Recover from Chikungunya

Chikungunya is a virus, transmitted to humans through the bite of an infected mosquito. These infected mosquitoes can also carry other diseases like dengue and yellow fever. Chikungunya can be found throughout the world, including the Caribbean, tropical areas of Asia, Africa, South America, and North America. There's no cure, vaccination, or treatment of the disease. Instead, treatment focuses on relieving symptoms.[1] It's important to identify the signs and symptoms of chikungunya, treat the symptoms, and be aware of complications from the disease.

Steps

Identifying Signs and Symptoms

  1. Look for the symptoms in the acute phase. The acute phase of a disease is a rapid, but short lived period of time where you experience symptoms of the disease.[2] There may be no symptoms for up to two to 12 days after being bitten by an infected mosquito. Typically, there are no symptoms for three to seven days. Once symptoms appear, you'll probably experience about 10 days of chikungunya symptoms before getting better.[3] You may experience these symptoms during the acute phase:
    • Fever: The fever is Usually 102 to 105 °F (39 to 40.5 °C) and typically lasts from three days up to one week.[4][1] The fever can be biphasic (where it disappears for a few days followed by a few days of a low grade fever (101–102 °F or 38–39 °C). During this time, the virus accumulates in your bloodstream, spreading to different parts of the body.
    • Arthritis (joint pain): You'll usually notice arthritis in the small joints of the hand, wrist, ankles, and larger joints, like knees and shoulders, but not the hips.[4] Up to 70% of people have pain that spreads from one joint to the next after the previous joint starts feeling better.[5] The pain is usually worse in the morning, but improves with mild exercise. Your joints may also look swollen or feel tender to the touch and you may have inflammation of tendons (tenosynovitis).[4] Joint pain usually resolves within one to three weeks, with severe pain improving after the first week. However, in some cases joint pain can continue for up to a year.
    • Rash: Approximately 40% to 50% of patients experience a rash. The most common type is a morbilliform eruption (maculopapular). These are red rashes with small bumps overlying them that appear three to five days after start of fever and subside within three to four days. The rash usually starts on the upper limbs followed by the face and trunk/torso.[6] Look in the mirror with your shirt off and note any red bumpy areas over a wide area and whether they itch. Make sure to turn around to look at your back side, back of neck, and raise your arms to examine your underarms.
  2. Know the symptoms of the subacute phase. The subacute phase of Chikungunya happens a month to three months after the acute phase of the illness ends. During the subacute phase, the main symptom is arthritis. Aside from this, disorders of blood vessels like Raynaud’s phenomenon can occur.
    • Raynaud’s phenomenon is a condition where there is decreased blood flow to the hands and feet in response to cold or stress on your body. Look at the tips of your fingers and note if they are cold and bluish/dark in color.
  3. Recognize symptoms of the chronic phase. This phase starts following the three months from the initial onset. It's marked by the continuation of joint pain symptoms, with 33% of patients experiencing joint pain (arthralgia) for four months, 15% for 20 months, and 12% for three to five years.[4] One study showed 64% of people reporting joint stiffness and/or pain for over a year after the initial infection.[7] You may also have relapses of fever, asthenia (abnormal physical weakness and/or lack of energy), arthritis (inflammed/swollen joints) in multiple joints, and tenosynovitis (inflammation of the tendons).
    • If you have underlying joint problems, like rheumatoid arthritis, you're more prone to developing the chronic stage of chikungunya.[4]
    • Rheumatoid arthritis has been documented, rarely, after the initial infection. The average time of onset is around 10 months.[8]
  4. Be aware of other symptoms. While fever, rash, and joint pain are the most common or obvious symptoms, many patients experience other issues. These can include:[4]
    • Myalgia (muscle/back pain)
    • Headache
    • Sore throat discomfort
    • Abdominal pain
    • Constipation
    • Swollen lymph nodes in the neck
  5. Distinguish chikungunya from similar diseases. Since so many symptoms of chikungunya are also symptoms of similar or mosquito-born diseases, it's important to be able to differentiate between them. Diseases similar to chikungunya include:
    • Leptospirosis: Notice if your calf muscles (the muscles behind your leg below your knees) ache or hurt when you walk. You should also look in the mirror to see if the white part of your eye is bright red (subconjunctival hemorrhage). This is caused by the eruption of tiny blood vessels. Recall if you were around farm animals or water since the contaminated animals can spread this disease in the water or soil.
    • Dengue fever: Note if you came into contact with mosquitoes or have bites that occurred in tropical climates like Africa, South America, Central America, Caribbean, India and southern parts of North America. Dengue is more prevalent in these areas. Look in the mirror for bruising of the skin, bleeding or redness around the white of your eyes, bleeding from the gums of your mouth and repeated bloody noses. Bleeding is the biggest difference between dengue fever and chikungunya.
    • Malaria: Note if you came into contact with mosquitoes or bites from known source areas such as South America, Africa, India, Middle East, and Southeast Asia. Pay attention to whether you feel cold and shiver, then have fevers and then sweating. This can last from six to 10 hours. You may experience relapses of these phases.
    • Meningitis: Look for local outbreaks in highly congested areas or facilities. If you were in the area you may have gotten the disease. Check your temperature for a fever and note if you have neck stiffness or pain/discomfort when moving your neck. Severe headaches and feeling tired/confused may accompany the disease. You may also have a rash that consists of red, brown, or purple small dots that can become larger blotches or even blisters. This rash is commonly located on the trunk, legs, and on the palms and soles.
    • Rheumatic fever: Rheumatic fever usually occurs after a streptococcal infection such as strep throat. It is not caused by mosquito bites. This happens more commonly in children five to 15 years old. Check your child for multiple joint pains that can migrate (as one joint gets better another joint hurts) and fever like in chikungunya. But, noticeable differences in your child will be uncontrollable or jerky body movements (chorea); small, painless nodules under the skin; and a rash. The rash will be flat or slightly elevated with jagged edges (erythema marginatum) and will appear blotchy or circular with a darker pink ring and lighter area inside the ring.[9]

Treating the Symptoms of Chikungunya

  1. Know when to get medical attention. Your doctor can collect blood samples to test for chikungunya and other mosquito-borne diseases. You should see your doctor if you experience any of the following:[9]
    • Fever for more than five days or above 103 °F (39°C)
    • Dizziness (possibly due to a neurological issue or dehydration)
    • Cold fingers or toes (raynaud's)
    • Bleeding from mouth or under skin (this can be Dengue)
    • Rash
    • Joint pain, redness, stiffness, or swelling
    • Low urine output (this can be from dehydration that can lead to kidney damage)
  2. Understand lab tests for chikungunya. Your doctor will take blood samples to send to labs. Several tests or methods will be run on the samples for diagnosis. ELISA (enzyme linked immunoassay) will look for specific antibodies against the virus. These antibodies normally develop toward the end of the first week of illness and peak around three to weeks lasting up to two months. If they are negative, your doctor may repeat the blood test to see if they have risen.[10][11]
    • Viral cultures will also look for growth. These are usually used within the first 3 days of illness, when the virus is rapidly growing.[10][11]
    • RT-PCR (reverse transcriptase polymerase chain reaction) methods use virus-specific gene coding proteins to replicate specific genes of chikungunya. If it is chikungunya, then the lab will see higher than normal chikungunya genes displayed on a computerized graph.[10][11]
  3. Rest. There is no approved/specific treatment or cure for this virus nor a vaccine to prevent you from getting it. Treatment is purely symptom management. The World Health Organization recommends that you start home care treatment by resting. This will provide relief and time for your body to recover. Rest in an environment that is not damp or too hot, which could aggravate your joint symptoms.[9]
    • Apply a cold pack to reduce pain and inflammation. You can use a bag of frozen vegetables, packaged steak, or an ice pack. Wrap the frozen back in a towel and apply it to painful areas. Avoid applying a frozen pack or ice directly to your skin, which could cause tissue damage.
  4. Take pain medication. If you're experiencing fever and joint pain, take paracetamol or acetaminophen. Take up to two 500mg tablets with water up to four times a day. Be sure to drink plenty of water throughout the day. Since fever can lead to dehydration and electrolyte imbalance, try to drink at least two liters of water a day with added salt (which mimics electrolyte sodium).
    • If you have pre-existing liver or kidney issues consult your doctor before taking paracetamol/acetaminophen. Talk to your pediatrician or pharmacist for dosing for children.
    • Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, naproxen, etc. Chikungunya can mimic other mosquito-borne diseases like dengue which can cause excessive bleeding. Aspirin and NSAIDS can thin your blood and increase the bleeding. Your doctor must rule out Dengue first. Your doctor may recommend NSAIDS for the joint symptoms after ruling out Dengue.
    • If you have unbearable joint pain or no relief after your doctor has advised you to take NSAIDS, your doctor may prescribe you hydroxychloroquine 200 mg orally once a day or chloroquine phosphate 300 mg once per day for up to 4 weeks.
  5. Exercise. You should only perform mild exercises so you don't aggravate your muscle or joint pains. If possible, arrange an appointment with a physical therapist to undergo physiotherapy treatment. This can help strengthen your muscles around the joints which can reduce pain and stiffness. Try to exercise in the morning, when your joints may be the stiffest. Try some of these simple movements:
    • Sit on a chair. Extend one leg parallel to the floor and hold for 10 seconds before lowering your leg with the sole flat on the floor. Do the same with the other leg. Repeat this several times a day, doing two to three sets of 10 repetitions per leg.
    • Try standing on your toes with both feet close together and place your heels up and down, up and down.
    • Turn to your side. Raise one leg upwards for a second before bringing it down atop your other leg. Do this 10 times for that leg. Then, turn to the other side, and repeat. Do a set of 10 raises for each leg several times a day.
    • You can also do your own low-impact aerobic exercise. The idea is not to do aggressive movements or use weights.
  6. Use oils or creams for skin irritation. You may experience scaling dryness (xerosis) or an itchy rash (morbilliform rash). These don't need treatment, but you can treat the itchiness and rebuild your skin's natural conditions and moisture. Apply mineral oils, moisturizing creams, or calamine lotion.[6] If you have the itchy rash, take oral antihistamines, like diphenhydramine, as directed on the package. This can reduce inflammatory cells from releasing proteins that cause itching.
    • Be careful using antihistamines, as they can make you drowsy. Don't drive or operate machinery after taking them.
    • Soaking in a warm bath with added colloidal oatmeal can help sooth your skin.
    • Persistent hyperpigmented spots can be treated with hydroquinone-based products. This will help whiten or lighten the spots.[6]
    • Since a variety of liquids and creams are available to treat skin irritation, you may want to ask your doctor's advice about what to use.
  7. Try herbal remedies. It's been suggested that many combinations of herbs and plants can help relieve the symptoms of chikungunya. While you can find most of these at drug stores, you should always consult with your doctor before trying herbal supplements or remedies. Herbal remedies include:[12]
    • Eupatorium perfoliatum 200C: This is the number one homeopathic remedy for chikungunya. It is a plant based extract that you should use while experiencing the symptoms. It can relieve the symptoms and joint pain. To use, take six drops at full strength for a month, while symptoms exist.
    • Echinacea: This is a flower-based extract used to treat chikungunya symptoms by improving your immune system's effectiveness. Take a 40 drops a day, divided into three daily doses.

Paying Attention to Complications and Preventing Chikungunya

  1. Watch for heart complications. Specifically, pay attention for abnormal heart rhythms (arrhythmias) which can be potentially fatal.[13] To check, take the pads of your index and middle fingers, gently placing them on your wrist below the thumb area. If you feel a pulse this is the radial artery. Count how many beats you feel over a minute. 60 to 100 beats is considered normal. Also, note if the rhythm is a constant beat; extra beats or abnormal pauses may mean an arrhythmia. You may also notice skipped or extra beats in the form of palpitations. See your doctor right away if you notice signs of an arrhythmia. Your doctor may do an electrocardiogram, where electrodes are attached to your chest to check your heart's rhythm.
    • The chikungunya virus can invade heart tissue causing inflammation (myocarditis), which causes the abnormal heart rhythms.
  2. Watch for neurological complications. Look for fever, fatigue, and mental confusion, which are signs of encephalitis or inflammation of the brain. Distraction and disorientation is also a sign. If you also notice severe headache, neck stiffness/pain, sensitivity to light, fever, seizures, double vision, nausea and vomiting in addition to the encephalitis symptoms, you may have meningoencephalitis. This is a combination of meningitis and encephalitis (inflammation of the tissue in our spinal cord that is connected to the brain).[14]
    • If you experience nerve damage starting from the legs or arms, you may have Guillain Barre syndrome. Look for decreased sensation, reflexes, and movement on both sides of your body. Also notice pain on both sides of the body that feels sharp, burning, numbness or pins and needles sensation. This can gradually progress higher up the body and potentially lead to breathing troubles from nerves that supply your respiratory muscles.[15]
    • If you have trouble breathing or any of the above symptoms, seek emergency care immediately.[15]
  3. Pay attention to eye complications. Look for eye pain, watery eyes and red eyes. These can all be symptoms of inflammation of your eye linings caused by conjunctivitis, episcleritis, and uveitis. You may also notice blurry vision and sensitivity to light with uveitis. See your doctor right away if you have any of these eye symptoms.
    • If you have trouble seeing objects straight ahead (central vision) and if the colors of objects you see everyday look duller, you may have neuroretinitis.[4]
  4. Watch your skin for signs of hepatitis. Look in the mirror for any yellowing of your skin or the whites of your eyes (jaundice). These can be signs of hepatitis, inflammation of the liver. This inflammation can make the liver's products (bilirubin) spill over and cause your skin to turn yellow and itchy. Get immediate medical attention.
    • If untreated, hepatitis can lead to liver failure.
  5. Look for dehydration signaling kidney failure. Chikungunya can lead to dehydration since the kidneys may not get enough blood flow to function normally. This can lead to kidney failure, so monitor your urine output. If you feel the amount is drastically decreased and your urine is very concentrated and dark colored seek immediate medical expertise.
    • Your doctor or emergency provider will perform more accurate lab tests and measurements to detect kidney function and give you IV fluids if you are dehydrated.
  6. Prevent chikungunya when traveling. Look on the Center for Disease Control's website for an updated map of where chikungunya has been reported.[16] If you're traveling in any of these areas there are several things you can do to help prevent getting the disease. These preventative measures include:[17]
    • Walking or being outside after daylight hours. Though mosquitoes can bite anytime, peak chikungunya activity is during daylight hours.
    • Wearing long sleeve clothing to protect your body as much as possible from mosquitoes. Try wearing light colored clothing to easily detect mosquitoes and other bugs on your clothing.
    • Sleeping in a bed/mosquito net at night to protect from mosquitoes while sleeping.
    • Using repellents with more than 20% DEET. Other active ingredients to use include oil of eucalyptus, Picaridin, and IR3535. Generally the higher the active ingredient, the longer it works.

Tips

  • Hydroxychloroquine and Chloroquine phosphate are disease-modifying drugs used for rheumatoid arthritis but can be effective in the case of severe arthritis in chikungunya. An x-ray may be done to confirm damage or changes to your joint cartilage.[9]

Warnings

  • Avoid using aspirin because it may cause bleeding in the stomach or intestines and Reye’s syndrome in children under age 18. Reye’s syndrome is a serious disease among children four to 12 years old where there are serious brain and liver symptoms, and can be fatal.

Related Articles

Sources and Citations

  1. ↑ 1.0 1.1 Staples J, Hills S, Powers A. Chikungunya. Chapter 3 Infectious Diseases Related to Travel. CDC. May 2, 2014. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/chikungunya
  2. ↑ http://www.medicinenet.com/script/main/art.asp?articlekey=2133
  3. ↑ Chikungunya Virus Clinical Fact Sheet. Armed Forces Pest Management Board. June 20, 2014. http://www.afpmb.org/sites/default/files/contingency/chikungunya/Chikungunya%20Virus%20Fact%20Sheet%20Clinical.pdf
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatology. 2010 Jan-Mar; 55(1): 54–63.
  5. ↑ Information for Healthcare providers. Chikungunya fever. Pan American Health Organization. Jan 2014.
  6. ↑ 6.0 6.1 6.2 Bandyopadhyay D, Ghosh S. MUCOCUTANEOUS MANIFESTATIONS OF CHIKUNGUNYA FEVER. Indian Journal of Dermatology. 2010 Jan-Mar; 55(1): 64–67.
  7. ↑ Staples J, Breiman R, Powers A. Chikungunya Fever: An Epidemiological Review of a Re-Emerging Infectious Disease. Emerging Infections. 2009:49 (15 September).
  8. ↑ Bouquillard E, Combe B. A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years. Joint, Bone, & Spine Journal. 76 (2009) 654–657.
  9. ↑ 9.0 9.1 9.2 9.3 Guidelines on clinical management of chikungunya fever. World Health Organization. October 2008.
  10. ↑ 10.0 10.1 10.2 Chikungunya Fact Sheet. World Health Organization. May 2015. http://www.who.int/mediacentre/factsheets/fs327/en/
  11. ↑ 11.0 11.1 11.2 Chikungunya virus Diagnostic testing. CDC. June 25, 2014. http://www.cdc.gov/chikungunya/hc/diagnostic.html
  12. ↑ http://www.newsday.co.tt/features/0,203399.html
  13. ↑ Mendoza I. et al. ChIkungunya Myocarditis: An emergIng threAt to AmerIcA. American College of Cardiology-Heart Failure and Cardiomyopathies - Presentation Number: 1184-222. March 17, 2015 Volume 65, Issue 10S
  14. ↑ Kalita J, Kumar P, Misra U.K. Stimulus-sensitive myoclonus and cerebellar ataxia following chikungunya meningoencephalitis. A Journal of Infectious Disease. June 2013, Volume 41, Issue 3, pp 727-729.
  15. ↑ 15.0 15.1 Lebrun G. et al. Guillain-Barré Syndrome after Chikungunya Infection. Journal of Emerging Infectious Diseases. 2009 Mar; 15(3): 495–496.
  16. ↑ http://www.cdc.gov/chikungunya/geo/index.html
  17. ↑ Nasci R, Gutierrez E, Wirtz R, Brogdon W. Protection against Mosquitoes, Ticks, & Other Insects & Arthropods. Chapter 2 Pre Travel Consultation. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/protection-against-mosquitoes-ticks-and-other-insects-and-arthropods
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