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Chikungunya is an acute mosquito-transmitted viral disease. Fever (>39ºC [102.2°F]) and severe, often debilitating polysrthralgias that are typically bilateral and symmetric present 1-12 days after a bit by an infected mosquito. Other symptoms may include headache, myalgia, conjunctivitis, nausea/emesis, and fatigue. Patients may have arthritis and/or maculopapular rash on physical exam. Laboratory studies may show lymphopenia, thrombocytopenia, an elevated creatinine, and/or elevated hepatic transaminases.
Chikungunya is most commonly transmitted via the bites of Aedes aegypti and Aedes albopictus mosquitoes, the latter of which can be found within the United States. The disease is endemic in many parts of Africa and Asia, especially in and around the Indian Ocean and Southeast Asia, as well as parts of Oceania; autochthonous transmission has been documented in the Caribbean since 2013. Rarely, chikungunya virus can be transmitted from blood-borne exposure or in utero and intrapartum from mother to neonate.
The risk of a person transmitting chikungunya to a biting mosquito or through blood is highest when the patient is viremic during the first 2-6 days of illness. Individuals suspected or confirmed to have chikungunya should therefore be instructed to stay indoors and avoid mosquito bites during their first week of illness. Patients should be encouraged to aggressively control and eliminate mosquitoes around their homes and businesses by eliminating areas of standing water. Windows and door screens should be checked for holes/tears and repaired. Individuals should use mosquito repellents containing 20-30% DEET and wear long sleeves and pants when possible.
Diagnosis can be made via serological methods to detect evidence of acute infection (IgM and neutralizing antibiotics) as well as via polymerase chain reaction (PCR) testing for virus in viremic patients. Acute antibodies should be detectable ≥4 days after onset, but all patients suspected of having chikungunya should also have convalescent-phase testing performed. PCR testing will most often identify virus in samples collected in the first 8 days of illness.
You may have to have testing through your local DOH.
