Chikungunya Update by Dr. K. K. Aggarwal

Chikungunya fever is a non-fatal debilitating viral illness, which spreads by the bite of infected female Aedes aegypti / albopictus mosquito. Symptoms develop 3-7 days after the bite by an infected mosquito. The classical triad is skin rash, joint pains and high fever. Most patients will usually recover within 1-2 weeks. Cold compressions may easy pain. There is no vaccine to prevent or drugs to treat. Plenty of rest and fluids to prevent dehydration is recommended. Aspirin or NSAIDs should not be taken until dengue is ruled out. Both ailments may present with similar symptoms. In 20% cases, joint involvement may persist for weeks and in 10% cases, they tend to persist for months. While in 10% cases, swelling disappears and the pain subsides, but will reappear with every other febrile illness for many months. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after the fever subsides. Clinically, about 92% have symmetric polyarthralgias, 67% have arthritis and 75% skin rash. About 89% show a very good clinical response to NSAIDs, some 27% require low-dose steroids and 5% may need methotrexate therapy. Non weight-bearing exercises may be suggested such as slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley-assisted exercises, milder forms of yoga. Standard treatment is paracetamol 1 g up to four times a day for up to 4 weeks. If pain persists at 4 weeks, then a 4-week course of oral steroids can be given. At 8 weeks, if pain persists, then specific disease-modifying drugs like hydroxychloroquine may need to be added. Chikungunya can unmask psoriatic arthritis or rheumatoid arthritis in some cases. It can cause, in some cases, neuro and ocular manifestations (encephalitis, mononeuritis, optic neuritis).