Chikungunya virus: Difference between revisions
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==Background== |
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= Chikungunya = |
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===Microbiology=== |
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*Member of the ''Alphavirus'' genus within the ''Togaviridae'' family |
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== Definition == |
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**Closely related to [[oβnyong-nyong virus]] |
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*Four genotypes: East-Central-South African, West African, Indian Ocean, and Asian |
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===Epidemiology=== |
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* Infection with the Chikungunya virus |
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*The primary vectors are ''[[Aedes aegypti]]'' and ''[[Aedes albopictus]]'' mosquitoes |
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== Presentation == |
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*Endemic in most of Africa, Southeast Asia, the Philippines, and South and Central America |
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**There has been autochthonous transmission in Italy and Frace |
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==Clinical Manifestations== |
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* History |
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** Fever |
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** Rash |
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** Arthralgias |
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*Incubation period of [[Usual incubation period::1 to 12 days]] |
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== Management == |
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*[[Causes::Fever]], [[Causes::rash]], and [[Causes::arthralgias]] |
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**Fever may be "saddleback", with remittance at 4 to 8 days followed by recrudescence for 2 weeks |
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**Arthritis is typically a symmetrical polyarticular arthritis that involves small joints and knees |
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***Resolves over months to a year (sometimes longer), but arthralgias (Β± arthritis) can persist for years |
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**Rash is macular or maculopapular, and more often central but can involve palms and soles |
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*Other common symptoms include headache, fatigue, nausea, vomiting, and conjunctivitis |
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*Bloodwork shows leukopenia, thrombocytopenia, hypocalcemia, and mild to moderate transaminase elevation |
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*Children are more likely to develop neurological symptoms (status epilepticus, complex seizures, and encephalitis) and dermatologic symptoms (bullous rash) |
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==Differential Diagnosis== |
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* High-dose NSAIDs |
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{| class="wikitable" |
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* May need aggressive rheumatology medications for arthritis |
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!Feature |
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* Supportive treatment |
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![[Dengue]] |
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![[Zika]] |
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!Chikungunya |
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|- |
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|Asymptomatic |
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|40-80% |
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|35-85% |
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|3-28% |
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|- |
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|Fever |
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| +++ |
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| ++ |
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| +++ |
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|- |
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|Rash |
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| + |
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| +++ |
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| ++ |
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|- |
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|Conjunctivitis |
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|β |
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| ++ |
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| + |
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|- |
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|Arthralgia |
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| + |
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| ++ |
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| +++ |
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|- |
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|Myalgia |
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| ++ |
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| + |
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| + |
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|- |
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|Headache |
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| ++ |
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| + |
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| ++ |
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|- |
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|Hemorrhage |
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| ++ |
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|β |
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|β |
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|- |
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|Shock |
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| + |
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|β |
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|β |
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|- |
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|Thrombocytopenia |
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| +++ |
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| + |
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|β |
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|- |
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|Leukopenia |
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| ++ |
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|β |
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| ++ |
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|} |
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==Management== |
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*High-dose [[NSAID|NSAIDs]] |
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== Prognosis == |
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*May need aggressive rheumatologic medications for arthritis |
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*Supportive treatment |
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==Prognosis== |
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* 12% risk of chronic arthralgias up to 3 years post-infection |
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* Neonates and elderly at highest risk for neurological sequelae |
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*12% risk of chronic arthralgias up to 3 years post-infection |
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*Neonates and elderly at highest risk for neurological sequelae |
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[[Category:Togaviridae]] |
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Latest revision as of 18:13, 22 August 2020
Background
Microbiology
- Member of the Alphavirus genus within the Togaviridae family
- Closely related to oβnyong-nyong virus
- Four genotypes: East-Central-South African, West African, Indian Ocean, and Asian
Epidemiology
- The primary vectors are Aedes aegypti and Aedes albopictus mosquitoes
- Endemic in most of Africa, Southeast Asia, the Philippines, and South and Central America
- There has been autochthonous transmission in Italy and Frace
Clinical Manifestations
- Incubation period of 1 to 12 days
- Fever, rash, and arthralgias
- Fever may be "saddleback", with remittance at 4 to 8 days followed by recrudescence for 2 weeks
- Arthritis is typically a symmetrical polyarticular arthritis that involves small joints and knees
- Resolves over months to a year (sometimes longer), but arthralgias (Β± arthritis) can persist for years
- Rash is macular or maculopapular, and more often central but can involve palms and soles
- Other common symptoms include headache, fatigue, nausea, vomiting, and conjunctivitis
- Bloodwork shows leukopenia, thrombocytopenia, hypocalcemia, and mild to moderate transaminase elevation
- Children are more likely to develop neurological symptoms (status epilepticus, complex seizures, and encephalitis) and dermatologic symptoms (bullous rash)
Differential Diagnosis
| Feature | Dengue | Zika | Chikungunya |
|---|---|---|---|
| Asymptomatic | 40-80% | 35-85% | 3-28% |
| Fever | +++ | ++ | +++ |
| Rash | + | +++ | ++ |
| Conjunctivitis | β | ++ | + |
| Arthralgia | + | ++ | +++ |
| Myalgia | ++ | + | + |
| Headache | ++ | + | ++ |
| Hemorrhage | ++ | β | β |
| Shock | + | β | β |
| Thrombocytopenia | +++ | + | β |
| Leukopenia | ++ | β | ++ |
Management
- High-dose NSAIDs
- May need aggressive rheumatologic medications for arthritis
- Supportive treatment
Prognosis
- 12% risk of chronic arthralgias up to 3 years post-infection
- Neonates and elderly at highest risk for neurological sequelae
