In South Africa, chikungunya is managed by tropical medicines. Chikungunya is a mosquito-borne alphavirus disease whose name translates from the Kimakonde language as 'that which bends up' — a vivid description of the intensely painful joint disease it causes. WHO estimates more than 3 million reported cases across more than 110 countries since the virus re-emerged across the Indian Ocean and the Americas after 2004.
Chikungunya virus disease (ICD-10: A92.0) is an arboviral infection caused by chikungunya virus (CHIKV), a single-stranded RNA alphavirus in the Togaviridae family. The virus is transmitted by Aedes aegypti and Aedes albopictus mosquitoes; A. albopictus has extended transmission into temperate and Indian Ocean island regions. After a 3-7 day incubation period, infection causes a biphasic illness: an acute febrile arthritic phase lasting 7-14 days, followed in 30-40% of patients by a post-acute or chronic phase of persistent polyarthralgia and arthritis lasting months to years.
The key symptoms of Chikungunya are: Sudden onset of high fever (often above 39°C) lasting 3-7 days after a 3-7 day incubation following mosquito bite., Severe symmetric polyarthralgia of the small joints of the hands, wrists, ankles, and feet — the most distinctive feature., Joint swelling and tenderness, often disabling — patients cannot grip, walk, or perform daily tasks., Maculopapular rash on the trunk and limbs in 40-75% of patients, appearing 2-5 days after fever onset., Severe headache, often retro-orbital, lasting several days., Marked myalgia and back pain accompanying the polyarthralgia., Fatigue and malaise that can persist long after fever resolves..
Suspect chikungunya in any patient with sudden high fever and severe symmetric polyarthralgia within 7 days of travel to or residence in an active transmission area. Differential diagnosis with dengue and Zika is mandatory in co-endemic regions, and concurrent testing is standard. Diagnosis combines clinical features with molecular and serologic confirmation. Reverse-transcription PCR (RT-PCR) on serum within the first 7-8 days of illness detects viral RNA with high sensitivity; viremia peaks at day 2-4. IgM antibody by ELISA becomes positive 5-7 days after symptom onset and persists for several months; IgG appears later and persists for years. Concurrent dengue NS1 antigen and IgM testing is mandatory because the two viruses share clinical features but have different management implications — most importantly, NSAIDs should be avoided until dengue is excluded because they can worsen hemorrhagic complications. Acute joint examination documents symmetric arthritis of small joints; in patients with persistent symptoms past 4-6 weeks, screening for inflammatory arthritis differentials (rheumatoid factor, anti-CCP, ANA) helps distinguish post-chikungunya arthritis from new-onset rheumatologic disease. Imaging is rarely needed acutely; persistent joint pain past 3 months may warrant ultrasound or MRI for synovitis assessment and rheumatology referral.
Acute mortality is low (under 0.1% of infections in most outbreaks). Most adults recover from acute disease within 7-14 days. However, post-chikungunya arthralgia persists in 30-40% of patients at 3 months, 25-40% at 1 year, and 10-20% at 2 years. Predictors of chronic joint disease include age over 40, female sex, severity of acute joint symptoms, and pre-existing osteoarthritis or inflammatory arthritis. Quality of life can be substantially affected during the chronic phase. Severe disease in neonates infected perinatally carries higher mortality and rates of long-term neurodevelopmental impairment. Lifelong immunity follows infection in immunocompetent adults; clinically apparent re-infection is rare. The introduction of the IXCHIQ vaccine in 2023 has the potential to change this prognosis in vaccinated populations once experience and supply expand.
Infectious disease referral is recommended for any patient with severe acute chikungunya, atypical presentation, or persistent symptoms beyond 4-6 weeks. Rheumatology involvement is essential for chronic post-chikungunya arthritis lasting more than 3 months. Maternal-fetal medicine evaluates pregnant women diagnosed in the third trimester because of perinatal transmission risk.
Find specialists →Acute symptoms resolve over 7-14 days in most patients. Post-acute joint pain may persist for several weeks. Chronic post-chikungunya arthritis lasts 3 months to several years in 25-40% of patients. Rehabilitation gains continue for 6-12 months in those with chronic disease.
Rest in the acute febrile phase. Once fever resolves and pain is manageable, gradual range-of-motion exercises help prevent stiffness. Pool walking and stationary cycling are often the best-tolerated reintroduction activities. Patients with persistent arthritis benefit from structured physiotherapy with progressive strengthening over 6-12 weeks.
Look for an infectious disease specialist or tropical medicine physician with experience in arboviral disease; many academic centers run dedicated travel medicine clinics. Rheumatologists managing post-viral arthritis are best for chronic joint involvement. Verify that the clinic offers chikungunya PCR and serology, plus dengue and Zika testing.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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