Chikungunya is a virus that is transmitted to humans through the bite of an infected mosquito. Infected mosquitoes can also carry other diseases such as dengue and yellow fever. Chikungunya can be found all over the world, including the Caribbean islands, tropical areas of Asia, Africa, South America, and North America. There is no cure, vaccine, or treatment for this disease, all you can do is focus on alleviating the symptoms. In the treatment steps, it is important to identify the signs and symptoms of chikungunya, manage the symptoms that arise, and be aware of complications of the disease.
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Part 1 of 3: Identifying Signs and Symptoms
Step 1. Watch for symptoms in the acute phase
The acute phase is a period of illness that occurs quickly but is short-lived. There may be no symptoms for 2 to 12 days after being bitten by an infected mosquito. Usually, there are no symptoms for 3 to 7 days. After symptoms appear, you may experience chikungunya symptoms for about 10 days before gradually recovering. It is likely that you will experience the following symptoms during the acute phase:
- Fever: Fever usually reaches 39°C to 40°C and lasts 3 days to 1 week. Fever can occur in two phases, namely disappearing a few days and then followed by a low fever (38 ° C) for a few days later. During this period, the virus accumulates in the bloodstream and spreads to different parts of the body.
- Arthritis (joint pain): Usually you will feel arthritis in small joints such as the hands, wrists, and larger joints such as the knees and shoulders, but not in the hips. About 70% of people feel pain that radiates from one joint to another after the previous joint feels better. The pain is usually most pronounced in the morning, but gets better with light exercise. Your joints may also appear swollen or feel supple to the touch, and there may be inflammation in the tendons (tenosynovitis). Joint pain usually resolves within 1 to 3 weeks, with severe pain improving after the first week.
- Rash: Approximately 40% to 50% of patients develop a rash. The most common type of rash is a morbilli (maculopapular) rash. This is a red rash with small bumps on it that appears 3 to 5 days after the fever starts and will go away in 3 to 4 days. The rash usually starts on the arms to the shoulders followed by the face and torso. Look in the mirror shirtless and notice if there are any large red bumps and if they feel itchy. Then turn around to examine your back, back of your neck, and lift your arms to examine your armpits.
Step 2. Recognize subacute symptoms
The subacute phase of chikungunya occurs one to three months after the acute phase ends. The main symptom during the subacute phase is arthritis. In addition, vascular disorders such as Raynaud's phenomenon can occur.
Raynaud's phenomenon is a condition of decreased blood flow to the hands and feet in response to cold or stress in the body. Look at your fingertips and see if they feel cold and dark/bluish in color
Step 3. Recognize the symptoms of the chronic phase
This phase starts after 3 months from the first attack. This phase is characterized by persistent symptoms of joint pain, with 33% of patients experiencing joint pain (arthralgia) for 4 months, 15% for 20 months, and 12% for 3 to 5 years. One study showed 64% of people reported joint stiffness and/or pain for more than a year after the initial infection. You may have another fever, asthenia (abnormal lack of energy and/or physical weakness), arthritis (inflammation/swelling of the joints) in many joints, and tenosynovitis (inflammation of the tendons).
- If you already have joint problems, such as rheumatoid arthritis, you are more likely to reach the chronic phase of chikungunya.
- Rheumatoid arthritis has been reported after initial infection, although it is rare. The average duration is 10 months.
Step 4. Watch for other symptoms
Although the common symptoms of chikungunya are fever, rash, and joint pain, many patients also experience other problems, including:
- Myalgia (muscle/back pain)
- Headache
- Sore throat
- Pain in stomach
- Constipation
- Swollen lymph nodes in neck
Step 5. Distinguish cikunyunga from similar diseases
Since many of the symptoms of chikungunya are also symptoms of a similar disease carried by mosquitoes, you should be able to tell the difference. Diseases similar to chikungunya include:
- Leptospirosis: Pay attention to whether the calf muscles (the muscles behind the shinbone below the knee) are sore or sore when you walk. You should look in the mirror and see if the whites of your eyes are bright red (subconjunctival hemorrhage). This condition is caused by the rupture of small blood vessels. Keep in mind whether you have been on the farm or around puddles as contaminated animals can spread the disease through water or soil.
- Dengue fever: Pay attention to whether you have been in contact with or bitten by mosquitoes from tropical climates such as Africa, Central America, the Caribbean Islands, India and southern North America. Dengue attacks are more common in these areas. Stand in front of a mirror to look for bruising on the skin, bleeding or redness around the whites of the eyes, bleeding from the gums and nosebleeds. Bleeding is the big difference between dengue fever and chikungunya.
- Malaria: Pay attention to whether you have been in contact with or bitten by mosquitoes in known areas of infection such as certain areas of South America, Africa, India, the Middle East and Southeast Asia. Watch for chills and chills, then fever and sweats. This condition can last from 6 to 10 hours. You may experience these phases over and over again.
- Meningitis: Find out if there is a local outbreak in a heavily congested area or facility. If you have been in the area, you may have contracted the disease. Check your temperature for fever and notice if your neck is stiff or painful/uncomfortable when moved. The disease may be accompanied by a severe headache and feeling tired/confused.
- This condition is more common in children aged 5 to 15 years. Check if your child has pain in various moving joints (once one joint improves, the other begins to ache) and fever such as chikungunya. However, the differences that are clearly visible in children are uncontrolled body movements or seizures (chorea), small painless bumps under the skin, and rashes. The rash is flat to the skin or slightly raised with jagged edges (erythema marginatum) and appears blotchy or round in shape with a darker pink outer ring and lighter interior.
Part 2 of 3: Coping With Chikungunya Symptoms
Step 1. Know when to go to the doctor
The doctor will take a blood sample to test for chikungunya and other diseases carried by mosquitoes. You should see a doctor if you experience the following symptoms:
- Fever more than 5 days
- Dizziness (possibly due to neurological problems or dehydration)
- Cold toes or hands (Raynaud's phenomenon)
- Bleeding from the mouth or under the skin (may indicate dengue fever)
- Rash
- Joint pain, skin redness, body stiffness, or swelling
- Decreased urination volume (this may be due to dehydration causing kidney damage)
Step 2. Understand the blood test process for chikungunya
The doctor will take a blood sample to send to the lab. Several tests or methods will be performed on the sample to seek a diagnosis. An ELISA (enzyme linked immunoassay) test will look for specific antibodies against the virus. Normally antibodies develop at the end of the first week of illness and peak around 3 weeks and last up to 2 months. If the result is negative, the doctor may repeat the blood test to see if it has appeared.
- Virus cultures will also be taken to see how it progresses. Usually used in the first 3 days of illness when the virus is growing rapidly.
- The RT-PCR (reverse transcriptase polymerase chain reaction) method uses a protein encoding a specific viral gene to replicate specific chikungunya genes. If it's chikungunya, the lab will see a higher-than-normal chikungunya gene displayed on a computer graphic.
Step 3. Rest
There is no specific/approved treatment or drug for this virus and no vaccine to prevent transmission. Treatment is only by overcoming the symptoms that arise. WHO recommends starting treatment at home with rest. Rest will relieve the illness and give your body time to recover. Rest in an environment that is neither humid nor too hot, as humidity and heat can exacerbate symptoms in the joints.
Use a cold compress to reduce pain and inflammation. You can use frozen vegetable bags, wrapped frozen steaks, or ice packs. Wrap the frozen bag in a towel and place it on the painful area. Do not touch the frozen bag directly to the skin, this may cause tissue damage
Step 4. Take pain medication
If you have a fever and joint pain, take paracetamol or acetaminophen. Take 2 tablets of 200 mg with water up to 4 times a day. Make sure you drink plenty of water throughout the day. Since fever causes dehydration and electrolyte imbalance, try to drink at least 2 liters of water a day with added salt (which is similar to electrolyte sodium).
- If you have had liver or kidney problems before, consult your doctor before taking paracetamol/acetaminophen.
- Do not take aspirin or other NSAIDs such as ibuprofen, naproxen, and others. Chikungunya is similar to other mosquito-borne diseases such as dengue which can cause excessive bleeding. Aspirin and other NSAIDs can thin the blood and increase bleeding. Your doctor must determine in advance that you are not infected with dengue.
- If your joint pain is unbearable or doesn't improve after your doctor advises you to take a pain reliever or nonsteroidal anti-inflammatory drug (NSAID), your doctor may prescribe hydroxychloroquine 200 mg orally once a day or chloroquine phosphate 300 mg once daily for up to 4 weeks.
Step 5. Exercise
You should only exercise lightly so that it doesn't worsen joint or muscle pain. If possible, make an appointment with a physical therapist for physiotherapy treatment. Physiotherapy can strengthen the muscles around the joints which will reduce pain and stiffness. Try to exercise in the morning when your joints are the stiffest. Try some of these simple moves:
- Sit on the chair. Raise one leg parallel to the floor and hold for 10 seconds before lowering with the sole of the foot on the floor. Do the same movement with the other leg. Repeat several times a day, 2 to 3 sets of 10 repetitions per leg.
- Try standing on your toes with your feet together, then moving your heels up and down.
- Lie on your side to the right. Lift the right leg for a few seconds before lowering it over the left leg. Do this movement 10 times for the right leg. Then, turn to the left side, and repeat the same movement with the left leg. Do a set of 10 lifts for each leg several times a day
- You can also do low-impact aerobics. Here you don't make aggressive moves or use weights.
Step 6. Use oil or cream to treat skin irritation
You may have dry, scaly skin (xerosis) or an itchy rash (rash morbilli). This condition does not require treatment, but you can treat the itching and restore the skin's natural condition and moisturize it. Apply mineral oil, moisturizing cream, or calamine lotion. If your rash is itchy, take an antihistamine, such as diphenhydramine, as directed on the package. This medication can reduce inflammation-causing cells that release proteins that cause itching.
- Be careful when using antihistamines as they can cause drowsiness. Do not drive a vehicle or operate machinery after drinking it.
- A warm bath with a colloidal oatmeal solution can help soothe your skin.
- Hyperpigmented patches that do not fade can be treated with hydroquinone-based products. Hydroquinone will help whiten or lighten dark patches.
- Since there are many different types of liquids and creams available to treat skin irritation, you may need to ask your doctor for advice to determine which one to use.
Step 7. Try herbal remedies
The combination of herbs and plants is believed to help relieve the symptoms of chikungunya. Although they can be found easily in drug stores, you should always consult your doctor before trying any herbal remedies or supplements. Herbal remedies for chikungunya include:
- Eupatorium perfoliatum 200C: This is the main homeopathic treatment option for chikungunya. This preparation is a plant extract that is used when experiencing symptoms of chikungunya. This herb can relieve symptoms and joint pain. To use it, take 6 drops of the full extract for a month while symptoms persist.
- Echinacea: This is a flower-based extract that is used to treat the symptoms of chikungunya by increasing the effectiveness of the immune system. Take 40 drops a day, divided into doses three times a day.
Part 3 of 3: Beware of Complications and Prevent Chikungunya
Step 1. Be aware of cardiac complications
In particular, watch for abnormal heart rhythms (arrhythmias) which can be potentially fatal. To check your heart rate, place the tips of your index and middle fingers on your wrist, under the thumb area. If you feel a pulse, it is the radial artery. Count how many beats you feel for one minute. 60 to 100 beats is considered normal. Also, pay attention to whether the rhythm is constant, extra beats or abnormal pauses may mean an arrhythmia. The doctor may also perform an electrocardiogram, where electrodes are placed on your chest to check your heart rhythm.
The chikungunya virus can attack the tissues that make up the heart and cause inflammation (myocarditis), which causes an abnormal heart rhythm
Step 2. Watch for neurological complications
Find out if there is fever, fatigue, and mental confusion, which are signs of encephalitis or inflammation of the brain. Other signs are confusion and disorientation. If you also have a severe headache, neck stiffness/pain, sensitivity to light, fever, seizures, double vision, nausea and vomiting in addition to symptoms of encephalitis, you may have meningoencephalitis. This condition is a combination of meningitis and encephalitis (inflammation of the tissue in the spinal cord that connects to the brain).
- If you have nerve damage from your legs to your arms, you may have Guillain Barre syndrome. Watch for decreased sensation, reflexes, and movement on both sides of the body. Also pay attention to pain on both sides of the body that feels sharp, burning, numb or the sensation of being stabbed by hundreds of needles. This may occur gradually to the upper part of the body and potentially cause breathing difficulties from the nerves that supply the respiratory muscles.
- If you have difficulty breathing, go to the hospital immediately.
Step 3. Watch out for eye complications
Watch for pain in the eye, watery eyes and red eyes. These can all be symptoms of inflammation of the lining of the eye caused by conjunctivitis, episcleritis, and uveitis. If you have uveitis, your vision will be blurry and sensitive to light.
If you have trouble seeing objects straight ahead (central vision) and if the colors of the objects you see every day appear duller, you may have neuroretinitis
Step 4. Watch your skin for signs of hepatitis
Look in the mirror and see if there is yellowing in the skin or the whites of the eyes (jaundice). These may be signs of hepatitis or liver inflammation. This inflammation can cause excess production of liver fluid (bilirubin) and make the skin turn yellow and itchy. Seek immediate medical help.
If left untreated, hepatitis can lead to liver failure
Step 5. Watch for dehydration indicative of kidney failure
Chikungunya can cause dehydration because the kidneys don't get enough blood flow to function normally. This can lead to kidney failure, so keep an eye on your urine. If you feel that the amount of urine has decreased drastically and is very concentrated and dark in color, go to the hospital immediately.
Doctors or health workers will perform lab tests and measurements that are more accurate to detect kidney function
Step 6. Prevent chikungunya when traveling
The American Center for Disease Control's website has the most recent map of reported chikungunya spreads. If you are traveling to any of these areas, there are several things you can do to avoid contracting the disease. These preventive measures include:
- Get out of the house or go for a walk after noon. Although mosquitoes can bite at any time, the peak of chikungunya activity is during the day.
- Wear long-sleeved clothing to protect yourself as much as possible from mosquitoes. Try wearing light-colored clothing so that it's easier for you to see mosquitoes and other insects that land on your clothes.
- Use mosquito nets at night to protect yourself from mosquitoes while you sleep.
- Using mosquito repellent with DEET more than 20%. Other active ingredients used are eucalyptus oil, Picaridin and IR3535. Generally, the higher the active ingredient, the longer the duration of protection.
