Arthropod-borne viral arthritis and rash

CASES/YEAR
0 (US); 100,000 (Global)
CATEGORY
Arthropod-Borne
AGENT TYPE
Viruses
OTHER NAMES
Chikungunya; Ross River fever; O'nyong-nyong fever; Mayaro virus disease; Sindbis virus disease (Pogosta disease); Zika virus infection;
ACUITY
Acute-Severe
INCUBATION
1-12 days; [CCDM]
INITIAL SYMPTOMS
Flu-like syndrome followed by maculopapular rash for 7-10 days and arthralgias that may last for months; [CCDM, p. 33] Chikungunya infections are asymptomatic in about 3% to 28% of people. [CDC Travel, p. 183]
PRECAUTIONS
Vector prevention measures; For the first few days of illness, individuals infected with chikungunya virus can introduce virus into receptive areas. Healthcare workers may become infected from blood containing chikungunya virus. [CCDM, p. 35]
COMMENTS
FINDINGS:
A maculopapular rash of the trunk and extremities may erupt 1-10 days after the onset of the arthralgias. The rash lasts for 7-10 days and concludes with fine desquamation. Chikungunya causes vesiculobullous lesions in infants. Other findings are lymphadenopathy, myalgia, fatigue, headache, conjunctivitis, paresthesias, tenderness of palms and soles, and mild hemorrhagic manifestations. [CCDM, p. 33-4] The arthralgia/arthritis may persist for months or more in some cases. [Guerrant, p. 519-24] Findings include severe arthralgias, fever (often "saddleback'), myalgia, petechiae, headache, pharyngitis, nausea/vomiting, and leukopenia. Children may present with seizures. [PPID, p. 2004] Chikungunya virus causes fever accompanied by severe arthralgias and migratory polyarthritis (mainly small joints). The appearance of the rash often coincides with defervescence 2-3 days into the illness. [Harrisons, p. 569] Chikungunya virus rarely causes petechiae, purpura, epistaxis, hematemesis, and melena. [Guerrant, p. 523] Laboratory results in chikungunya virus infection include thrombocytopenia, lymphopenia, and abnormal liver and kidney function tests. Complications include myocarditis, uveitis, hepatitis, acute renal disease, bullous skin lesions, meningoencephalitis, Guillain-Barre syndrome, paresis, and palsies. [CDC Travel, p. 183]

EPIDEMIOLOGY:
Reservoirs are marsupials (Ross River virus), primates (chikungunya), and birds (Sindbis). [CCDM, p. 34] Chikungunya virus causes encephalitis in an epidemic setting in India and Southeast Asia. [PPID, p. 1235t] Bloodborne transmission of chikungunya virus is possible. The disease has spread in the Americas since 2013 with cases reported in the Caribbean and in several North, Central, and South American countries. [CDC Travel, p. 183] Since 2014, local transmission of Chikungunya virus has been identified in Florida, Puerto Rico, and the U.S. Virgin Islands. [CDC website]

RELATED INFECTIONS:
Zika virus infection is indistinguishable from infections by Chikungunya or mild Dengue (without hemorrhagic manifestations). 50% to 80% are asymptomatic. The incubation is 3-14 days. Symptoms usually last a few days to one week. The most common symptoms are: rash (90%), fever (65%), arthralgia (65%), nonpurulent conjunctivitis (55 %), and headache (45%). Laboratory findings include mild leukopenia and mild elevation of liver function tests. Recent outbreaks have been associated with neurological syndromes, particularly Guillain-Barre syndrome. Sexual transmission from infected men to women has been documented in about 100 cases. Fetal microcephaly or other brain disease following maternal infection: 4-6% risk if Zika virus infection during pregnancy. [ABX Guide, PPID, p. 2031-2]
DIAGNOSTIC
Paired sera; IgM persists for weeks to months; RT-PCR; Culture virus from blood in first few days; [CCDM ] Viral culture or nucleic acid amplification can detect Chikungunya in serum in first week after symptom onset. [CDC Travel]
SCOPE
Chikungunya (Africa, India, SE Asia, Pacific Is., Mideast); Ross River (mainly Australia, also Papua New Guinea & Pacific Is.); Sindbis (Africa, N. Europe, rare in Asia & Australia); O'nyong-nyong (Africa); Mayaro (C. & northern S. America); [CCDM]
SIGNS & SYMPTOMS
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >fever, biphasic or relapsing
  • >myalgia
  • E epistaxis
  • E pharyngitis
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G hematemesis
  • G liver function test, abnormal
  • G nausea, vomiting
  • H leukopenia
  • H lymphadenopathy
  • H thrombocytopenia
  • N headache
  • N paresthesia
  • N seizure
  • O conjunctivitis, acute
  • S papules or plaques
  • S petechiae and ecchymoses
  • S rash (exanthem)
  • S rash on palms
  • S skin blister or vesicles
  • *arthritis
  • *bleeding tendency
  • *cranial neuropathy
  • *encephalitis
  • *hepatitis
  • *meningitis
  • *myelitis
  • *myocarditis
  • *paralysis
  • *pericarditis
  • *uveitis
ANTIMICROBIC

No

VACCINE

No

ENTRY
Needle (Includes Drug Abuse), Scalpel or Transfusion
SOURCE
RESERVOIR
Birds and Poultry, Monkeys, Human, Wild Animals
RISK FACTORS
  • Travel to endemic area
  • Victim--air release of infectious agents
  • Work in a medical or research lab
TREATMENT
Symptomatic management; [CCDM]
REFERENCES FOR CASES/YEAR
1.
2. (Global) 2007 was first time Chikungunya was in Europe; [Fact sheets from WHO] Cases reported in England & Wales: All cases in travelers; 63 (2009); 79 (2010), 15 (2011), 16 (2012); [Public Health England website] An outbreak of o'nyong-nyong fever occurred in Cote d'Ivoire in 2003; An outbreak of Mayaro fever occurred in Brazil in 1988, affecting 800 of 4000 latex gatherers, and travel infections have been documented; 55,000 cases of Ross River fever were reported in Australia 1992-2006; [Cecil, p. 2227] Guesstimate: 100,000 cases/year;