Treatment of Chikungunya Lung Disease
There is no specific treatment for chikungunya lung disease; management is entirely supportive with symptomatic care using acetaminophen for pain and fever, while strictly avoiding NSAIDs and aspirin due to bleeding risk. 1, 2
Primary Management Approach
Symptomatic treatment is the cornerstone of care, as no antiviral therapies or vaccines are currently approved for chikungunya virus infection 2, 3, 4
Acetaminophen (paracetamol) at standard doses is the recommended analgesic and antipyretic for managing fever and pain in chikungunya patients 1
NSAIDs and aspirin must be strictly avoided until dengue fever is definitively ruled out, as these medications significantly increase bleeding risk in arboviral infections 1, 2
Respiratory Support for Pulmonary Involvement
Ensure adequate oxygenation monitoring with pulse oximetry for patients developing respiratory symptoms 1
Provide supplemental oxygen as needed to maintain adequate oxygen saturation in patients with pulmonary complications 1
Consider early pulmonary rehabilitation interventions once the patient is hemodynamically stable, including passive and active activities to promote sputum drainage and lung function recovery 1
Monitoring and Assessment
Obtain chest radiography if respiratory symptoms develop or persist to assess for pulmonary involvement 1
Monitor for warning signs of severe disease, including persistent fever, respiratory distress, hypoxia, or signs of shock 1
Assess for secondary bacterial infections if fever persists beyond the typical 5-7 day acute phase, as bacterial superinfection can complicate viral respiratory illness 1
Management of Severe or Complicated Cases
Hospitalization is indicated for patients with severe respiratory manifestations, hemodynamic instability, or inability to maintain adequate oral hydration 5
Multidisciplinary team assessment should guide the timing and intensity of supportive interventions, particularly for patients requiring respiratory support 1
Consider empirical antibiotics only if there is clinical evidence of secondary bacterial pneumonia (new infiltrates, elevated procalcitonin, clinical deterioration), not for viral symptoms alone 1
Rehabilitation and Recovery Phase
Pulmonary rehabilitation training should be initiated early for patients with impaired pulmonary function, including combined aerobic and strength exercises with specific respiratory exercises 1
Breathing exercise management and posture management can significantly improve pulmonary function recovery and exercise capacity in patients with post-viral lung complications 1
Monitor for chronic sequelae, as up to 40% of chikungunya patients may develop long-term complications requiring ongoing supportive care 5, 3
Critical Pitfalls to Avoid
Never use NSAIDs or aspirin in the acute phase until dengue and other hemorrhagic fever viruses are excluded, as co-circulation of these arboviruses is common in endemic areas 1, 2
Do not delay supportive respiratory care while awaiting definitive viral diagnosis, as early intervention improves outcomes 1
Avoid attributing all symptoms to chikungunya without considering secondary bacterial infections or other complications that may require specific treatment 1
Do not prescribe corticosteroids routinely, as their role in chikungunya lung disease is not established and may be harmful in the acute viral phase 5