Chikungunya Clinical Presentation and Diagnosis

Acute Phase Characteristics

The World Health Organization notes that chikungunya presents as an acute febrile illness characterized by abrupt onset of high fever with severe polyarthralgia/polyarthritis, typically affecting the hands, wrists, ankles, and metatarsal-phalangeal joints of the feet, accompanied by constitutional symptoms and rash lasting 1-7 days 1
High fever develops after an incubation period of 5-7 days (range: 2-12 days) following mosquito bite, as reported by the Centers for Disease Control and Prevention 1
The disease course is almost always self-limiting and rarely fatal in uncomplicated cases, with symptoms typically appearing 5-7 days post-infection, though the range extends from 2-12 days 1

The American Society for Microbiology recommends that PCR or viral culture is most effective during the first 5-7 days of symptoms, while IgM/IgG serology becomes positive from day 5-7 onwards and is appropriate for later-stage diagnosis 1, 5

The National Institute of Neurological Disorders and Stroke notes that encephalitis and encephalopathy can occur, particularly in infants <1 year old and adults >60 years, with a 10% case fatality rate among patients with neurological presentation 2, 3, 4
Other neurological manifestations include Guillain-Barré syndrome, acute disseminated encephalomyelitis, and febrile seizures, with long-term neurological sequelae including cerebral palsy and low developmental quotient in infants 2, 3, 4