Treatment and Diagnosis of Chikungunya
Chikungunya treatment is primarily supportive care focused on symptom management, particularly joint pain relief, as there are no specific antiviral therapies approved for this infection. 1, 2
Diagnostic Approach
Testing Methods
- PCR testing is most effective during the first 1-4 days of symptoms for direct detection of the virus 3
- IgM antibody testing should be used from day 5 of symptoms onward 3, 1
- Acute chikungunya can be diagnosed by positive PCR early in the illness, or IgM/IgG from 5-7 days after symptom onset 3
Clinical Presentation
- Classic presentation includes fever, headache, myalgia, and severe polyarthralgia/arthritis 3, 2
- Rash is common and typically maculopapular 1, 2
- Incubation period is typically 2-3 days (range: 1-12 days) 3
- Joint pain can be debilitating and may persist for weeks to years after the acute infection 2, 4
Treatment Protocol
Acute Phase Management
- Provide adequate hydration, preferably oral fluids unless the patient is unable to tolerate oral intake 3, 1
- Administer acetaminophen/paracetamol for fever and pain control 1
- Avoid NSAIDs during the acute phase (first 7-10 days) due to potential bleeding risk, especially if dengue co-infection cannot be ruled out 5
- Monitor for rare but serious neurological complications, particularly in patients >60 years and infants 3
Chronic Joint Pain Management
- For persistent arthralgia after the acute phase has resolved, NSAIDs may be used for pain relief 2, 4
- Physical therapy may be beneficial for patients with prolonged joint symptoms 4
- Severe or persistent cases may require referral to a rheumatologist 2
Special Populations
- Pregnant women: Monitor closely as vertical transmission can occur, particularly near term 3
- Infants: Require close monitoring as they are at higher risk for severe disease 3
- Elderly patients (>60 years): Higher risk for severe manifestations and complications 3
Complications to Monitor
- Neurological complications: Encephalitis, encephalopathy, and Guillain-Barré syndrome have been reported, though rare 3
- Case fatality rate of approximately 10% has been observed among patients with neurological manifestations 3
- Long-term joint symptoms can significantly impact quality of life 2, 4
- Maternal-fetal transmission can lead to severe complications in neonates 3
Prevention Strategies
- Vector control measures targeting Aedes mosquitoes (primarily Aedes aegypti and Aedes albopictus) 4
- Use of insect repellents, protective clothing, and bed nets in endemic areas 2
- Currently, no vaccine is licensed for human use 6, 7
Common Pitfalls
- Misdiagnosis as dengue fever due to similar initial presentation and vector 3, 1
- Failure to consider chikungunya in differential diagnosis of travelers returning from endemic areas 3
- Inappropriate use of NSAIDs during acute phase when dengue co-infection cannot be excluded 5
- Underestimating the potential for chronic debilitating arthralgia 2, 4