Chikungunya history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Alonso Alvarado, M.D. [3]; Vendhan Ramanujam M.B.B.S [4]


Chikungunya which follows a bite of an infected mosquito Aedes aegypti or Aedes albopictus carrying chikungunya virus, can either present as an asymptomatic or as a symptomatic disease. The most common symptoms of the symptomatic disease include fever, arthralgia or polyarthritis, and maculopapular rash.

History and Symptoms

While few infected with chikungunya virus become asymptomatic (around 3-28%),[1][2] most of the individuals will develop some symptoms after an incubation period of 3-7 days (range: 1-12 days). The symptoms of the disease can manifest as any of the following clinical forms.[3]

Acute Disease

The following are the acute symptoms that usually last for 3–10 days.[4][5][6]

  • High fever: High fever is the most characteristic acute symptom. It is usually
    • Sudden in onset.
    • Lasts from several days up to a week.
    • Typically >39°C [102°F].
    • Continuous or intermittent.
    • May be associated with relative bradycardia.
  • Arthralgia or polyarthritis: Arthralgia or polyarthritis is another characteristic acute symptom of the disease that follows fever. Polyarthritis is usually
    • Symmetrical.
    • Affects 10 or >10 joint groups.
    • Most commonly involves the hands and feet, but can also affect the proximal joints.
    • Associated with tenosynovitis.
    • Severe and debilitating, confining the patients to bed and thus affecting their normal day to day activities.
  • Rash: Half the patients are affected by rash that usually occurs 2-5 days after the onset of fever. The rashes are
    • Typically maculopapular.
    • Involve the trunk and extremities, and can also include the palms, soles, and face.
    • Can also manifest as diffuse erythema that blanches with pressure.
    • Vesiculobullous lesions, the most common skin presentation in infants.
  • Other symptoms may include headache, myalgia, conjunctivitis, nausea, vomiting, and diffuse back pain.

Subacute and Chronic Disease

Subacute and chronic disease can manifest as any of the following after an acute stage.

Atypical Manifestations

Besides the typical symptoms, the disease can atypically present with any of the following clinical manifestations due to the virus itself, immunological response to the virus, or drug toxicity.[7]


  1. Queyriaux B, Simon F, Grandadam M, Michel R, Tolou H, Boutin JP (2008). "Clinical burden of chikungunya virus infection". Lancet Infect Dis. 8 (1): 2–3. doi:10.1016/S1473-3099(07)70294-3. PMID 18156079.
  2. Moro ML, Gagliotti C, Silvi G, Angelini R, Sambri V, Rezza G; et al. (2010). "Chikungunya virus in North-Eastern Italy: a seroprevalence survey". Am J Trop Med Hyg. 82 (3): 508–11. doi:10.4269/ajtmh.2010.09-0322. PMC 2829919. PMID 20207883.
  3. Preparedness and response for Chikungunya virus introduction in the Americas. Washington, DC: Pan American Health Organization CDC, Center for Disease Control and Prevention. 2011. ISBN 978-92-75-11632-6.
  4. Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP; et al. (2007). "Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients". Clin Infect Dis. 44 (11): 1401–7. doi:10.1086/517537. PMID 17479933.
  5. Staikowsky F, Le Roux K, Schuffenecker I, Laurent P, Grivard P, Develay A; et al. (2008). "Retrospective survey of Chikungunya disease in Réunion Island hospital staff". Epidemiol Infect. 136 (2): 196–206. doi:10.1017/S0950268807008424. PMC 2870803. PMID 17433130.
  6. Taubitz W, Cramer JP, Kapaun A, Pfeffer M, Drosten C, Dobler G; et al. (2007). "Chikungunya fever in travelers: clinical presentation and course". Clin Infect Dis. 45 (1): e1–4. doi:10.1086/518701. PMID 17554689.
  7. Rajapakse S, Rodrigo C, Rajapakse A (2010). "Atypical manifestations of chikungunya infection". Trans R Soc Trop Med Hyg. 104 (2): 89–96. doi:10.1016/j.trstmh.2009.07.031. PMID 19716149.

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