3. Chikungunya Fever

Chikungunya Fever

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

This disease is notifiable in the UK.

Chikungunya is one of a group of arboviruses (of the family Togaviridae) and is transmitted by mosquitoes (usually of the Aedes spp.). They tend to bite during daylight.

Its name derives from a verb from the Kimakonde language, meaning "to become contorted", referring to the sufferer's stooped posture caused by joint pains. It was first described in southern Tanzania in 1952.

  • Chikungunya fever occurs in both sporadic outbreaks and large epidemics in Africa, the Indian subcontinent and Southeast Asia, particularly the Philippines, Thailand, Cambodia, Vietnam, Mauritius and Sri Lanka.
  • It affects all age groups but more than 50% are over the age of 65 years - of which a third will die. Severe illness also occurs in children.[1]
  • It has also been reported in south-eastern France and Italy.[2]
  • There was an exceptionally virulent outbreak in the French island of La Réunion in the Indian Ocean, in 2005 and 2006, which also affected neighbouring islands, including Mauritius.[3][4]
  • It is said to affect thousands of people throughout the world every year, but the World Health Organization (WHO) does not offer figures.
  • The disease is rarely imported to other countries by travellers returning from endemic areas.[5][6] However, the number of reported cases for the UK in 2010 was 79 - an increase by 34% compared with 2009 (the majority of which was imported from India).[7]

Risk factors

Risk is highest in the rainy season when numbers of mosquitoes are at their greatest.

The illness characteristically begins with rapid onset of joint pains and may or may not be accompanied by the following: muscle pain, high fever, conjunctivitis and a rash.

  • Incubation period is 2-4 days.
  • There is sudden onset of fever and, with it, a severe, crippling migrating, polyarticular arthritis. This is due to the virus invading and causing inflammation of the cartilage.[8]
  • Between the 2nd and 5th day of illness there is a macular or maculopapular rash, mostly on the trunk and limbs.
  • There may be conjunctivitis and minor bleeding in the skin and eye.
  • Patients may also develop hepatomegaly.
  • In children, blindness due to retrobulbar neuritis, and acute flaccid paralysis, have been described.[9]
  • Other features include meningo-encephalitis, cardiovascular decompensation, or respiratory failure.
  • Most patients recover within a few days and death is a rarity. Arthritis may persist for rather longer, even several months or years.

Serological testing, eg enzyme-linked immunosorbent assays, can be used to confirm the diagnosis. More recently, indirect immunofluorescence has become available.[10] Reverse transcriptase-polymerase chain reaction can also be used but the sensitivity is variable.[11] Extreme care should be taken when obtaining blood samples and handling specimens.

The picture may be confused with the various viral haemorrhagic fevers or malaria.

Chikungunya is very similar in presentation to dengue fever. The main differences are:

  • In classical dengue fever there is no hepatomegaly whilst that is present in Chikungunya and haemorrhagic dengue fever.
  • In haemorrhagic dengue fever there is also a confluent petechial rash.

The management largely revolves around symptom relief.

  • Fever is marked and especially in a hot environment, plenty of fluid should be drunk.
  • Paracetamol and ibuprofen may help to relieve pyrexia and pain.
  • Sometimes chloroquine is used for persistent arthritis. This is based on a pilot study in 1984 that has not been repeated since.[12]

The relationship between malaria, glandular fever and Burkitt's lymphoma is well known, but the distribution in Africa may mirror that of Chikungunya fever too.[13][14]

The majority of patients will recover but some may be left with chronic joint pains which may last several years.[15] Chikungunya virus does not cause death directly but in the presence of other comorbidities it may contribute to a fatal outcome.

Epidemics have been associated with poor control of mosquitoes.[16] Prevention requires the use of insect repellants and elimination of breeding places for mosquitoes, eg stagnant water. There is no vaccine available.[11]

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Further reading & references

  1. Thiboutot MM, Kannan S, Kawalekar OU, et al; Chikungunya: a potentially emerging epidemic? PLoS Negl Trop Dis. 2010 Apr 27;4(4):e623.
  2. Clinical Update: Locally acquired Chikungunya virus: France (var); National Travel Health Network and Centre (NaTHNaC), Sept 2010
  3. Renault P, Solet JL, Sissoko D, et al; A major epidemic of chikungunya virus infection on Reunion Island, France, 2005-2006. Am J Trop Med Hyg. 2007 Oct;77(4):727-31.
  4. Beesoon S, Funkhouser E, Kotea N, et al; Chikungunya Fever, mauritius, 2006. Emerg Infect Dis. 2008 Feb;14(2):337-8.
  5. Taubitz W, Cramer JP, Kapaun A, et al; Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007 Jul 1;45(1):e1-4. Epub 2007 May 23.
  6. Hochedez P, Hausfater P, Jaureguiberry S, et al; Cases of chikungunya fever imported from the islands of the South West Indian Ocean to Paris, France. Euro Surveill. 2007 Jan 20;12(1).
  7. Clinical Update: HPA reports published on dengue and chikungunya in England, Wales and Northern Ireland in 2010, National Travel Health Network and Centre (NaTHNaC), May 2011
  8. Lokireddy S, Vadde S, Vadde R; Connective tissue metabolism in chikungunya patients. Virol J. 2008 Feb 27;5(1):31.
  9. Sebastian MR, Lodha R, Kabra SK; Chikungunya infection in children. Indian J Pediatr. 2009 Feb;76(2):185-9. Epub 2009 Mar 28.
  10. Litzba N, Schuffenecker I, Zeller H, et al; Evaluation of the first commercial chikungunya virus indirect immunofluorescence test. J Virol Methods. 2008 Feb 20.
  11. Chikungunya; Fact sheet No. 327, World Health Organization, March 2008
  12. Brighton SW; Chloroquine phosphate treatment of chronic Chikungunya arthritis. An open pilot study. S Afr Med J. 1984 Aug 11;66(6):217-8.
  13. Gandhi MK; Epstein-Barr virus-associated lymphomas. Expert Rev Anti Infect Ther. 2006 Feb;4(1):77-89.
  14. van den Bosch C, Lloyd G; Chikungunya fever as a risk factor for endemic Burkitt's lymphoma in Malawi. Trans R Soc Trop Med Hyg. 2000 Nov-Dec;94(6):704-5.
  15. Chikungunya Fever, Health Protection Agency
  16. Mudur G; Failure to control mosquitoes has led to two fever epidemics in India. BMJ. 2006 Oct 14;333(7572):773.
Original Author: Dr Gurvinder Rull Current Version: Peer Reviewer: Dr Adrian Bonsall
Last Checked: 19/08/2011 Document ID: 1935  Version: 24 © EMIS

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

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