Chikungunya Treatment
The recommended treatment for chikungunya is acetaminophen exclusively for pain and fever relief, aggressive oral hydration exceeding 2500ml daily, and strict avoidance of NSAIDs and aspirin during the acute phase until dengue co-infection is definitively ruled out. 1
Acute Phase Management (Days 1-7)
Pain and Fever Control
- Use acetaminophen at standard doses as the sole analgesic and antipyretic during the acute phase. 1, 2
- Never use NSAIDs or aspirin during the first 7-10 days of illness until dengue is definitively excluded, as both diseases share identical Aedes mosquito vectors and geographic distribution, and NSAIDs increase bleeding risk with dengue co-infection. 1, 3
Hydration Strategy
- Provide aggressive oral hydration with oral rehydration solutions, targeting fluid intake exceeding 2500ml daily for adults. 1
- Reserve intravenous fluids only for patients unable to tolerate oral intake. 1
Diagnostic Confirmation
- Order PCR testing during days 1-4 of symptoms when viral loads are highest for direct viral detection. 1
- Use IgM antibody testing from day 5 onward when viral loads decline. 1
- Always test to exclude dengue co-infection before considering NSAIDs, as both diseases present identically and share the same vectors. 1
Chronic Phase Management (Beyond 3 Months)
Up to 80% of patients develop persistent musculoskeletal manifestations lasting longer than 3 months, causing significant quality of life impairment. 3 The most common chronic manifestations include persistent or relapsing-remitting polyarthralgias, polyarthritis affecting fingers, wrists, knees, ankles, and toes. 3
Treatment Options for Chronic Arthritis
- Hydroxychloroquine in combination with corticosteroids or other disease-modifying antirheumatic drugs (DMARDs) has been successful in treating chronic rheumatic manifestations. 3
- Methotrexate and sulfasalazine (alone or in combination) have proven effective for chronic chikungunya arthritis. 3
- Low-dose corticosteroids for approximately 1-2 months may be beneficial in relieving acute rheumatic symptoms, though this remains somewhat controversial. 3
High-Risk Populations Requiring Enhanced Monitoring
Elderly Patients
- Patients over 60 years old are at significantly higher risk for severe manifestations, including neurological complications. 1
- Maintain heightened vigilance for encephalitis and encephalopathy, which carry a case fatality rate of approximately 10% among those with neurological manifestations. 1
Pregnant Women and Neonates
- Acetaminophen remains the safest analgesic option throughout pregnancy. 1, 2
- Infants and neonates are at increased risk for severe disease, particularly those infected via maternal-fetal transmission near term. 1
- Infected mothers may miscarry, and newborns infected in utero may be born with congenital illnesses. 4
Pediatric Patients
Critical Pitfalls to Avoid
- Do not assume chikungunya is the sole diagnosis without excluding dengue, as clinical presentations are virtually identical and co-infections occur. 1
- Never prescribe NSAIDs or aspirin empirically during the acute phase, even if joint pain is severe, until dengue is definitively excluded through negative testing. 1
- Do not delay rheumatologic evaluation for patients developing chronic arthritis beyond 3 months, as early DMARD therapy improves outcomes. 3
- Avoid dismissing persistent joint symptoms as purely psychological, as chronic chikungunya arthritis is a well-documented entity affecting up to 15% of patients. 5, 3
When to Consider Hospitalization
While chikungunya is generally self-limiting, severe manifestations warrant hospitalization: 5
- Neurological complications (meningoencephalitis, encephalopathy)
- Fulminant hepatitis
- Bleeding manifestations
- Inability to maintain oral hydration
- Hemodynamic instability
Prevention Counseling
Prevention relies on avoiding mosquito bites in endemic areas, particularly from day-biting Aedes mosquitoes (A. aegypti and A. albopictus). 1 No commercially available vaccine exists for public use. 5