What is the treatment for chikungunya?

Treatment for Chikungunya Virus Infection

Chikungunya treatment is primarily supportive and symptom-based, focusing on pain management with acetaminophen during the acute phase, while avoiding NSAIDs until dengue fever is ruled out. 1

Clinical Presentation and Diagnosis

Chikungunya virus (CHIKV) is an alphavirus transmitted by Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus. The disease presents with:

• Sudden onset high fever
• Severe polyarthralgia (often debilitating)
• Myalgia (muscle pain)
• Headache and retro-orbital pain
• Maculopapular rash
• Nausea and vomiting 1

Diagnosis is made through:

• PCR testing (first 1-4 days of symptoms)
• IgM antibody testing (after day 5 of symptoms) 2

Treatment Algorithm

Acute Phase (First 5-7 Days)

1. Pain and fever management:

   • Use acetaminophen/paracetamol as first-line therapy 1
   • Avoid NSAIDs and aspirin during this phase due to:
     • Potential bleeding risk
     • Difficulty distinguishing from dengue fever which has similar symptoms 1

2. Hydration:

   • Encourage increased fluid intake
   • Monitor for signs of dehydration

3. Rest:

   • Advise bed rest during febrile period

Post-Acute Phase (After 7 Days)

1. Joint pain management:
   • NSAIDs may be considered once dengue is ruled out
   • Physical therapy for persistent arthralgia
   • Graduated exercise program

Special Considerations

Neurological complications require specialized care:

• Monitor for encephalitis, myelitis, and Guillain-Barré syndrome
• These complications have approximately 10% case fatality rate 1

Chronic arthralgia:

• May persist for months to years after acute infection 3
• Requires long-term pain management strategy

Prevention

Since there is no specific antiviral treatment or approved vaccine for chikungunya 1, 4, prevention is critical:

• Eliminate mosquito breeding sites
• Use insect repellents
• Wear protective clothing
• Use mosquito nets

Important Caveats

• Diagnostic pitfall: Chikungunya can be mistaken for dengue fever, which requires different management approaches 5
• Treatment limitation: No specific antiviral drugs are commercially available 6
• High-risk groups: Advanced age and comorbidities are associated with severe or atypical forms of the disease 3
• Monitoring requirement: Close clinical monitoring is essential, particularly for neurological complications 1

The management of chikungunya is focused on symptom relief while the body clears the infection naturally. The most challenging aspect is often the management of persistent joint pain, which may require long-term follow-up and pain management strategies.