Chikungunya Virus Disease: Clinical Signs and Symptoms

For healthcare providers.

Suspect chikungunya virus disease in a patient with sudden fever and pain in many joints (polyarthralgia), especially a traveller recently back from an area where the virus is spreading. The disease usually resolves on its own, but some patients have joint pain for months or years, and rare, serious complications occur, mostly in certain risk groups.

Differential diagnosis

What else to consider depends on where the patient lives, their travel and their exposures.

• Dengue and Zika are spread by the same mosquitoes, look similar clinically, can circulate in the same places and occasionally infect the same patient together.
• Chikungunya more often causes high fever, severe joint pain, arthritis, rash and lymphopenia; dengue more often causes neutropenia, thrombocytopenia, bleeding, shock and death. Zika is generally mild, though it can cause congenital infections.
• Rule out dengue, because managing it properly can improve the outcome. See clinical features of dengue.
• Other possibilities: leptospirosis, malaria, rickettsia, group A streptococcus, rubella, measles, parvovirus, enteroviruses, adenovirus, other alphaviruses (Mayaro, Ross River, Barmah Forest, o'nyong-nyong and Sindbis viruses), post-infectious arthritis and rheumatological conditions.

Signs and symptoms

• Most people infected develop symptoms. The incubation period is usually 3–7 days (range 1–12).
• Typical onset is sudden, with fever, usually above 39°C (102°F), and polyarthralgia. The joint symptoms are usually on both sides of the body, symmetrical, and can be severe and disabling.
• Other symptoms can include headache, muscle pain, arthritis, conjunctivitis, nausea or vomiting, and a maculopapular rash.
• Rare complications include uveitis, retinitis, myocarditis, hepatitis, nephritis, blistering skin lesions, bleeding, meningoencephalitis, myelitis, Guillain-Barré syndrome and cranial nerve palsies. CDC has a fact sheet on atypical and severe disease.
• At risk of severe disease: newborns exposed during or shortly after birth, adults over 65, and people with underlying conditions such as high blood pressure, diabetes or heart disease.

Laboratory findings

Findings can include lymphopenia, thrombocytopenia and raised creatinine. Raised liver transaminases can occur in acute infection, but they are not specific and not common enough to be diagnostic.

Outcomes

Acute symptoms usually clear within 7–10 days. Some patients have lasting or returning rheumatological symptoms (polyarthralgia, polyarthritis, tenosynovitis) in the months after; studies report varying shares with joint pain lasting months to years. Death is rare, and mostly among older adults.

More

• CDC Yellow Book: chikungunya
• Medscape CDC Expert Commentary: Differentiating Chikungunya from Dengue

Sources

• Centers for Disease Control and Prevention, "Clinical Signs and Symptoms of Chikungunya Virus Disease." https://www.cdc.gov/chikungunya/hcp/clinical-signs/index.html
• A stock photograph of a patient at a doctor's office is not reproduced here.