Definition

Chikungunya is a virus that can be spread by the same type of mosquitoes that also spread dengue and Zika. Belonging to the Togaviridae family, the Chikungunya virus is categorized as a tropical disease since it has only been documented in Africa, Asia, and India. 'Chikungunya' originates from the Makonde language in Africa, meaning 'to bend over in pain.'

This virus is transmitted to humans through the bites of Aedes aegypti or Aedes albopictus mosquitoes. While Chikungunya can be transmitted from a pregnant mother to her baby, such occurrences are rare. Although Chikungunya does not usually result in death, it can cause long-lasting pain.

Causes

Chikungunya is caused by the Chikungunya virus, transmitted through the bites of Aedes aegypti or Aedes albopictus mosquitoes. These mosquitoes are also capable of transmitting dengue fever and the Zika virus.

Aedes mosquitoes acquire the Chikungunya virus by biting someone who is already infected. Subsequent transmission occurs when these mosquitoes bite other individuals. It's important to note that the Chikungunya virus can only spread through mosquito bites and cannot be transmitted directly from one person to another.

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Risk factor

While everyone is at risk of Chikungunya infection, certain groups face a higher risk. Newborns, individuals aged 65 and above, and people with underlying medical conditions such as hypertension, diabetes, and heart disease are particularly vulnerable to contracting Chikungunya.

Symptoms

Chikungunya symptoms typically manifest 3 to 7 days after transmission by an infected mosquito. Infected individuals may experience common symptoms such as fever and joint pain, headaches, joint swelling, muscle pain, nausea, and redness.

These symptoms can resemble those of the flu and may be severe. Fortunately, in most cases, individuals recover within a week. However, joint pain can sometimes persist for several months or even longer. While rare, severe symptoms of Chikungunya can lead to temporary paralysis. Importantly, the disease can be fatal in vulnerable elderly individuals.

Diagnosis

To establish Chikungunya infection, the doctor will conduct an examination and inquire about your symptoms and recent travel history. It's crucial to inform your doctor about the countries or regions you have recently visited to assess your risk accurately.

Doctors may perform blood tests and send samples to a laboratory to check for potential infections such as malaria and dengue parasites. Additionally, they may recommend ELISA (Enzyme-linked immunosorbent assay) testing. This serological examination detects the presence of Chikungunya IgM and IgG antibodies. Typically, IgM antibodies, produced in response to the disease, peak 3 to 5 weeks after symptom onset and can persist for up to 2 months.

While blood tests are crucial in supporting the diagnosis of Chikungunya based on symptoms, it's important to note that the symptoms can overlap with those of other fevers or pains. Rapidly ruling out the possibility of dengue fever is essential, as it carries a higher mortality rate (up to 50% if untreated) compared to Chikungunya (0.1%).

Management

While the Chikungunya virus rarely causes fatal effects, its symptoms can significantly disrupt patients' lives. Most patients recover from the fever within one week, but joint pain symptoms may persist for months.

Chikungunya typically does not require specific treatment as it often resolves independently. Treatment aims to alleviate symptoms such as fever and joint pain.

Around 20% of patients report recurring joint pain. Although treatment can only alleviate symptoms, it's crucial to promptly reduce fever as it carries a mortality risk (up to 50%) if left untreated. Patients should also ensure they drink plenty of water and get adequate rest. If undergoing treatment for other conditions, consulting with a doctor is advised. Additionally, if joint pain persists, further treatment from a physiotherapist may be beneficial.

Complications

Complications from Chikungunya are rare but can lead to serious conditions such as inflammation of the uvea of the eye (uveitis), inflammation of the retina of the eye (retinitis), inflammation of the heart muscle (myocarditis), inflammation of the kidneys (nephritis), inflammation of the liver (hepatitis), inflammation of the brain (encephalitis), inflammation of the joints (rheumatism), and nerve disorders such as Guillain-Barre syndrome or those affecting a segment of the spinal nerves.

Prevention

While no vaccine is currently available to prevent Chikungunya, efforts are underway to develop one. The National Institute of Health (NIH) is funding phase 2 clinical trials for a Chikungunya vaccine. Unlike traditional vaccines containing inactivated or weakened viruses, this vaccine utilizes a virus similar to Chikungunya, aiming to stimulate a similar immune response to natural infection.

In the absence of a vaccine, prevention primarily focuses on reducing mosquito bites by eliminating mosquito breeding sites using various approaches: draining stagnant water, covering water storage containers tightly, and disposing of old items that can collect water.

Additional measures that complement the prevention approach include sprinkling abate powder on water storage containers, maintaining mosquito larva-eating organisms, installing mosquito-proof wire screens on windows and house ventilation, planting mosquito-repellent plants, and cleaning the surrounding environment.

In Chikungunya-endemic areas, additional preventive measures include regularly using insect repellent lotions containing DEET (N, N-Diethyl-meta-toluamide), wearing long-sleeved shirts and pants, especially during peak mosquito activity, using mosquito nets, particularly during daytime sleeping, and applying mosquito repellent.

When to see a doctor?

If you plan to travel to or reside in an area where Chikungunya is prevalent and develop symptoms, it is crucial to contact a doctor promptly. Early diagnosis allows for more effective treatment. Do not hesitate to seek medical attention if you experience symptoms such as vision disturbances, abdominal pain, bleeding, loss of consciousness, severe pain, or joint swelling.

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