Chikungunya Virus – Symptoms, Causes, Blood Tests & Results

Chikungunya Virus – Symptoms, Causes, Blood Tests & Results

Just like the most dreaded dengue, Chikungunya is also a Mosquito Borne Viral Disease. Chikungunya blood test results are very important to know whether the person is suffering from chikungunya.  Chikungunya is mostly not fatal but its pain can be highly traumatizing. It causes fever and very severe joint pains that can last for up to many years. The pain is debilitating and can make it difficult even to walk properly for many patients.

Many symptoms of chikungunya are similar to Dengue and Zika. As a result of this, it can be easily misdiagnosed in areas where both these diseases are common. If the place of your residence is close to any mosquito breeding sites, you are at a very high risk of chikungunya and other mosquito borne diseases like Dengue and Zika. If chikungunya is not tested at the right time, it does not even reflect in lab results.

There is exactly no cure for chikungunya, states World Health Organization, as the treatment of the disease focuses on soothing the symptoms.

What Causes Chikungunya Virus?

Incidentally, both Dengue and Chikungunya are caused by Aedes Aegypti and Aedes Albopictus Mosquitoes, two species that are playing havoc in the country. It is transmitted from one person to another with the bite of the female species of the mosquito.

These mosquitoes are known to typically bite during the daylight hours. During the daylight hours, the risk of getting bitten is the highest at two points of time, early morning and late afternoon. Though typically these mosquitoes are known to bite outdoors, Aedes Aegypti can also bite indoors.

What are the Symptoms of Chikungunya?

If a person is bitten by an infected mosquito, symptoms will typically occur within a period of 4 to 8 days. They may even appear after 2 days or may not appear till 12 days.

City doctors suspect that the virus has mutated, leading to many severe symptoms now than before. Typically, chikungunya will begin with an abrupt fever which is accompanied by pain in joints. The pain in the joints can be debilitating for the condition of the sufferer as it can last for a very long period of time.

The viral majorly affects finger joints on hand and foot, leading to swelling and acute pain. Sadly, in some cases, this pain can persist for months or years. The criticality and longevity of this pain decided if chikungunya will be acute, subacute or a chronic disease. In most of the cases, however, the patients recover.

Besides pain in the joints, some patients have also reported problems with eyes, heart and neurological as well as gastrointestinal complications. However, cases of such complain remain uncommon.

If the patient of chikungunya is an aged person, the disease can get very critical and may even contribute to the cause of death of the patient. Many times symptoms in the patients of chikungunya go unrecognized. Also, they are quite often misdiagnosed especially in areas where other mosquito related diseases, like dengue, are prevalent.

However, the most common signs and symptoms of chikungunya include the following

  • Flu- Chills, Fever, Headache
  • Aching Joints – Joint pain can particularly occur in hands, wrist, ankles and feet which can last from weeks to months and can even continue for a year.
  • Nausea
  • Fatigue
  • Rashes

Blood Tests To Diagnose Chikungunya

Chikungunya blood test-Diagnostic Testing
Chikungunya infections can be confirmed by the detection of the virus, viral RNA, or specific antibodies in patient samples. The type of testing performed is typically dictated by the timing and volume of samples available. Blood test is the only reliable way to identify chikungunya since the symptoms are similar to much more deadly dengue fever. Common laboratory tests for chikungunya include for instance RT-PCR and serological tests.

RT-PCR

Viral RNA can be easily detected by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in serum specimens obtained from patients during the acute phase of infection. Chikungunya infections cause high levels of viremia (up to 1x10E6.8 plaque-forming units per mL), which typically last for 4–6 days after the onset of illness.

RT-PCR can therefore easily be done within the first 7 days on an acute-phase specimen to confirm chikungunya virus infection. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources. PCR results can be available within one to two days.

ELISA

Enzyme Linked Immunosorbent Assays (ELISA) detect both anti-CHIKV immunoglobulin (Ig) M and IgG antibodies from either acute or convalescent-phase samples. Serological diagnosis requires a larger amount of blood than the other methods. ELISA results require 2–3 days and the test is quite specific with very little cross reactivity with related alphaviruses. Testing of samples from imported cases found that chikungunya-specific IgM antibodies develop rapidly within a few days after illness onset and persist for several months.

Immunofluorescence Assays

Immunofluorescence assays are sensitive and specific but lack the ability to quantify antibodies, are subjective, and require special equipment and training. However, these tests are commercially available and are an option for laboratories that routinely use this method for detection of other infectious agents.

PRNT Test

Plaque Reduction Neutralization Tests (PRNT) are very useful. Because they are quite specific for alphaviruses and are the gold standard for confirmation of serologic test results. The major drawback to PRNT is that it requires the use of live virus. The test must be carried out in Biosafety level 3 laboratories (BSL-3) that require special laboratory containment equipment.

Haemagglutination Inhibition Tests

Another way to diagnose the disease is by distinguishing the chikungunya strain with Kinetic Haemagglutination-Inhibition tests. Chikungunya blood test is confirmed when symptoms such as fever and joint pain are seen along with a fourfold Haemagglutination Inhibition antibody difference in paired serum samples. This turns positive within 5 to 8 days of infection.

Testing of both acute and convalescent-phase samples, collected at least 3 weeks apart, from a patient presenting with a high fever combined with severe joint pain. And recent travel to a chikungunya outbreak area should be sufficient to confirm the infection. However, cryoglobulinemia has recently been reported in several patients. Therefore, if a patient presents with the appropriate clinical syndrome and travel to an affected area, this should be considered if serologic test results are negative.

Long Term Effects of Chikungunya

Chikungunya disease is rarely fatal and patients usually recover from the disease within a few weeks. Most patients recover quickly and are free from the symptoms such as joint pain within a few weeks or months. However, in some patients, Chikungunya may cause long term health effects and reduced quality of life.

The most common long term side effect of Chikungunya is a joint pain (Arthralgia). Persistent and disabling joint pain is observed in patients who had severe Chikungunya virus infection. Studies have found that a large number of patients had discomfort in performing daily activities such as walking or getting dressed even after 18 months of the disease. Joint swelling on ankles was also observed in some patients.

Treatment For Chikungunya

  • There is no vaccine to prevent or medicine to treat chikungunya virus
  • Treat the symptoms
  • Get plenty of rest
  • Drink fluids to prevent dehydration
  • Take medicine such as acetaminophen (Tylenol) or paracetamol to reduce fever and pain
  • Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS until dengue can be ruled out to reduce the risk of bleeding)
  • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication
  • If you have chikungunya, prevent mosquito bites for the first week of your illness
  • During the first week of infection, chikungunya virus can be found in the blood. And passed from an infected person to a mosquito through mosquito bites
  • An infected mosquito can then spread the virus to other people
  • Multivitamin and multimineral (zinc) supplements are very helpful in faster recovery especially in joint pain.

Management of Long Term Joint Pain of Chikungunya

Chikungunya blood test - Management of Long Term Joint Pain
If your chikungunya blood test results are positive then persistent joint pain is usually treated with Non-Steroidal Anti Inflammatory Drugs (NSAIDs) and Corticosteroids. Physiotherapy and mild exercise is also useful for management of pain and recovery. Simple exercise can help strengthen the muscles around the joints and can reduce pain and stiffness. Some of the useful simple movement exercises are

  • Sit on a chair and then extend each leg parallel to the floor and hold it for a few seconds before lowering it.Repeat this less than 10 times at a time. You can do this 2 or 3 times a day
  • Walk for 10 to 20 minutes at a mild pace. Avoid sitting for long periods of time at a stretch
  • Do simple movement exercises by moving fingers, hand and elbow
  • Some patients may need long term lifestyle changes for pain management
Medically Reviewed By
Dr. Kaushal M. Bhavsar (MBBS, MD)Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad