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Chikungunya is a disease caused by mosquitoes. It is most prevalent in Asian and African countries. However, incidences of this mosquito-borne disease have been found in some parts of Europe and America. The name “Chikungunya” originates from the Kimakonde language spoken by an ethnic group in southeast Tanzania and northern Mozambique. Meaning ‘contortion’, this word refers to the stooped posture of people experiencing severe joint or muscle pain. This is one of the major manifestations of Chikungunya.

This is a virus that you catch from the bite of infected female mosquitoes: Aedes aegypti and Aedes albopictus. The transmission of Chikungunya generally occurs outdoors during the day, especially in the early morning and late afternoon hours, when these mosquitoes are most active. This viral infection is characterised by an abrupt onset of fever accompanied by severe muscle and joint pain. Other symptoms could be headache, nausea, fatigue and rash.

The onset of Chikungunya occurs within 3-7 days of a mosquito bite. Though the condition mostly resolves on its own, this infection can be fatal for the elderly population and people with comorbid conditions. There is currently no cure or vaccine for the condition. The treatment is aimed at relief from symptoms like pain, swelling and fever. Chikungunya fever may lead to rheumatoid arthritis in a small percentage of patients.

Types

Chikungunya virus is known to spread in two cycles.

Urban transmission cycle prevalent in western hemisphere epidemic. In this cycle, the transmission is from human to mosquito to human.

Sylvatic transmission cycles this transmission is prevalent in Africa and occurs from animal to mosquito to human.

Stages

Stages of Chikungunya start after infection and inoculation of human endothelial and epithelial cells. After an immune response and initial sheltering of lymph nodes, the Chikungunya virus travels through the circulatory and lymphatic systems, causing infection. This is then transporter two the targeted organs such as joints, muscles, brain, and liver. An inflammatory reaction is mediated by CD4+ and CD8+ T lymphocytes and proinflammatory cytokines. This reaction may be responsible for chronic joint disease.

Symptoms

The signs and symptoms of Chikungunya may last for 10-12 days and subside on their own. Apart from fever and debilitating joint pain, there are other manifestations of Chikungunya too. Here are some of them:

1. Headache


2. Fatigue


3. Nausea


4. Vomiting (within approximately two to 22 days of infection, in some cases)


5. Tender lymph nodes

The symptoms of Chikungunya may often be mistaken for other mosquito-borne diseases like malaria and dengue. However, they affect the body differently, and the differences are subtle. One of them is the type and frequency of fever a patient experience. In dengue, a patient suffers from high fever that appears and subsides quickly only to reappear with rashes; haemorrhagic fever and bleeding could be other associated symptoms. Malaria patients, on the other hand, suffer from high fever, which is most predominant in the evenings. It is followed by chills and sweating in quick succession. In the case of Chikungunya, the patient experiences high fever with severe pain in the body, especially the joints, along with all the symptoms mentioned above. In all three conditions, the patient will experience a temperature of about 102 o F.
Rashes that are observed in Chikungunya fever is characterised by the maculopapular feature. However, bullous rashes have also been reported in some Chikungunya infants. These symptoms are resolved within 7 to 10 days, but the patients suffering from protracted arthralgia may have these symptoms for weeks, months and years.

Causes And Risk Factors

Causes

Chikungunya is caused due to a viral infection (CHIKV) and is transmitted when an infected mosquito carries the virus from an infected human to a healthy person. They are commonly seen breeding around clean water bodies and mostly attack during the day.” Poor sanitation, coming in contact with an infected person, living in or travelling to places with a high infestation of Aedes aegypti and Aedes albopictus mosquitoes, a weak immune system and having stagnant water in and around your home will increase the risk of Chikungunya. People above 65, newborns and those living with high blood pressure, diabetes, or heart disease are more at risk of developing the condition.

Risk Factors

Risk factors for Chikungunya virus infection are as follows-

1. Unsanitary environment


2. Increased frequency of mosquito bites


3. Age between 25 to 44 years


4. Female gender


5. Living in a high populated area

Prevention

You can take a few steps to prevent and reduce your risk of Chikungunya infection:

1. Since infected mosquitoes bite during the day, it is advisable to use a mosquito repellent cream while stepping out, especially in endemic areas. Read package instructions while using them.


2. Keep all water reservoirs like buckets, small tubs, mugs, etc., covered. It is essential to empty all the containers regularly and wash them well.


3. Remember to close all your windows and doors by mid-morning.


4. Wear long-sleeved trousers and tops to keep yourself covered.


5. Buy mosquito screens, nets or fibre glass meshes for your windows if you live in a mosquito-infested area. Magnetic insect repellent screens will also help.


6. Indoor residual spraying with an insecticide can also help in keeping mosquitoes at bay.

Diagnosis

Most doctors diagnose the condition using a process of elimination, by testing for dengue and malaria first, followed by tests for Chikungunya. A simple blood test known as the CHIKV test helps in the diagnosis of this mosquito-borne disease. You may also need other blood tests like ELISA (Enzyme-linked immunosorbent assays) for the presence of antibodies that fight Chikungunya: Immunoglobulin M and Immunoglobulin G. Your doctor will also recommend another bloodwork known as (RT)-PCR assay to detect the CHIKV RNA. This needs to be done within 1 week of catching the infection.

Treatment

As already mentioned, there is no treatment specific treatment for Chikungunya as it is a viral infection. Symptomatic treatment for Chikungunya fever is the primary goal of therapy. Pain relief with acetaminophen, adequate hydration and rest are essential. Low dose corticosteroid drugs for two months after the acute disease are prescribed. I related complications are managed with topical steroids and cycloplegics. Hydroxychloroquine in combination with corticosteroids or other DMARD's has been included for persistent or recurring polyarthritis, polyarthralgia, myalgia. Additionally, there is no vaccine to safeguard against this mosquito-borne disease. In most cases, people recover within a week. However, the joint pain may persist for months. Drugs to reduce the pain, swelling and fever that come with the disease are usually prescribed by the doctor as the first line of treatment. You also should drink plenty of liquids and get a lot of rest.

Lifestyle/management

Some foods alongside the prescribed medicines can help you in the fast recovery of this condition. Add them to your meals as battle Chikungunya.

Fluids: While suffering from a viral infection like Chikungunya, you may end up losing a lot of fluids from the body. So, you need to drink a lot of water and other liquids to replenish them. Include homemade soups, barley water, buttermilk/curd, lemon water and tender coconut water in your meals.
Vitamin C-rich fruits: They help your immune cells function better and fight any infection, including Chikungunya. Oranges, guavas and lemons, among others, can be good options.

Vegetables: Loaded with essential nutrients, they help you in the process of digestion while your gastrointestinal tract isn’t able to perform at its best during an infection. Green leafy vegetables also help you ease the symptoms of Chikungunya.
Use of mosquito repellents, use of bed nets while sleeping, wearing protective clothing and air-conditioned buildings are great ways to prevent Chikungunya virus exposure.

Prognosis And Complications

Prognosis

Chikungunya has a low mortality rate, so that the prognosis can be good. However, post Chikungunya fever patient experiences polyarthralgia for more than six weeks which can lead to a poor prognosis of the disease. Chikungunya is also associated with rheumatic mucus skeletal pain at three and six months.
Complications

Complications of Chikungunya fever are as follows-

Chronic arthritis
Polyarthritis
Polyarthralgia and myalgia
Conjunctivitis
Iridocyclitis
Optic neuritis
Retinitis
Episcleritis
Uveitis

Complications such as Guillain Barre syndrome and encephalitis are some of the neurological complications of acute Chikungunya virus disease. Additionally, hepatitis and myocarditis are some severe manifestations of Chikungunya virus disease.

Alternative Treatments

1. Stat Pearls. Chikungunya Fever [Internet] [Updated on July 2, 2020] Available at https://www.ncbi.nlm.nih.gov/books/NBK534224/.

2. Elsevier Public Health Emergency Collection. Chikungunya virus. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469677/.