- High fever with severe joint pain, especially on both sides of the body, can be a warning sign of chikungunya.
- Symptoms that last for weeks or joint pain that continues for more than 3 months may signal post-acute or chronic chikungunya.
- Swelling, trouble moving the joints, or signs of heart, kidney, or brain involvement need urgent medical evaluation.
Chikungunya is a viral infection spread by the bite of infected Aedes mosquitoes and is common in tropical and subtropical regions. It usually causes high fever, intense joint pain, rash, and fatigue that can affect daily activities.
Chikungunya symptoms often appear 3 to 7 days after a mosquito bite and may last for weeks or even months. In some cases, joint pain can persist long term and lead to complications that affect mobility and quality of life.
Chikungunya is diagnosed based on symptoms and lab tests, and treatment focuses on rest, fluids, and pain relief medications. Preventing mosquito bites and vaccination are key measures to reduce the risk of infection and outbreaks.
Chikungunya symptoms
The main chikungunya symptoms include:
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High fever and chills
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Severe joint pain or muscle pain
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Red spots on the trunk, arms, legs, and face
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Itching on the palms, soles, or across the whole body
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Swelling in the face, hands, and feet
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Headache or pain behind the eyes
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Abdominal pain, diarrhea, or vomiting
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Red, watery eyes
High fever and muscle pain are usually the first symptoms, appearing 3 to 7 days after the mosquito bite. These are followed by severe joint pain, which is often intense enough to interfere with daily activities and typically affects both sides of the body equally, especially the hands, elbows, ankles, and knees.
In severe cases, chikungunya can damage organs such as the brain, heart, or kidneys, potentially leading to complications like meningitis, heart failure, or kidney failure.
Stages of chikungunya
After a person is bitten by an Aedes aegypti mosquito, the chikungunya virus incubates in the body for about 3 to 7 days before symptoms appear. This marks the beginning of the acute phase of the infection, which usually lasts 5 to 10 days.
In most cases, symptoms, especially joint pain, continue for 1 to 3 weeks but may last up to 3 months. This period is known as the post-acute phase of chikungunya.
The chronic phase occurs when joint pain persists for more than 3 months.
Confirming a diagnosis
A doctor, typically an infectious disease specialist or primary care physician, can diagnose chikungunya based on the person’s symptoms, especially a high fever and severe joint pain affecting several areas of the body. Additional tests may be performed to exclude other illnesses with similar signs.
Main tests
The main tests that can help confirm a diagnosis of chikungunya include:
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RT-PCR: This test is most useful during the acute phase of infection, within the first five days after symptoms begin.
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Viral serology (ELISA or indirect fluorescent antibody test, IFA): These tests detect anti-chikungunya antibodies. IgM antibodies usually appear between five days and several weeks after symptoms start, while IgG antibodies typically appear from two weeks onward.
A complete blood count (CBC) is usually requested because chikungunya, dengue, and Zika have similar symptoms. In chikungunya, lymphocytes are often reduced (lymphopenia), whereas dengue usually causes a decrease in neutrophils and platelets.
Chikungunya vs dengue vs Zika
Chikungunya, dengue, and Zika are all transmitted by bites from the same mosquito species, Aedes aegypti.
Chikungunya is caused by an alphavirus from the Togaviridae family, dengue by one of the four Flavivirus serotypes (DENV-1, DENV-2, DENV-3, or DENV-4), and Zika by the ZIKV virus, also a member of the Flavivirus genus.
Although these diseases can look similar, there are some important differences. In chikungunya, the fever is usually high and comes on suddenly. In dengue, the fever is also high but tends to last longer. In Zika, the fever is usually mild and may not even appear.
Chikungunya often causes very strong pain in many joints on both sides of the body at the same time, while dengue usually causes moderate joint pain and Zika tends to cause only mild joint discomfort.
How is chikungunya transmitted?
Chikungunya is spread through the bite of the Aedes aegypti mosquito, the same mosquito that also transmits dengue and Zika. According to the World Health Organization (WHO), the mosquito becomes capable of transmitting the virus after biting a person who is infected and has the virus in their blood.
Chikungunya can also pass from a pregnant person to their baby or be transmitted through a blood transfusion, but these situations are much less common.
How is chikungunya treated?
Chikungunya should always be treated under the supervision of a doctor, such as an infectious disease specialist or a primary care provider, depending on the stage of the disease and how severe the symptoms are.
1. Treatment during the acute phase
During the acute phase of chikungunya, which occurs in the first few weeks after infection, the doctor may recommend antipyretics and pain relievers, such as acetaminophen (paracetamol), to help relieve symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, and aspirin are generally not recommended because they can increase the risk of bleeding in the first 2 days after symptoms start, or for up to 14 days if dengue is still a possibility.
It is also important to get plenty of rest, drink more fluids, and follow a light diet with anti-inflammatory foods.
2. Treatment during the chronic phase
In the chronic phase of chikungunya, treatment for complications may include corticosteroids, but these medications should only be used under a doctor’s supervision.
Possible complications
The main complications of chikungunya include:
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Joint pain and pain in other parts of the body
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Swelling
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Difficulty moving the joints
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Mood changes
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Low blood pressure when standing up
Although chikungunya symptoms usually go away once the infection clears, complications can last for up to 6 years or more. Anyone who suspects complications should see an infectious disease specialist or primary care provider for proper evaluation and treatment.
Prevention measures
Chikungunya can be prevented by taking measures to avoid mosquito bites, such as using insect repellents, installing window screens, and using bed nets.
According to the CDC, eliminating standing water and using protective measures against mosquito bites are essential strategies to reduce the risk of chikungunya transmission.
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.