What is Chikungunya? Symptoms, Causes, Treatment and Prevention

Table of Content

• What is chikungunya?

• How did chikungunya originate?

• How does chikungunya spread?

• Common symptoms of chikungunya

• What is different from dengue in chikungunya?

• Diagnosing chikungunya

• Treatment of chikungunya

• Preventing chikungunya

• Take-Home Points

• FAQ on What is Chikungunya?

What is chikungunya? 

Chikungunya is a disease which is caused by a virus, the virus is named Togaviridae alphavirus.  Especially because of the toga virus which is part of the chikungunya family. This disease is usually not deadly but it leads to joint pain and fever which are its common symptoms. These symptoms make it similar to dengue. It spreads through female mosquitoes which are named Aedes, just a name of a species. Chikungunya is usually predominant in countries like India, South Africa and South -Asia. 

Joint pain and fever usually resolve within weeks but sometimes Joint pain can last up to several months or up to several years.

Prevention and treatment of chikungunya become important because there is no vaccine or specific drug available for treatment according to W.H.O. Warm and moist places and stagnant water gives the Aedes mosquito a perfect place to breed and spread.

How did chikungunya originate?

The first case of chikungunya was detected in Tanzania in 1952. In 2004, an outbreak from Kenya reached the Indian Ocean, then two to 10 years down the line, almost 60 countries of Asia and western countries became infected.

The main species of mosquitoes found responsible came out to be Aedes. This has two groups one being Aedes aegypti and Aedes albopictus. A. aegypti is found in the tropics and subtropics but the other one is found in temperate regions of the world.

How does chikungunya spread? 

The Chikungunya virus spreads through mosquito bites. When a mosquito feeds on an infected person then again the same mosquito feeds on another person who doesn’t have the virus then the latter person also becomes infected

Sometimes spread and circulation of the chikungunya virus within birds and rodents happens.

Vertical transmission i.e, from a pregnant mother to her baby also happens but this is rare. Also spread through blood donation from an infected person is also very rare.

Stagnant water and moist places are common habitats of these causative mosquitoes.

Chikungunya finds its way to the mosquito's salivary gland when the mosquito bites an infected person and the virus stays in the salivary gland. 

When a mosquito with a virus in its salivary gland bites another healthy human then the mosquito ruptures the skin and starts sucking the blood, during the process of sucking the virus goes from the glands of the mosquito to another person’s blood.

The virus then reaches the site where symptoms begin, usually, in joints and muscles, enters normal cells and replicates and increases its population and causing infection and these symptoms. The incubation period meaning the time from which the infection happened to the time when symptoms arise, usually ranges from one to twelve days and is most typically three to seven.

Common symptoms of chikungunya

The symptoms of chikungunya start coming after 3 to 7 days after the mosquito bite and the virus entry. Newborns and older adults are at greater risk of severe chikungunya infection. People having Diabetes and chronic heart disease are also at risk.

Symptoms of chikungunya include:

• Fever

• Joint pain

• Headaches 

• Muscle pains 

• Joint swelling

• Rashes 

Joint pain is usually present on both sides of the body meaning if one knee is involved another knee is also involved. Joint pain usually comes after 2 to 5 days.

The hands are affected the most with some involvement reported to the axial skeleton, knees, and ankles accompanied by intense pain that lasts between one and three weeks.

Commonly rashes arise after 2 to 3 days after fever, these rashes are slightly raised above the skin(maculopapular rash). 

Symptoms such as abdominal pain, diarrhoea, vomiting, and generalized lymphadenopathy are seen but these symptoms are generalised symptoms meaning they are present in most diseases. These symptoms don’t help to differentiate it from other diseases.

Some studies showed that red eyes and other eye symptoms can be also present in chikungunya.

Other diseases with similar symptoms as chikungunya

Apart from resembling so much Dengue. Chikungunya has symptoms similar to viral infections, bacterial infections and parasitic infections. These come under differential diagnosis of chikungunya, meaning a medical practitioner has to eliminate the possibility of these diseases to reach the diagnosis of chikungunya.

1. Viral infections

• Dengue fever

• West Nile fever

• Adenovirus infection

• Anyone-nyong fever

• Ross River fever

• Sindbis fever

• Crimean-Congo fever

• Mayaro fever

• Ebola fever

• Hantavirus infection

• Kyasanur Forest disease

• Lassa fever

• Rubella

• Parvovirus B19 infection

• Hepatitis B

• Mumps

• Infection with herpes viruses

2. Parasitic infections

• Falciparum malaria infection

3. Bacterial infections

• Leptospirosis

• Rickettsial infections

• Gonococcemia

• Postinfectious reactive arthritis

• Group A streptococcal infection

Among these diseases when considering chikungunya, dengue shows the most similarities with chikungunya. So, what makes dengue different from chikungunya?

What is different from dengue in chikungunya?

Did you know earlier that chikungunya was called dengue, when an outbreak happened then scientists understood chikungunya as a different disease?

There is a similarity between these as both are spread by mosquitoes, and also by the same species the Aedes. 

Although dengue spread is a bigger concern, chikungunya is not.

Both dengue and chikungunya present with:

• High-grade fever

• Headache

• Joint and eye pain

• Red rashes

• Drowsiness 

Chikungunya is caused by Togaviridae alphavirus whereas Dengue is caused by Flavirideae flavivirus.  There is a difference in the incubation period, chikungunya has an incubation period of 3 to 10 days, and Dengue has 4 to 7 weeks.

Chikungunya has more severe symptoms of pain and swelling.

The rashes of chikungunya appear on the arms and torso first. In Dengue the rash fist comes on the face and arms.

Joint pain is seen in the shoulders in Dengue. Chikungunya joint pain appears in the hands, feet, wrists and on legs.

Fever, joint pain, headache, and rashes are the first to appear in Chikungunya. 

Fever, joint pain, muscle pain, headache, and eye infection rashes are the first to appear in dengue. 

Platelet count is lower than 150,000 platelets per microliter of blood in the case of Chikungunya but in Dengue it goes far below 10,000. 

There is no muscle pain in Chikungunya. In Dengue it is present.

Bleeding is not seen in Chikungunya since platelets are not that low. 

Bleeding is generally seen in Dengue since the platelet count goes below 10,000.

In chikungunya, some cases of neurological symptoms have been reported, but there is no such report supporting brain involvement in Dengue.

Chikungunya is rarely fatal, but fatalities due to Dengue are reported much higher than chikungunya.

Diagnosing chikungunya

Immediately seek help from a medical practitioner. Apart from clinical symptoms, doctors need help with clinical testing to reach a diagnosis.

Laboratory testing

• Serum testing

• Plasma testing to look for the virus 

• Antibody testing IgM and other neutralizing antibodies

• Serological testing like ELISA is performed to detect the presence of antibodies, and IgM levels increase and stay high for about 2 months.

• RT–PCR methods are available but with variable sensitivity.

A positive ELISA and increase in IgM antibodies, platelet and other parameters help doctors to reach a diagnosis and differentiate from other diseases.

Treatment of chikungunya

Home remedies

• Stay hydrated

• Healthy diet

• Using castor oil

• Turmeric: Acts as an antioxidant, hence enhancing the immune system to fight chikungunya.

• Papaya leaf juice increases the platelet count.

Doctor’s treatment

• Currently no antiviral drug for chikungunya

• Symptomatic treatment is given like pain and fever medications.

• In dengue-prone areas, paracetamol is the first line of treatment for pain and fever, but these medications should be strictly taken only by consulting your physician.

• Rest and fluids are also suggested by doctors

Treatment of joint pain

• Although doctors prescribe NSAIDs and other painkillers still there are something which you can do to improve joint pain

• Mild exercise: Joint pain usually occurs in the morning because at night time there is less movement of joints and therefore they become stiff. Mild exercise can help with the pain. Avoid doing heavy exercise.

• Cold packs

• Eating turmeric, leafy vegetables, and garlic

• Physiotherapy can help with joint pain

• Medications, as advised by the physician

Treatment of fever

• Usually, medications like paracetamol/acetaminophen help while dealing with a fever.

Preventing chikungunya

• Use of insect repellant that has DEET or picaridin.

• Remove stagnant water

• Mosquito netting and screen protection of rooms

• Avoid travelling to places of chikungunya outbreak, especially if pregnant, or have heart disease and diabetes.

• Wear long sleeve shirts and pants

• Wear clothes are gear that is treated with permethrin or other repellents.

• Use mosquito coils

• Avoid crowd gatherings at places of a chikungunya outbreak.

Take-Home Points

• Chikungunya is spread by mosquitoes hence prevention is necessary to prevent the spread

• Common symptoms of  Chikungunya include joint pain and fever often confused with other fever-causing diseases like dengue.

• Symptoms and Laboratory tests both are utilised in confirming the diagnosis of Chikungunya.

• Treating involves curing the symptoms since no specific vaccine or antiviral drugs is available, especially for Chikungunya.

• Mild exercise and cold packs can be used as a home remedy for relieving joint pain. Apart from these, maintaining a healthy diet is also important for helping the immune system to fight the virus.

• Prevention of chikungunya is done by preventing mosquito bites, using insect repellents and avoiding water collection.

• Seeking help from a Physician is important in curing the disease.

References

• https://www.who.int/news-room/fact-sheets/detail/chikungunya

• https://www.cdc.gov/chikungunya/symptoms/index.html

• https://www.cdc.gov/chikungunya/hc/treatment-prevention.html

• https://www.ncbi.nlm.nih.gov/books/NBK5342