**Chikungunya virus infection should be considered in patients with acute
onset of fever and polyarthralgia** — joint pain in multiple joints —
**especially travellers who recently returned from areas with known
transmission.**
Fever plus joint pain plus a recent trip is the trigger.
Which test depends on the timing
| When | Test |
|---|---|
| During the acute phase | Nucleic acid testing — detecting the virus itself |
| After the first week of illness | Serologic testing — detecting the antibody response |
The virus is present in blood early and gone later; antibodies are absent
early and present later. A test chosen for the wrong week returns a negative
that means nothing.
Laboratory diagnosis is generally done on serum or plasma, to detect virus,
viral nucleic acid, or virus-specific IgM and neutralising antibodies.
The confirmation step
**A positive chikungunya virus-specific IgM antibody test result should be
confirmed by neutralizing antibody testing at a state public health
laboratory or CDC.**
IgM tests cross-react between related viruses — dengue and Zika circulate in
the same places and are carried by the same mosquitoes. A positive IgM is a
strong signal and not a diagnosis, and the neutralising antibody test is what
separates them.
Reporting
Chikungunya virus disease is a nationally notifiable condition. Providers
are encouraged to report suspected cases to their state or local health
department **to facilitate diagnosis and mitigate the risk of local
transmission**.
Both halves of that matter. The health department is the route to the
confirmatory testing above — and an imported case in a place where the
mosquito lives is how local transmission starts.
**Contact your state or local health department for assistance with
diagnostic testing**, and note that some tests are not currently available at
the CDC.
Source: Centers for Disease Control and Prevention.
许可协议： CC0 1.0（公有领域） · 改编自 www.cdc.gov
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