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==Overview==
==Overview==
Chikungunya that 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 common symptoms of chikungunya include [[fever]], [[petechial]] or [[maculopapular rash|maculopapular]] [[rash]] and [[arthralgia]] or [[polyarthritis]].
The common symptoms of chikungunya include [[fever]], [[petechial]] or [[maculopapular rash|maculopapular]] [[rash]] and [[arthralgia]] or [[polyarthritis]].


==Symptoms==
==Symptoms==
While a proportion of individuals infected with chikungunya [[virus]] become asymptomatic (around 3-28%),<ref name="pmid18156079">{{cite journal| author=Queyriaux B, Simon F, Grandadam M, Michel R, Tolou H, Boutin JP| title=Clinical burden of chikungunya virus infection. | journal=Lancet Infect Dis | year= 2008 | volume= 8 | issue= 1 | pages= 2-3 | pmid=18156079 | doi=10.1016/S1473-3099(07)70294-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18156079  }} </ref><ref name="pmid20207883">{{cite journal| author=Moro ML, Gagliotti C, Silvi G, Angelini R, Sambri V, Rezza G et al.| title=Chikungunya virus in North-Eastern Italy: a seroprevalence survey. | journal=Am J Trop Med Hyg | year= 2010 | volume= 82 | issue= 3 | pages= 508-11 | pmid=20207883 | doi=10.4269/ajtmh.2010.09-0322 | pmc=PMC2829919 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20207883  }} </ref> most of them 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.
===Acute Disease===
The following are the acute symptoms that usually last for 3–10 days.
*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.
*Polyarthritis: 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.
*Swollen and stiff joints
*Swollen joints with fine desquamation
*Hyperpigmentation
*Tenosynovitis
*Hygroma
===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.<ref name="pmid19716149">{{cite journal| author=Rajapakse S, Rodrigo C, Rajapakse A| title=Atypical manifestations of chikungunya infection. | journal=Trans R Soc Trop Med Hyg | year= 2010 | volume= 104 | issue= 2 | pages= 89-96 | pmid=19716149 | doi=10.1016/j.trstmh.2009.07.031 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19716149  }} </ref>


* The majority of people infected with chikungunya [[virus]] become symptomatic.
*Neurological:
* The incubation period is typically 3–7 days (range, 1–12 days).
**Seizures
* The disease is most often characterized by acute onset of [[fever]] (typically >39°C [102°F]) and [[polyarthralgia]].
**Neuropathy
* [[Joint]] symptoms are usually bilateral and symmetric, and can be severe and debilitating.
**Meningoencephalitis
* Other symptoms may include [[headache]], [[myalgia]], [[arthritis]], [[conjunctivitis]], [[nausea]]/[[vomiting]], or [[maculopapular rash]].
**Encephalopathy
* Acute symptoms typically resolve within 7–10 days.
**Encephalitis
**Guillain-Barré syndrome
**Cerebellar syndrome
*Ocular:
**Optic neuritis
**Iridocyclitis
**Episcleritis
**Retinitis
*Cardiovascular
**Myocarditis
**Pericarditis
**Heart failure
**Arrhythmias
**Ischemic heart disease
**Hemodynamic instability
*Skin:
**Photosensitive hyperpigmentation
**Penoscrotal ulcers
**Vesiculobullous dermatosis
*Renal:
**Nephritis
**Acute renal failure
*Neonatal infection with vertical transmission:
**Ante-partum fetal deaths
**Meningoencephalitis
**Disseminated intravascular coagulation
*Other possible associations:
**Pneumonia
**Respiratory failure
**Hepatitis
**Pancreatitis
**SIADH
**Hypoadrenalism


==References==
==References==
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[[Category:Tropical disease]]
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Revision as of 17:28, 13 June 2014

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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]

Overview

Chikungunya that 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 common symptoms of chikungunya include fever, petechial or maculopapular rash and arthralgia or polyarthritis.

Symptoms

While a proportion of individuals infected with chikungunya virus become asymptomatic (around 3-28%),[1][2] most of them 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.

Acute Disease

The following are the acute symptoms that usually last for 3–10 days.

  • 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.
  • Polyarthritis: 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.

  • Swollen and stiff joints
  • Swollen joints with fine desquamation
  • Hyperpigmentation
  • Tenosynovitis
  • Hygroma

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.[3]

  • Neurological:
    • Seizures
    • Neuropathy
    • Meningoencephalitis
    • Encephalopathy
    • Encephalitis
    • Guillain-Barré syndrome
    • Cerebellar syndrome
  • Ocular:
    • Optic neuritis
    • Iridocyclitis
    • Episcleritis
    • Retinitis
  • Cardiovascular
    • Myocarditis
    • Pericarditis
    • Heart failure
    • Arrhythmias
    • Ischemic heart disease
    • Hemodynamic instability
  • Skin:
    • Photosensitive hyperpigmentation
    • Penoscrotal ulcers
    • Vesiculobullous dermatosis
  • Renal:
    • Nephritis
    • Acute renal failure
  • Neonatal infection with vertical transmission:
    • Ante-partum fetal deaths
    • Meningoencephalitis
    • Disseminated intravascular coagulation
  • Other possible associations:
    • Pneumonia
    • Respiratory failure
    • Hepatitis
    • Pancreatitis
    • SIADH
    • Hypoadrenalism

References

  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. ↑ 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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