Epidemiology, clinical manifestations, and diagnosis of chikungunya fever: Lessons learned from the re-emerging epidemic

Abstract

Chikungunya fever, caused by “Chikungunya virus,” is an arbovirus disease transmitted by the bite of infected mosquitoes belonging to the genus Aedes. Chikungunya fever epidemics have been reported from several countries around the world. The disease that was silent for nearly 32 years re-emerged in the October 2005 outbreak in India that is still ongoing. The incubation period ranges from 3 to 12 days. The onset is usually abrupt and the acute stage is characterized by sudden onset with high-grade fever, severe arthralgias, myalgias, and skin rash. Swollen tender joints and crippling arthritis are usually evident. In the chronic stage, relapses that include sensation of fever, asthenia, exacerbation of arthralgias, inflammatory polyarthritis, and stiffness may be evident. Neurological, ocular, and mucocutaneous manifestations have also been described. Chronic arthritis may develop in about 15% of the patients. Viral culture is the gold standard for the diagnosis of Chikungunya fever. Reverse transcription polymerase chain reaction and real-time loop-mediated isothermal amplification have also been found to be useful. Serodiagnostic methods for the detection of immunoglobulin M and immunoglobulin G antibodies against Chikungunya virus are more frequently used. Chikungunya is a self-limiting disease; however, severe manifestations such as meningoencephalitis, fulminant hepatitis, and bleeding manifestations may sometimes be life-threatening. Treatment is symptomatic and supportive. Prevention by educating the community and public health officials, vector control measures appear to be the best approach at controlling Chikungunya fever as no commercially available vaccine is available for public use in India for this condition presently.

Estimation of underreporting of Chikungunya virus infection cases in Girardot, Colombia, from November, 2014, to May, 2015

“…La enfermedad presenta tres fases: la primera es la aguda, con un periodo de hasta diez días, caracterizada por fiebre, poliartralgia y erupción cutánea (en 3 % a 28 % de la población la enfermedad puede cursar sin síntomas) (2); la segunda es la subaguda, que se desarrolla en 20 a 40 % de los casos y puede durar hasta tres meses, considerada como una reactivación de la enfermedad (3), y la tercera es la crónica, la cual se presenta con la exacerbación de los dolores articulares y la rigidez, siendo las personas de la tercera edad y aquellos con trastornos articulares subyacentes (reumáticos y traumáticos) los más proclives a desarrollarla; esta fase puede persistir en cerca de 33 % de los pacientes durante cuatro meses, en 15 % durante 20 meses, y en 12 % entre 3 y 5 años (4,5). La mortalidad es rara y ocurre principalmente en los adultos mayores (6).…”

Neurological manifestations of Chikungunya in children

“…Chikungunya disease re-emerged in India in October 2005 after nearly 32 years of quiescence, and has shown cyclical trend since then [1]. The city of Delhi experienced an outbreak of chikungunya fever from August to October 2016.…”

Global epidemiology of Zika and Chikungunya virus human infections

“…These epidemics are characterized by explosive outbreaks interspersed by periods of disappearance ranging from several years to a few decades. Several mechanisms play a role: the human and the mosquito vector susceptibility to the virus; conditions facilitating mosquito breeding (resulting in a high vector density), ability of the vector to efficiently transmit the virus (83).…”