Chikungunya: fever and joint pains after vacation in a tropical area

• Published in: Deutsche medizinische Wochenschrift (1946) Vol. 133; no. 9; p. 406
• Main Authors: Ahrenstorf, G, Burkhardt, O, Witte, T, Stoll, M, Schmidt, R E
• Format: Journal Article
• Language: German
• Published: Germany 01.02.2008
• Subjects: Acetaminophen - therapeutic use; Adult; Alphavirus Infections - diagnosis; Alphavirus Infections - drug therapy; Alphavirus Infections - etiology; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antipruritics - therapeutic use; Arthralgia; Chikungunya virus - genetics; Chikungunya virus - isolation & purification; Clemastine - therapeutic use; Dipyrone - therapeutic use; Fever; Humans; Male; Mauritius; Polymerase Chain Reaction; RNA, Viral - blood; Tramadol - therapeutic use; Travel; Mauritius
• ISSN: 1439-4413
• DOI: 10.1055/s-2008-1046727

A 27-year-old man was admitted to our hospital, two days after returning from a vacation in Mauritius, with fever, chills, headache and myalgia, as well as arthritis of the legs. He had a temperature of 38.6 C and painful swellings of both talocalcanean joints. Laboratory studies revealed leukopenia, lymphopenia and thrombopenia, as well as a slight elevation of transaminases and serum bilirubin. Diagnostic tests for malaria were negative, as were tests for antibodies against Epstein-Barr virus, cytomegalovirus, leptospirosis, dengue, chikungunya and hepatitis viruses, legionella, streptococcus and HIV. But PCR with chikungunya virus RNA was positive, establishing the diagnosis of acute chikungunya. All symptoms disappeared on administration of analgesics and antipyretics. But after two days a maculopapular rash on the trunk and limbs was noted: it responded well to the application of clemastine. The patient was discharged from hospital three days after admission. Chikungunya virus belongs to the family of alphaviruses and is common in Southeast Asia and Africa. It can be transmitted to humans by bites of the Aedes mosquitoes. Symptoms are similar to those of dengue and consist of fever, headache, arthralgia, myalgia and conjunctivitis. After two or three days these symptoms subside and a maculopapular rash appears. The fever may return. Arthralgia can persist over weeks and even months. While the diagnosis is normally established by antibody tests, these may be negative in early stages of the disease. when the diagnosis can be made by PCR. Treatment is symptomatic with analgesics and antipyretics.