Fast Five Quiz: Mosquito-Borne Diseases

Michael Stuart Bronze, MD

Disclosures

May 06, 2020

Chikungunya fever is a self-remitting febrile viral illness that has been associated with frequent outbreaks in tropical countries of Africa and Southeast Asia. The illness has only recently become a concern in Western countries and temperate zones around the world.

The incubation period is 3-7 days. It affects all age groups and both sexes equally. Patients present with abrupt onset of high-grade fever, often reaching 102°-105° F, with shaking chills that last 2-3 days. The fever may return for 1-2 days after an afebrile period of 4-10 days, called a "saddleback fever." Prodromal symptoms are uncommon. However, sore throat, headache, abdominal pain, constipation, and retro-orbital pain have been reported during the acute phase of the illness.

Clinical examination reveals high-grade fevers (up to 105° F), pharyngitis, conjunctival suffusion, conjunctivitis, and photophobia. Cervical or generalized lymphadenopathy has also been reported in rare cases.

The arthralgias are usually polyarticular and migratory and frequently involve the small joints of the hands, wrist, and ankle, with lesser involvement of the large joints such as the knee or shoulder, with associated arthritis. More than 10 joint groups may be involved simultaneously, incapacitating the patient. Swollen tender joints with tenosynovitis and crippling arthritis are often evident at the time of presentation. Joint pain is worse in the morning, gradually improving with slow exercise and movement but exacerbated by strenuous exercise.

Chikungunya infection is confirmed via serologic tests, which take about 5-7 days into the illness to turn positive. Therefore, early diagnosis is based on a high index of clinical suspicion based on epidemiology and clinical presentation that includes the triad of high fever, rash, and associated rheumatologic manifestations.

No specific antiviral treatment is available for Chikungunya fever. Once other infections are excluded, management includes hydration, monitoring of hemodynamic status, collection of blood specimens for diagnosis, and antipyretic therapy. Severe arthralgia may be managed with nonsteroidal anti-inflammatory drugs (once dengue is excluded) and physiotherapy. Poor glycemic control in patients with diabetes who have Chikungunya infection has been reported. Published evidence does not recommend the use of corticosteroids or antiviral agents.

Read more about Chikungunya virus.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles West Nile Virus, Dengue, Zika Virus, Chikungunya Virus, and Malaria.

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