chikungunya

Question 1

how is chikungunya transmitted?

Answer 1

bite of infected Aedes mosquitoes, predominantly A. aegypti and A. albopictus

Question 2

how does chikungunya present?

Answer 2

Typically characterised by high fever, joint pain and rash

• acute onset of fever that lasts 3-5 days (range 1-10 days)
• Joint pain is a prominent feature that begins 2-5 days after onset of fever. It commonly involves multiple joints, is bilateral and symmetric, and involves distal more than proximal joints.
• A rash usually appears in or after 3 days from onset of illness and lasts 3-7 days. A maculopapular rash typically involves the trunk and limbs, and can involve the face.

Other reported symptoms include headache, conjunctival injection, nausea, vomiting and fatigue.

Question 3

What are the complications of chikungunya?

Answer 3

• More common in those aged >65 years and with underlying chronic conditions (e.g. diabetes, cardiovascular disease).
• Complications include respiratory failure, bleeding, meningoencephalitis, acute hepatitis, myocarditis and ocular manifestations (e.g. iridocyclitis, retinitis).

Question 4

how is chikungunya investigated?

Answer 4

• Within 5 days from onset of symptoms: PCR

- more than 5 days from onset of symptoms: IgM, IgG

Question 5

how is chikungunya managed?

Answer 5

Management is supportive and symptomatic. Non-steroidal anti-inflammatory drugs may be considered for joint pain (though these should be withheld in the event of thrombocytopenia or haemorrhagic features).