Chikungunya is a febrile illness caused by an alphavirus transmitted through the bite of the Aedes aegypti mosquito. It can cause symptoms such as high fever, chills, severe joint pain, pain behind the eyes, and red spots on the skin.

This arboviral disease, similar to dengue and Zika, has overlapping symptoms; however, the joint pain is usually more intense and may lead to complications such as joint stiffness and body pain that can last for years.

If chikungunya is suspected, it is recommended to consult an infectious disease specialist or a primary care doctor to start appropriate treatment, which usually includes rest, increased fluid intake, and medications to relieve symptoms.

Common symptoms

The main symptoms of chikungunya include:

High fever and chills
Severe joint pain or muscle pain
Red spots on the trunk, arms, legs, and face
Itching on the palms, soles, or all over the body
Swelling in the face, hands, and feet
Headache or pain behind the eyes
Swollen lymph nodes
Abdominal pain, diarrhea, or vomiting
Red, watery eyes

High fever and muscle pain are typically the first symptoms, appearing 3 to 7 days after the mosquito bite, followed by severe joint pain. This joint pain tends to be intense, affecting daily activities and occurring symmetrically on both sides of the body, especially in the hands, elbows, ankles, and knees.

In severe cases, chikungunya can also affect organs such as the brain, heart, or kidneys, leading to complications such as heart failure, kidney failure, or meningitis.

Stages of chikungunya

After the bite of an Aedes aegypti mosquito, the chikungunya virus incubates in the body for 3 to 7 days before the first symptoms appear, starting the acute phase of the infection, which can last 5 to 10 days.

In most cases, symptoms—especially joint pain—last 1 to 3 weeks, but they can persist for up to 3 months. This is called the post-acute phase of chikungunya.

The chronic phase of chikungunya is characterized by joint pain lasting longer than 3 months.

Confirming a diagnosis

A doctor, usually an infectious disease specialist or primary care provider, can diagnose chikungunya by evaluating symptoms, particularly high fever and intense pain in multiple joints. Additional tests may be ordered to rule out other infections with similar symptoms.

Tests that identify chikungunya

The main tests that can help confirm chikungunya include:

RT-PCR: mainly during the acute phase of infection, in the first 5 days after the onset of symptoms
Viral serology by ELISA or indirect fluorescent antibody test (IFA): detects anti-chikungunya IgM antibodies, which appear 5 days to several weeks after symptom onset, or IgG antibodies, which appear from 2 weeks onwards

In addition, a complete blood count is usually ordered, as chikungunya, dengue, and Zika share similar symptoms. Chikungunya typically shows a reduction in lymphocytes (lymphopenia), while dengue more commonly causes a reduction in neutrophils and platelets.

Difference between chikungunya, dengue, and Zika

Chikungunya, dengue, and Zika are all transmitted by the bite of the same mosquito, the Aedes aegypti.

Chikungunya is caused by an alphavirus from the Togaviridae family, while dengue is caused by the Flavivirus serotypes DENV-1, 2, 3, or 4, and Zika is caused by the ZIKV virus.

Although symptoms are similar, there are key differences: chikungunya fever is high and appears suddenly, dengue fever is high and persistent, while Zika fever is usually mild and may not always be present. Another difference is that chikungunya causes severe pain in multiple joints at the same time, symmetrically (on both sides of the body), while dengue causes moderate joint pain, and Zika typically causes mild joint pain.

How is chikungunya transmitted?

Chikungunya is transmitted by the bite of the Aedes aegypti mosquito, the same mosquito that transmits dengue and Zika. Transmission occurs after the mosquito becomes infected by feeding on the blood of a sick person.

Chikungunya can also be transmitted from a pregnant person to their baby or through blood transfusion, although these forms are much rarer.

How is chikungunya treated?

Chikungunya treatment should always be carried out under the guidance of an infectious disease specialist or primary care doctor, depending on the phase of the disease and the severity of the symptoms.

Treatment during the acute phase

During the acute phase of chikungunya, in the first weeks of infection, the doctor may recommend the use of antipyretics and pain relievers such as acetaminophen (paracetamol) to relieve symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, and aspirin are generally not recommended due to the risk of bleeding in the first 2 days after symptoms begin, or up to 14 days if dengue is still suspected.

It is also important to rest, increase fluid intake, and follow a light, anti-inflammatory diet.

Treatment during the chronic phase

In the chronic phase of chikungunya, treatment of complications may include the use of corticosteroids, which should only be taken under medical supervision.

Possible complications

The main complications of chikungunya include:

Joint pain and pain in other parts of the body
Swelling
Difficulty moving the joints
Mood changes
Low blood pressure when standing up

Although the symptoms of chikungunya generally disappear as the infection resolves, complications may persist for up to 6 years or longer. Anyone with suspected complications should see an infectious disease doctor or primary care provider for diagnosis and treatment.

How to prevent chikungunya

Chikungunya can be prevented by taking measures to avoid mosquito bites, such as using insect repellents, installing window screens, and using bed nets.

It is also important to eliminate stagnant water sources around the house and use insecticides to control mosquito populations.

Chikungunya vaccine

The chikungunya vaccine is the most effective way to prevent the infection. It is recommended for adults over 18 years of age and is given as a single dose. In the US, the FDA-approved vaccine is called IXCHIQ.

This vaccine is a live-attenuated recombinant vaccine, meaning it contains a weakened form of the virus that stimulates the body to produce antibodies against the chikungunya virus without causing infection.

Chikungunya: Symptoms, Diagnosis, Treatment & Prevention