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You should worry more about this disease than Zika.

Posted by Stuart Rose on

Like the Zika virus, chikungunya fever is caused by a virus transmitted by daytime-biting mosquitoes. There is no vaccine. The only prevention is insect-bite protection.

If you are going to a country with Zika virus, and you're not pregnant, and especially have a young family, you should be much more worried about this disease!

Chikungunya fever is a rapid-onset disease, characterized by high fever, intense weakness, severe joint and muscle pain, headache, and rash. The abrupt onset of fever follows a mean incubation period of 3 days; when fever is present, the body temperature is usually higher than 39°C

Soon after the onset of fever, the muscle and joint pain are so intense that patients have difficulty leaving the position they were in when their symptoms began.

The joint pain is usually symmetric and localized in both the arms and legs. The large joints are almost invariably symptomatic, as are, to a lesser extent, the small joints and the vertebral column. Periarticular edema and acute arthritis may also occur, in particular in the fingers, wrists, and ankles, as well as pain along ligament insertions.

Patients with severe chikungunya fever requiring hospitalization tend to be older and to have coexisting conditions such as cardiovascular, neurologic, and respiratory disorders or diabetes, which are independent risk factors for severe disease. Severe chikungunya fever can manifest as encephalopathy and encephalitis, myocarditis, hepatitis, and multiorgan failure. These rare forms can be fatal and typically arise in patients with underlying medical conditions. 

Neonates are another group at risk for severe infection associated with neurologic signs. Whereas fetal infection appears to be extremely rare (unlike Zika), the rate of infection of neonates born to viremic mothers and exposed to the virus during birth can reach 50%, leading to severe disease and encephalopathy in half and resulting in long-term neurologic sequelae. Young children also tend to have severe disease. 

The major disease and economic burdens of chikungunya fever result not only from the high attack rate and severity of acute infection but also from chronic joint pain. This can be persistent or relapsing arthralgia that is located mostly in the distal joints, which may be associated with arthritis and may mimic rheumatoid arthritis (chronic inflammatory, erosive, and rarely deforming polyarthritis) in up to 50% of patients. Chronic arthralgia can lead to persistent incapacitation requiring long-term treatment with nonsteroidal antiinflammatory and immunosuppressive drugs such as methotrexate, although their safety and efficacy also have yet to be demonstrated in clinical trials.


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