Chikungunya

Chikungunya is a viral illness caused by an arbovirus (a virus spread by mosquitoes). It is transmitted by the bite of an infected mosquito and cannot spread directly from person to person. Unlike most viral fevers that resolve quickly, Chikungunya is known for causing severe joint pain, which can persist even after the fever has settled. Because of this, it is sometimes called a form of post-viral arthritis.

What happens when you get Chikungunya?

When the virus enters your body through a mosquito bite, it usually causes sudden high fever and severe joint pain.
Joint pain can affect larger joints in the early stage but later tends to involve the small joints of the hands and feet.
Joints may become swollen, stiff, and painful. The pain can wax and wane (increase and decrease), often worsening with activity.
Swelling in the feet is common, and some patients may develop rashes on the face and feet.
Unlike dengue, the joint pain in Chikungunya tends to persist for weeks to months.

Diagnosis

Doctors suspect Chikungunya if there is a history of 1–2 days of fever followed by persistent joint pain. In the early stages, blood tests are important to rule out dengue fever.

Tests include:

Blood counts and dengue tests (to exclude dengue in the acute stage).
RT-PCR: positive within the first 7 days of illness.
ELISA antibody tests: IgM antibodies appear after about 1 week; IgG antibodies indicate longer-term disease.
Liver and kidney function tests are usually done to check for complications.

Treatment

For most patients, Chikungunya settles with rest, fluids, and simple pain relief such as paracetamol. However, in patients with more severe joint pain and swelling, further treatment may be needed.

Treatment options include:

Excluding dengue and other infections first, and checking blood and organ function.
NSAIDs (non-steroidal anti-inflammatory drugs) if blood counts and kidney function are normal.
Low-dose steroids for short periods in severe cases.
Hydroxychloroquine in persistent arthritis.
Steroid injections into joints for severe localised pain.
If arthritis persists beyond 3 months (chronic chikungunya arthritis), disease-modifying drugs such as sulfasalazine may be used.

It is important to note that Chikungunya can worsen pre-existing joint or spine problems such as cervical spondylosis, lumbar spine issues, carpal tunnel syndrome, or rotator cuff pain.

Prognosis

The majority of patients recover fully within the first 3 months. However, in some people, joint pains may persist longer. With appropriate treatment, most patients improve and return to normal activities.

Prevention – How to avoid mosquito bites

Preventing mosquito bites is the best way to avoid Chikungunya. In Sri Lanka, mosquitoes that carry the virus are most active in the early morning and late afternoon/evening.

Protect yourself by:

Using mosquito nets, especially when resting or sleeping
Applying mosquito repellents on exposed skin
Wearing long-sleeved clothes and trousers to reduce bites
Keeping doors and windows closed or screened
Cleaning your surroundings regularly – removing stagnant water in pots, gutters, and containers where mosquitoes breed
Clearing roof gutters and drains to prevent water collection
Covering water storage tanks and barrels
Keeping your garden and home environment clean and free of mosquito breeding places