How to Treat Chikungunya Virus Symptoms

Chikungunya is a virus (CHIKV) spread by bites from infected mosquitoes. Outbreaks have occurred in most areas of the world, including the Americas, Asia, Africa, Europe, and islands in the Indian and Pacific Oceans. There have been no reported cases of locally acquired chikungunya in the United States or its territories since 2019.

Fever and joint pain are the most common symptoms of chikungunya. Other symptoms may include muscle pain, joint swelling, headache, or rash. Currently, there are no medications to treat chikungunya. The best protection against chikungunya is to take measures to prevent mosquito bites. A vaccine is available in the United States.

Countries and Origins of Chikungunya Virus

Chikungunya was first identified in 1952 in the United Republic of Tanzania and subsequently in other countries in Africa and Asia. The first recorded urban outbreaks were in Thailand in 1967 and India in the 1970s. Since 2004, there have been more widespread and frequent outbreaks. Chikungunya has been identified in 110 countries in Europe, Africa, Asia, and the Americas.

Chikungunya circulates in tropical and subtropical regions. The name chikungunya comes from a word in the Kimakonde language (spoken in parts of Tanzania), meaning "to become contorted." It alludes to the stooped appearance caused by joint pain.

The United States

Between 2006 and 2013, an average of 28 people per year in the United States tested positive for recent chikungunya virus infection. All of them were people visiting or returning to the United States from affected areas in Asia, Africa, or the Indian Ocean. Chikungunya was rarely identified in U.S. travelers before 2006.

In 2013, Caribbean countries and territories were identified as the sites of the first local transmission (spread through infected mosquitoes in that area) in the Americas.

Chikungunya was reported among U.S. travelers returning from affected areas in the Americas in 2014. Local transmission was identified in Florida, Texas, Puerto Rico, and the U.S. Virgin Islands. Since 2019, no locally acquired chikungunya cases have been reported from U.S. states or territories.

Transmission

The chikungunya virus is part of a group of viruses called alphaviruses. This group includes viruses that cause similar diseases, such as the Mayaro and Ross River viruses.

Mosquitoes transmit chikungunya, most commonly Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus, which can also transmit dengue and Zika viruses. These mosquitoes lay eggs in standing water. Both mosquito species feed outdoors, and Aedes (Stegomyia) aegypti also feeds indoors.

Mosquitoes that spread chikungunya bite during the day and night. They are found in many countries worldwide, including nations in Africa, Asia, the Americas, and islands in the Indian and Pacific Oceans.

Mosquitoes become infected with the virus by biting a person who is infected with the virus. The infected mosquito then transmits the virus by biting another person.

The virus is not spread from person to person. It is blood-borne and not spread through coughing, sneezing, or touching.

It may spread through contact with blood infected with the virus, such as through:

• Blood transfusion
• Drawing blood from an infected person
• Handling infected blood in a laboratory
  

Rarely the virus can be transmitted from a pregnant person to the fetus, particularly during the second trimester. The baby can also become infected at birth if the pregnant person is infected around the time of the delivery. This may result in severe disease in the baby.

There have been no reports of infants being infected through breastfeeding or chestfeeding, and the virus has not been found in breast milk.

Start of Chikungunya Rash and Virus Symptoms

Most people who become infected with chikungunya experience some symptoms. Symptoms can appear between two and 12 days after being bitten and last three to 10 days.

The symptoms usually begin three to seven days after a bite from an infected mosquito. Typically, people feel better within a week.

Chikungunya generally starts with an abrupt onset of fever (may be continuous or intermittent), frequently accompanied by severe joint pain that usually lasts a few days. For some, joint pain from chikungunya can become chronic and debilitating and may last for weeks, months, or years.

Other symptoms of chikungunya may include:

• Joint swelling
• Muscle pain
• Headache
• Nausea/vomiting
• Fever
• Rash
• Back pain
• Body ache
• Redness around the eyes
• Loss of energy

Chikungunya can have mucocutaneous (typical skin and mucous membranes) involvement. These may include a rash that:

• Is erythematous (red-appearing, although this may be less apparent on darker skin) and macular (areas of discolored skin) or maculopapular (areas of discolored skin with raised bumps)
• Appears during the first two to three days of the illness and subsides within seven to 10 days
• Can be patchy or diffuse on the face, trunk, and limbs
• Usually lacks other characteristics but may be itchy
  
• May result in postinflammatory areas of discoloration or diffuse pigmentation, most commonly on the face/nose

Chikungunya may also cause:

• Painful ulcers (similar to canker sores) predominantly involving the oral mucosa and groin
• A vesiculobullous eruption (blisters)
• Hemorrhagic (bleeding) lesions
• Desquamation (peeling or flaking skin)
• A lichenoid eruption (rash of plaques or patches resembling lichen, stuck onto the skin like lichen on a tree)
• Secondary bacterial infection
• Exacerbation of pre-existing skin disorders such as psoriasis or lichen planus (conditions that cause skin inflammation)
  

Treatment

Treatment for chikungunya is symptom management. Currently, there are no medications to treat chikungunya.

Typically, chikungunya is self-limiting and doesn't require special treatment other than supportive measures.

How Soon Infection Clears

The chikungunya virus may be detected in the blood during the first week of illness using tests such as reverse transcriptase–polymerase chain reaction (RT–PCR).

After the first week of infection, tests can be performed to detect antibody levels (the body's response to the chikungunya infection). Antibody levels are typically detectable by the first week after the beginning of the illness and can continue to be detected for about two months.

Because the chikungunya virus can be found in the blood during the first week of illness, it is important to prevent mosquito bites. If a mosquito bites you during this time, it can spread the virus to other people.

Research suggests that once you have had chikungunya, you are likely to be immune to future infections of the virus.

Risk Factors for Prolonged Viral Symptoms

Most people make a full recovery from chikungunya, but occasionally, eye, heart, or neurological complications can occur. Chronic joint pain and chronic arthritis following a chikungunya infection can also occur and may be debilitating.

Those at risk for more severe disease include:

• Newborns
• Adults 65 years and older
• People with medical conditions such as diabetes, high blood pressure, or heart disease
  

How to Ease Symptoms

To help ease symptoms while you recover from chikungunya, you can try measures such as:

• Getting rest
• Drinking plenty of fluids
• Tylenol (acetaminophen) to relieve fever and pain
• Emollients, calamine lotion, or low-potency topical steroids may help with itching

Do not take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil/Motrin (ibuprofen) or Aleve (naproxen) before dengue fever has been ruled out as a cause of your symptoms, to reduce the risk of bleeding.

Summary

Chikungunya is a virus spread by infected mosquitoes. The most common symptoms are fever and joint pain, but other symptoms, such as rash, may be present.

For most people, the illness lasts about a week, and then there is a full recovery. In some cases, joint pain can become long-lasting, chronic, and debilitating. Complications occasionally arise. Newborns, older adults, and people with pre-existing conditions are most at risk for severe illness.

Chikungunya is typically self-limiting and resolves without treatment. Treatment for chikungunya involves symptom relief, such as rest, fluids, and Tylenol for fever and pain.

It is important to take measures, such as insect repellent and mosquito nets, to prevent mosquito bites if you are in affected areas and, if you have a chikungunya infection, to prevent spreading it to others via mosquito bites.