That Which Bends Up: A Case Report and Literature Review of Chikungunya Virus

Abstract

We present a case of chikungunya virus (CHIKV) in a 39-year-old female who developed an acute febrile illness marked by polyarthralgia and rash after returning from Saint Lucia. This epidemic-prone pathogen is increasingly likely to be encountered by primary care and hospital physicians in the coming months. The virus was first locally transmitted in the Caribbean in December 2013 and has since spread to 44 countries and 47 US states, affecting a suspected 1.2 million people. A mosquito-borne virus, CHIKV causes a severe and symmetric polyarthralgia that can relapse for months to years, creating debilitating illness and profound socioeconomic consequences. Current treatment is limited to supportive measures, which are dependent on nonsteroidal anti-inflammatory drugs. Research into immunomodulatory agents, antiviral therapies, and vaccines is ongoing. Prevention remains key in slowing the spread of disease. Patient education should focus on personal protective measures, such as insect repellant and remaining indoors, while public health departments should implement strategies to control vector breeding grounds. Given the possibility of relapsing and debilitating disease, general internists should consider CHIKV in the differential diagnosis of a returning traveler with acute onset of fever, polyarthralgia, and rash.

Keywords: Caribbean; chikungunya; febrile rash; mosquito-transmitted virus; symmetric polyarthralgia.

Figure 1.

CHIKV is endemic in nonhuman primates, where it exists in an enzootic cycle between the animal and the Aedes mosquito. However, the virus can be transmitted to a human host via the mosquito and become established in a human-mosquito cycle without the need for an animal reservoir.

Figure 2.

Countries with local transmission of CHIKV, as of March 2015.

Figure 3.

States with confirmed cases of CHIKV infection, as of February 2015.

Figure 4.

Distribution of Ae. aegypti in the US.

Figure 5.

Distribution of Ae. albopictus in the US.

Figure 6.

Although both chikungunya and dengue present with fever and acute polyarthralgia, there are important clinical signs to help distinguish between the two viruses.