Chikungunya virus: Difference between revisions
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*Incubation period of [[Usual incubation period::1 to 12 days]] |
*Incubation period of [[Usual incubation period::1 to 12 days]] |
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*[[Causes::Fever]], [[Causes::rash]], and [[Causes::arthralgias]] |
*[[Causes::Fever]], [[Causes::rash]], and [[Causes::arthralgias]] |
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β | *Fever may be "saddleback", with remittance at 4 to 8 days followed by recrudescence for 2 weeks |
+ | **Fever may be "saddleback", with remittance at 4 to 8 days followed by recrudescence for 2 weeks |
β | *Arthritis is typically a symmetrical polyarticular arthritis that involves small joints and knees |
+ | **Arthritis is typically a symmetrical polyarticular arthritis that involves small joints and knees |
β | **Resolves over months to a year (sometimes longer), but arthralgias (Β± arthritis) can persist for years |
+ | ***Resolves over months to a year (sometimes longer), but arthralgias (Β± arthritis) can persist for years |
β | *Rash is macular or maculopapular, and more often central but can involve palms and soles |
+ | **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 |
*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 |
*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) |
*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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+ | {| class="wikitable" |
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+ | !Feature |
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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== |
==Management== |
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Latest revision as of 14:13, 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