Chikungunya Virus Treatment & Management

Updated: Sep 19, 2017
  • Author: Suganthini Krishnan Natesan, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Approach Considerations

No specific antiviral treatment is available for Chikungunya fever.

It is important to exclude other serious infections similar to Chikungunya fever such as dengue, malaria, or bacterial infections.

Once other infections are excluded, management includes hydration, monitoring of hemodynamic status, collection of blood specimens for diagnosis, and antipyretic therapy. Severe arthralgia may be managed with nonsteroidal anti-inflammatory drugs (NSAIDS) (once dengue is excluded) and physiotherapy. Poor glycemic control in patients with diabetes who have Chikungunya infection has been reported. It is important to monitor the blood glucose closely in these patients.

Published evidence does not recommend the use of corticosteroids or antiviral agents.

Conservative treatment includes management of electrolyte imbalance, prerenal azotemia, and hemodynamic monitoring based on severity of illness. Indiscriminate use of corticosteroids, NSAIDS (especially aspirin), and other antibiotics could result in thrombocytopenia, gastritis, gastrointestinal bleeding, and renal failure and indirectly contribute to overall mortality.

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Prevention

Vector control plays a key role in preventing the spread of Chikungunya virus. Humans traveling to endemic/epidemic areas are recommended to use mosquito repellents, to wear long-sleeve shirts and long pants, and to use air-conditioned rooms or rooms with window and door screens.

People with suspected Chikungunya fever should avoid mosquito exposure during the first week of viremia to prevent local transmission of the illness.

Appropriate education of the community and public health officials on eliminating mosquito breeding sites (stagnant water, weeds and tall grass) and spraying insecticides is essential for optimal vector control and for interrupting transmission of the disease.

Humans at risk for severe disease must avoid travel to areas with ongoing outbreaks.

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Future Perspectives

Research into development of a live-virus and attenuated-virus vaccine against Chikungunya virus is ongoing. However, no vaccines are available at this time. [91, 92, 93]

Chikungunya fever is an emerging global disease with several intriguing and unanswered questions such as the reason for sudden major rapid outbreaks with disease-free intervals, mode of survival or maintenance of the virus in nature between epidemics, factors that trigger the outbreaks, and strain replacements during outbreaks. [94]

More research is needed to understand the epidemiology and natural history of this disease. Until then, prevention and vector control at personal and community level should be implemented.

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Consultations

Consultations may include the following:

  • Infectious disease specialist
  • Rheumatologist
  • Intensive care specialist
  • Neurologist
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Long-Term Monitoring

Arthralgias resolve spontaneously within 3 weeks in about 70% of patients. However, they can persist for 3-6 months in 30% of patients, for 20 months in 15%, and for 3-5 years in 12%. Elderly patients and patients with prior rheumatologic conditions are at higher risk for chronic polyarthritis, tenosynovitis, and bursitis. Bouquillard et al have reported the possible unmasking or occurrence of rheumatoid arthritis in patients infected with Chikungunya virus. Patients with chronic arthritis may need long-term follow-up with both infectious disease and rheumatology experts. [78]

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