Chikungunya

Source: Wikipedia, the free encyclopedia.

Chikungunya
Supportive care[3]
PrognosisRisk of death ~ 1 in 1,000[4]
Frequency> 1 million (2014)[3]

Chikungunya is an

joint swelling, and a rash.[2] Symptoms usually improve within a week; however, occasionally the joint pain may last for months or years.[2][6] The risk of death is around 1 in 1,000.[4] The very young, old, and those with other health problems are at risk of more severe disease.[2]

The

immune after a single infection.[2]

The best means of prevention are overall

Ixchiq) for prevention of the disease.[8] Once infected and symptomatic, recommendations to patients should include rest, fluids, and medications to help with fever and joint pain.[2][3]

In 2014, more than a million suspected cases occurred globally.

continental United States, but as of 2016 there were no further locally-acquired cases.[9][10]

Signs and symptoms

Around 85% of people infected with Chikungunya virus experience symptoms, typically beginning with a sudden high fever above 39 °C (102 °F).

reddening and sometimes small bumps on the palms, foot soles, torso, and face.[12] For some, the rash remains constrained to a small part of the body; for others, the rash can be extensive, covering more than 90% of the skin.[11] Some people experience gastrointestinal issues, with abdominal pain and vomiting. Others experience eye problems, namely sensitivity to light, conjunctivitis, and pain behind the eye.[12] This first set of symptoms – called the "acute phase" of Chikungunya – lasts around a week, after which most symptoms resolve on their own.[12]

Many people continue to have symptoms after the "acute phase" resolves, termed the "post-acute phase" for symptoms lasting three weeks to three months, and the "chronic stage" for symptoms lasting longer than three months.[12] In both cases, the lasting symptoms tend to be joint pains: arthritis, tenosynovitis, and/or bursitis.[12] If the affected person had pre-existing joint issues, these tend to worsen.[12] Overuse of a joint can result in painful swelling, stiffness, nerve damage, and neuropathic pain.[12] Typically the joint pain improves with time; however, the chronic stage can last anywhere from a few months to several years.[12]

Joint pain is reported in 87–98% of cases, and nearly always occurs in more than one joint, though joint swelling is uncommon.

iridocyclitis, or uveitis, and retinal lesions may occur.[15] Temporary damage to the liver may occur.[16]

People with Chikungunya occasionally develop neurologic disorders, most frequently

paralysis of the eye muscles.[12]

Newborns are susceptible to particularly severe effects of Chikungunya infection. Signs of infection typically begin with fever, rash, and swelling in the extremities.[12] Around half of newborns have a mild case of the disease that resolves on its own; the other half have severe disease with inflammation of the brain and seizures.[12] In severe cases, affected newborns may also have issues with bleeding and bloodflow, and problems with heart function.[12]

In addition to newborns, the elderly, and those with

human immunodeficiency virus infection tend to have more severe cases of Chikungunya. Around 1 to 5 in 1,000 people with symptomatic Chikungunya die of the disease.[12]

Cause

Virology

Chikungunya virus
Cryoelectron microscopy reconstruction of "Chikungunya virus". From EMDB entry EMD-5577
EMDB entry EMD-5577[17]
Virus classification Edit this classification
(unranked): Virus
Realm: Riboviria
Kingdom: Orthornavirae
Phylum: Kitrinoviricota
Class: Alsuviricetes
Order: Martellivirales
Family: Togaviridae
Genus: Alphavirus
Species:
Chikungunya virus

Chikungunya virus (CHIKV), is a member of the genus

biosafety level III precautions.[21]

Transmission

Chikungunya is generally transmitted from mosquitoes to humans. Less common modes of transmission include vertical transmission, which is transmission from mother to child during pregnancy or at birth. Transmission via infected blood products and through organ donation is also theoretically possible during times of outbreak, though no cases have yet been documented.[14] The incubation period ranges from one to twelve days, and is most typically three to seven.[13]

Chikungunya is related to

antigenic character: West African, East/Central/South African, and Asian genotypes.[24] The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown that there are two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013.[25] The rate of molecular evolution was estimated to have a mean rate of 5 × 10−4 substitutions per site per year (95% higher probability density 2.9–7.9 × 10−4).[25]

Chikungunya is spread through bites from

Asian tiger mosquito (A. albopictus).[26] Other species potentially able to transmit Chikungunya virus include Ae. furcifer-taylori, Ae. africanus, and Ae. luteocephalus.[14]

Mechanism

Chikungunya virus is passed to humans when a bite from an infected mosquito breaks the skin and introduces the virus into the body. The

cytopathic, but susceptible to type-I and -II interferon.[27] In vivo, in studies using living cells, chikungunya virus appears to replicate in fibroblasts, skeletal muscle progenitor cells, and myofibers.[28][29][30]

The type-1 interferon response seems to play an important role in the host's response to chikungunya infection. Upon infection with chikungunya, the host's fibroblasts produce type-1 alpha and beta

phosphorylated.[37]

In the acute phase of chikungunya, the virus is typically present in the areas where symptoms present, specifically skeletal muscles, and

monocyte chemoattractant protein 1 (MCP-1), monokine induced by gamma interferon (MIG), and interferon gamma-induced protein 10 (IP-10). Cytokines may also contribute to chronic Chikungunya virus disease, as persistent joint pain has been associated with elevated levels of IL-6 and granulocyte-macrophage colony-stimulating factor (GM-CSF).[22] In those with chronic symptoms, a mild elevation of C-reactive protein (CRP) has been observed, suggesting ongoing chronic inflammation. However, there is little evidence linking chronic Chikungunya virus disease and the development of autoimmunity.[citation needed][39]

Viral replication

Transmission electron micrograph of Chikungunya virus particles

The virus consists of four nonstructural proteins and three structural proteins.

heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells.[18]

Diagnosis

Chikungunya is diagnosed on the basis of clinical, epidemiological, and laboratory criteria. Clinically, acute onset of high fever and severe joint pain would lead to suspicion of chikungunya. Epidemiological criteria consist of whether the individual has traveled to or spent time in an area in which chikungunya is present within the last twelve days (i.e.) the potential incubation period). Laboratory criteria include a decreased lymphocyte count consistent with viremia. However a definitive laboratory diagnosis can be accomplished through viral isolation, RT-PCR, or serological diagnosis.[41]

The

dengue or malaria, or other infections such as influenza. Chronic recurrent polyarthralgia occurs in at least 20% of chikungunya patients one year after infection, whereas such symptoms are uncommon in dengue.[42]

false positives can occur with infection due to other related viruses, such as o'nyong'nyong virus and Semliki Forest virus.[43]

Presently, there is no specific way to test for chronic signs and symptoms associated with Chikungunya fever although nonspecific laboratory findings such as

cytokines can correlate with disease activity.[44]

Prevention

A. aegypti mosquito biting a person

Because no approved

insecticide resistance presents a challenge to chemical control methods.[citation needed
]

Wearing bite-proof long sleeves and trousers also offers protection, and garments can be treated with

A. albopictus, however, this will have only a limited effect, since many contacts between the mosquitoes and humans occur outdoors.[citation needed
]

Vaccination

This section is an excerpt from Chikungunya vaccine.[edit]


A

chikungunya virus.[45]

The most commonly reported side effects include headache, fatigue, muscle pain, joint pain, fever, nausea and tenderness at the injection site.[46]

The first chikungunya vaccine was approved for medical use in the United States in November 2023.[46]

Treatment

Currently, no specific treatment for chikungunya is available.

corticosteroids are not recommended during the acute phase of disease, as they may cause immunosuppression and worsen infection.[14]

Passive immunotherapy has potential benefit in treatment of chikungunya. Studies in animals using passive immunotherapy have been effective, and clinical studies using passive immunotherapy in those particularly vulnerable to severe infection are currently in progress.[48] Passive immunotherapy involves administration of anti-CHIKV hyperimmune human intravenous antibodies (immunoglobulins) to those exposed to a high risk of chikungunya infection. No antiviral treatment for Chikungunya virus is currently available, though testing has shown several medications to be effective in vitro.[13]

Chronic arthritis

In those who have more than two weeks of arthritis,

NSAIDs and simple analgesics can be used to provide partial symptom relief in most cases. Methotrexate, a drug used in the treatment of rheumatoid arthritis, has been shown to have benefit in treating inflammatory polyarthritis resulting from chikungunya, though the drug mechanism for improving viral arthritis is unclear.[49]

Prognosis

The mortality rate of chikungunya is slightly less than 1 in 1000.[50] Those over the age of 65, neonates, and those with underlying chronic medical problems are most likely to have severe complications.[22] Neonates are vulnerable as it is possible to vertically transmit chikungunya from mother to infant during delivery, which results in high rates of morbidity, as infants lack fully developed immune systems.[22] The likelihood of prolonged symptoms or chronic joint pain is increased with increased age and prior rheumatological disease.[51][52]

Epidemiology

Main article: Epidemiology of chikungunya
Dark green denotes countries with current or previous local transmission of CHIKV, per CDC as of Sept 17, 2019.
A. albopictus distribution as of December 2007
Dark blue: Native range
Teal: introduced

Historically, chikungunya has been present mostly in the

developing world. The disease causes an estimated 3 million infections each year.[53] Epidemics in the Indian Ocean, Pacific Islands, and in the Americas, continue to change the distribution of the disease.[54]
In Africa, chikungunya is spread by a sylvatic cycle in which the virus largely cycles between other non-human primates, small mammals, and mosquitos between human outbreaks.[55] During outbreaks, due to the high concentration of virus in the blood of those in the acute phase of infection, the virus can circulate from humans to mosquitoes and back to humans.[55] The transmission of the pathogen between humans and mosquitoes that exist in urban environments was established on multiple occasions from strains occurring on the eastern half of Africa in non-human primate hosts.[38] This emergence and spread beyond Africa may have started as early as the 18th century.[38] Currently, available data does not indicate whether the introduction of chikungunya into Asia occurred in the 19th century or more recently, but this epidemic Asian strain causes outbreaks in India and continues to circulate in Southeast Asia.[38] In Africa, outbreaks were typically tied to heavy rainfall causing increased mosquito population. In recent outbreaks in urban centers, the virus has spread by circulating between humans and mosquitoes.[14]

Global rates of chikungunya infection are variable, depending on outbreaks. When chikungunya was first identified in 1952, it had a low-level circulation in West Africa, with infection rates linked to rainfall. Beginning in the 1960s, periodic outbreaks were documented in Asia and Africa. However, since 2005, following several decades of relative inactivity, chikungunya has re-emerged and caused large outbreaks in Africa, Asia, and the Americas. In India, for instance, chikungunya re-appeared following 32 years of absence of viral activity.

PAHO.[60]

An analysis of the genetic code of Chikungunya virus suggests that the increased severity of the 2005–present outbreak may be due to a change in the genetic sequence which altered the E1 segment of the virus'

tropical main vector, Aedes aegypti.[62] Enhanced transmission of Chikungunya virus by A. albopictus could mean an increased risk for outbreaks in other areas where the Asian tiger mosquito is present.[63] A albopictus is an invasive species which has spread through Europe, the Americas, the Caribbean, Africa and the Middle East.[citation needed
]

After the detection of zika virus in Brazil in April 2015, the first ever in the Western Hemisphere,[64][65] it is now thought some chikungunya and dengue cases could in fact be zika virus cases or coinfections.

History

The disease was first described by Marion Robinson

Tanganyika (the mainland part of modern-day Tanzania). Since then outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia; recent outbreaks have spread the disease over a wider range.[citation needed
]

The first recorded outbreak may have been in 1779.[68] This is in agreement with the molecular genetics evidence that suggests it evolved around the year 1700.[69]

According to the original paper by Lumsden, the term 'chikungunya' is derived from the

posture of people affected with the severe joint pain and arthritic symptoms associated with this disease.[70] Subsequent authors apparently overlooked the references to the Makonde language and assumed the term to have been derived from Swahili, the lingua franca of the region. The erroneous attribution to Swahili has been repeated in numerous print sources.[71] Erroneous spellings of the name of the disease are also in common use.[citation needed
]

Research

Chikungunya is one of more than a dozen agents researched as a potential

biological weapon.[72][73]

This disease is part of the group of neglected tropical diseases.[74]

See also

References

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Works cited

External links
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