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CHIKUNGUNYA FEVER
Chikungunya fever is due to the chikungunya virus, a member of the Togaviridae family, that is transmitted primarily by A. aegypti and A.ย albopictus mosquitoes. Initially, infections occurred primarily in India, Indian Ocean islands, Southeast Asia, and Africa, with subsequent outbreaks in Italy, France, Central and South America, Caribbean islands, Mexico, and Florida. After a typical incubation period of 2โ7 days, patients present with fever, headache, and myalgias.
Acute cutaneous manifestations include morbilliform eruptions; acral or facial erythema and edema (sometimes localized to the nose or ears); and genital, intertriginous, and oral ulcers. Widespread vesiculobullous eruptions are common in infants and occasionally occur in older children and adults. Subsequently, prominent hyperpigmentation often develops on the face (especially the tip of the nose [โchik signโ]) and extremities. Freckle-like macules and flagellate streaks can be seen as well as diffuse or reticulated pigmentation. Severe low back pain and debilitating arthralgias are characteristic and may last for weeks to months. Complications can include meningoencephalitis, GuillainโBarrรฉ syndrome, and myocarditis. No specific treatment is available, and several candidate vaccines are under investigation. VLA1553, a single-shot live-attenuated chikungunya vaccine, was found to be safe and immunogenic in a phase 3 clinical trial73a.