What is the recommended treatment approach for a patient diagnosed with Chikungunya?

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 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
• Absolutely avoid NSAIDs (ibuprofen, naproxen) and aspirin during the first 7-10 days of illness because dengue and chikungunya share identical mosquito vectors (Aedes species) and geographic distribution, making co-infection common. 1, 2
• NSAIDs increase bleeding risk and cause platelet dysfunction, which is catastrophic if dengue is present. 2

Hydration Strategy

• Ensure oral fluid intake exceeding 2500ml daily for adults using oral rehydration solutions. 1, 2
• 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
• Switch to IgM antibody testing from day 5 onward as viral loads decline. 1
• Always test for dengue simultaneously using nucleic acid amplification tests on serum collected ≤7 days after symptom onset, as both infections present identically and require different management approaches. 2

High-Risk Population Monitoring

Elderly Patients (>60 years)

• Maintain heightened surveillance for neurological complications including encephalitis and encephalopathy, which carry a 10% case fatality rate among those with neurological manifestations. 1

Pregnant Women

• Acetaminophen remains the safest analgesic throughout all trimesters. 1, 2
• No dose adjustment needed from standard adult dosing. 2

Infants and Neonates

• Infants face increased risk for severe disease, particularly those infected via maternal-fetal transmission near term. 1
• Calculate acetaminophen dosing carefully based on weight (10-15 mg/kg/dose every 4-6 hours, maximum 75 mg/kg/day). 1

Chronic Phase Management (Beyond 3 Months)

Up to 80% of patients develop persistent musculoskeletal symptoms lasting beyond 3 months. 3 While the acute phase guidelines are clear, chronic management becomes more complex:

• Low-dose corticosteroids for 1-2 months may relieve persistent symptoms, though this is based on observational data. 3
• Hydroxychloroquine combined with corticosteroids or other disease-modifying antirheumatic drugs (DMARDs) has shown success for chronic manifestations. 3
• Methotrexate and sulfasalazine (alone or combined) have demonstrated effectiveness for chronic chikungunya arthritis. 3

Patients with symptoms persisting beyond 3 months warrant rheumatology referral for consideration of DMARD therapy. 3

Critical Pitfalls to Avoid

• Never assume chikungunya is the sole diagnosis without excluding dengue through laboratory testing. Both diseases are transmitted by identical vectors and occur in the same geographic regions. 1
• Do not prescribe NSAIDs based on symptom improvement or negative initial dengue testing—wait a minimum of 7-10 days from symptom onset. 1
• Avoid empiric antibiotics, as bacterial co-infection occurs in less than 10% of viral illness cases and contributes to antimicrobial resistance without clinical benefit. 4

Prevention Counseling

Prevention relies entirely on avoiding bites from day-biting Aedes mosquitoes (primarily Aedes aegypti and Aedes albopictus) in endemic areas, as no commercially available vaccine exists. 1, 5