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For further information, see CMDT Part 32-05: Other Systemic Viral Diseases

Key Features

  • A flaviviral infection transmitted to humans by Aedes aegypti and Aedes albopictus (the "Asian tiger mosquito")

  • In the United States in 2018, there were at least

    • 75 travel-associated cases in 22 states (with the largest number of reports from California, New York, New Jersey, and Texas)

  • As of October 30, 2018, 5 locally acquired cases were reported in Puerto Rico

  • The attack rates are often as high as 50%

  • Prevalence is ubiquitous with endemic countries in Africa, the Americas, Asia, and Europe

  • Vertical transmission is documented if the mother is viremic during parturition

Clinical Findings

  • Incubation period of 1–12 days (average 2–4)

  • Abrupt onset of fever; headache; intestinal complaints; myalgias; and arthralgias/arthritis affecting small, large, and axial joints

  • Joint symptoms persist for 4 months in 33% and linger for years in about 10%

  • A centrally distributed pigmented or pruritic maculopapular rash is reported in 10–40% of patients

  • Mucosal disease occurs in about 15%

  • Facial edema and localized petechiae are reported

  • There are reports of coinfection with yellow fever, plasmodia, Zika virus, and dengue fever

  • Some of the pathology may be immune mediated

Diagnosis

  • Made epidemiologically and clinically

  • Mild leukopenia occurs as does thrombocytopenia, which is seldom severe

  • Elevated inflammatory markers do not correlate well with the severity of arthritis; radiographs of affected joints are normal

  • Serologic confirmation requires elevated IgM titers or fourfold increase in convalescent IgG levels using an enzyme-linked immunosorbent assay (ELISA)

  • Reverse transcriptase-polymerase chain reaction (RT-PCR) and culture techniques (viral isolation in insect or mammalian cell lines or by inoculation of mosquitoes or mice) are seldom available

Treatment

  • Largely supportive with nonsteroidal anti-inflammatory drugs and corticosteroids

  • Chloroquine may be useful for managing refractory arthritis

  • Methotrexate was associated with a positive response in a retrospective study

  • Live recombinant measles-virus-based vaccine and a virus-like particle vaccine are in early clinical trials

  • Prevention relies on avoidance of the mosquito vectors

  • Prophylaxis with specific Chikungunya immunoglobulins may be useful for exposed neonates or immunosuppressed persons

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