THE classic presentation of chikungunya is a high fever of greater than 102ºF, severe joint pains and rash.

Not everyone who gets bitten by an infectious mosquito will show symptoms. Up to three per cent of persons will not show any symptoms. Majority will be affected and show signs after two to 10 days of being bitten.

The first symptom to appear is the high fever, which persists for days. Shortly after, there is severe, unbearable joint pains, especially in the small joints. The patient may start to feel better and then approximately day three or four, a rash appears in every one in five persons that are affected. It can look like fine bumps, but can be reddish-looking or fluid-filled, resulting in the skin desquamating (stripping).

Other symptoms are headache, eye pain and redness, poor appetite, itching, nausea, vomiting, abdominal pain, dizziness, fainting, swollen joints, mouth sores, and swollen lymph nodes or “wax and canon” behind the ears, under arms and in the groin area.

TREATMENT

The treatment is supportive of the symptoms. This includes rest, hydration, taking medication to reduce fever and pain such as (paracetamol or codeine, as well as for the itching and rash – antihistamines like diphenhydramine (dph) and topical steroids.

No commercial vaccine or cure is available currently and the infection is thought to confer lifelong immunity – you can only catch it once.

COMPLICATIONS

Symptoms of the virus usually disappear after the acute phase, with most patients recovering, but some patients will have lingering joint pains for up to months or years. Previous joint pathologies like old injuries and previous joint pains may also now have magnified symptoms. The affected persons may walk with a bent over gait pulling the affected limbs. It is not unusual to see young and middle-aged people using walking aides like canes.

MENINGITIS

Inflammation of the covering of the brain and spinal cord may also result and even encephalitis where the brain is affected. The coverings of the nerves may also be affected causing myeloneuropathy, flaccid paralysis of the muscles and weakness of the peripheral nerves manifested by weakness in the limbs. Some persons may present with seizures if predisposed, and children may also present with febrile seizures.

INCONTINENCE OF STOOL AND URINE

Persons who are severely affected may be too weak or in too much pain to deal with and attend to normal bodily functions in a timely manner, and may have stool and urine incontinence.

INABILITY TO CARRY OUT DAILY FUNCTIONS

Because of pain and weakness, severely affected persons may be unable to carry out their daily functions such as bathing, brushing teeth, combing hair, attending school and work.

DEATH

Persons with underlying chronic diseases such as sickle cell disease, heart conditions, kidney failure, hypertension, and diabetes mellitus may present severely ill and septic, and may die after being affected by the disease.

The chikungunya illness is not thought to cause the death, but served as a trigger to worsen the underlying conditions. These persons are considered at risk inclusive of newborns and the elderly, and should seek medical attention early after experiencing the symptoms.

PREVENTION

This viral illness is prevented by not being bitten and controlling the breeding of the vector, the mosquito. This is done by avoiding mosquito bites, using repellents and mosquito nets and window mesh, as well as wearing light colours and covering most of the body with clothing. It is also very important to find and get rid of areas capable of breeding mosquitoes, such as flower pots, open cans and containers around the house and in nearby gullies.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer at the University of the West Indies.