What is it like to have Chikungunya

The aches and pains of Chikungunya

Aedes_albopictus_2.jpg
Aedes Albopictus Mosquito. "Aedes albopictus 2" by James Gathany, CDC

Chikungunya hit the city where they were. It seemed like everyone had it the same week. Everyone had their own way of describing it. "When I type on the computer, it feels like my fingers are broken". Another added, "It feels like all my bones are broken" Everyone could list what hurt. When Chikungunya had spread, they had all had it seemingly at once. "It hurts where I hurt my wrist years before" "And where I hurt my back"  "I feel like I can't walk" "It just makes me feel old" "I just want to be asleep every night by 6pm." The last added, "I never got it. I didn't feel a thing." Really? everyone asked.

The highlights of a conversation I listened to one night as Chikungunya spread in a Caribbean city.

What are the symptoms?

Chikungunya (chik-en-gun-ye) is an alphavirus infection. Its symptoms generally develop 3-7 days after a bite, but may occur in 1-12 days. Most who are infected develop symptoms. In Dengue and other viruses, many, even half, do not develop systems. Some, possibly 1 in 10 (or fewer or more), do not have symptoms. Most develop a sudden high fever and joint pain. Pain often occurs in finger and toe joints that may feel like broken bones. Pain also occurs in knees, ankles, and lower back. Pain often occurs at sites of past injuries. Severe fatigue coupled with insomnia and muscles aches are common. Many find it difficult to get out of bed for days. Some have swollen lymph nodes, nausea, a rash (small bumps, oftentimes red). In rare cases, a patient may have mouth ulcers, eye irritation, or even confusion (encephalitis) and difficulty breathing.

There are a number of rare symptoms associated with the disease. There is a wide range in the severity of symptoms. The disease rarely results in death.

Those most vulnerable are the elderly, newborns infected at birth, and those with other diseases, such as diabetes or chronic kidney or heart problems.

 Laboratory values may show white blood count (infection fighting cells) dropping with infection.

Some may be more vulnerable to other infections or medical disorders. They may develop new infections or worsened underlying medical concerns that require treatment.

Those who have been infected are likely to be free from future infections. However, some have symptoms persisting for months; others have symptoms come and go without having a new infection.

How long does it last?

Most symptoms resolve in days or within 1 to 2 weeks, particularly for those who are younger. Fever often lasts only 2-3 days and ends abruptly. Those who are younger are more likely to have short illnesses. For some, the disease lasts longer, with persistent or recurrent symptoms, especially joint aches, lasting months or even years. Persistent disease is more common in those who are older, even over the age of 35 or 40. Of older adults, 30-60% may have symptoms beyond a year. Those with more severe initial symptoms are more likely to have persistent symptoms.

Chronic pain can affect mood in patients wanting to return to a pre-Chikungunya quality of life.

How is it diagnosed?

Many diagnoses are based on clinical symptoms during an epidemic that often spreads explosively. However, other diseases, such as dengue, may be mistaken for chikungunya. PCR and antibody testing can identify chikungunya (through the CDC if necessary in the US). Laboratory values showing low platelets should raise suspicion for dengue rather than chikungunya. 

Is there a treatment?

There is no specific treatment. The CDC recommends rest, keeping hydrated, and controlling pain and fever with acetaminophen, ibuprofen, or naproxen. Some doctors have looked at other treatments for chronic arthritis.

If there's no treatment, why should I see a doctor?

Symptoms of other diseases, such as dengue, possibly malaria, or other illnesses that require treatment, may be mistaken for Chikungunya. It is important to seek medical attention in this case.  (Ibuprofen/Advil and Naproxen/Aleve should not be taken with Dengue)

Could I have had chikungunya twice?

Sometimes Chikungunya lasts and lasts. It feels like you've gotten it again and again. Once you're free of Chikungunya, you aren't expected to get it again. What happens though is that Chikungunya can cause persistent or relapsing disease. There may be a virus that persists or continued pain from the initial joint inflammation. This may even happen after an individual has left an area with Chikungunya. It likely does not represent a new infection. Biopsies of those with a recurrent or persistent disease have sometimes shown the persistence of the virus in specific affected regions, such as muscle or joints.

Is there an approved vaccine?

Not yet. There is hope for a vaccine. A vaccine is being studied (that has completed Phase I trials) and appears promising. Hopefully, there will be a vaccine soon.

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