Chikungunya virus infection

Following the initial visit, a stable patient should return within 1 week to discuss confirmatory tests and exclusion of other conditions, in particular dengue fever. During the second visit, additional education about the self-limited nature of the disease should be provided. Potential complications with emphasis on progression towards chronic manifestations, especially in patients with higher risk (older age, pre-existing rheumatological conditions, immunosuppressed, patients with comorbidities) should be discussed.

There is no standard follow-up visit recommended after the initial ones; however, if the symptoms persist or recur after 3 to 4 weeks, additional clinical monitoring is indicated.

If chronic rheumatological symptoms develop, measuring of acute phase reactants such as erythrocyte sedimentation rate and C-reactive protein may be helpful for monitoring. Rheumatoid factor and anti-cyclic citrullinated peptide antibodies could be tested. X-rays of affected joints can also be obtained. Usually, hand x-rays are the most helpful.

There is no indication to repeat serology; however, in chronic cases, persistence of immunoglobulin M antibody has been described and may help confirm the manifestations are not due to other diseases.

If chronic infection is established and symptoms are not controlled with the usual analgesics, referral to a rheumatologist and use of disease-modifying anti-rheumatic drugs should be considered.