease 3
- Adjust medication doses based on renal and hepatic function
Monitoring for Complications
Neurological Complications
- Monitor for signs of encephalitis, myelitis, and Guillain-Barré syndrome
- These complications require specialized neurological care 1
- Case fatality rate is approximately 10% in patients with neurological manifestations
Other Severe Manifestations
- Watch for myocarditis, uveitis, retinitis, hepatitis, and acute renal disease 4
- Refer to appropriate specialists if these complications develop
Prevention Measures
- Eliminate mosquito breeding sites
- Use insect repellents containing DEET
- Wear protective clothing (long sleeves, long pants)
- Use bed nets, especially during daytime hours when Aedes mosquitoes are most active
Common Pitfalls to Avoid
- Misdiagnosing as dengue fever - laboratory confirmation is essential
- Using NSAIDs too early in the disease course
- Underestimating the potential for chronic joint symptoms
- Failing to recognize severe or atypical manifestations that require specialized care
The management of chikungunya requires a systematic approach based on disease phase and symptom severity. While most cases are self-limiting, a significant proportion of patients may develop chronic arthralgia requiring long-term management.