Chikungunya Fever - A Case Study
- Rachel Smith
- May 5
- 5 min read
Chikungunya (pronounced chik-en-GUN-ye-uh) is a viral disease transmitted by Aedes mosquitoes (Aedes aegypti and Aedes albopictus). It was first identified in Tanzania in 1952 and causes sudden, high fever and severe, often debilitating joint pain, with symptoms appearing 4–8 days after infection. While fatal cases are rare, recovery can take weeks, and joint pain may persist for months or years.
The name Chikungunya derives from a word in the Kimakonde language of southern Tanzania, meaning ‘that which bends up’, and describes the contorted posture of infected people with severe joint pain. CHIKV virus has been found in 110 countries in Africa, Asia, Europe and the Americas
This World Health Organisation (WHO) Chikungunya Fact Sheet provides some useful information.
We often reiterate to our students and colleagues that so many diseases start with the fairly tame sounding ‘flu-like symptoms’ that it’s fair to say that historically clinicians are often somewhat unimpressed when someone presents with flu-like symptoms. However COVID-19 made us all sit up and take notice, and when you think about this in a worldwide context, on a ship, for crew and guests transiting all continents, we really do need to take it seriously.
Some respiratory infections can spread quickly and need to be contained rapidly using tried and tested outbreak prevention plans to protect everyone onboard. When we ask the question about what starts with flu-like symptoms, the list we get back normally starts with: the common cold, Flu (Influenza A and B), COVID, pneumonia, bronchitis, SARS, MERS, Mpox, dengue fever, malaria, RSV, viral meningitis… the list goes on! But it also includes some less common conditions such as Chikungunya, which may be harder to spot.
Case Study
A crew member presented to the onboard Doctor with symptoms including a sudden onset of fever, generalised malaise, muscle and joint aches and a headache.
They had taken their own Paracetamol earlier, but noticed little improvement.
During the examination, they described feeling very unwell with aches and pains all over their body.
There was no report of any sore throat, cough, shortness of breath, chest pain, nasal symptoms, abdominal pain, nausea, vomiting, diarrhoea, urinary symptoms, rash, petechiae or bleeding.
There was no recent trauma.
The patient wasn’t aware of being in contact with anyone else onboard who was unwell.
Their medical history appeared unrelated, any pre existing issues were well controlled, and no allergies were reported.
On Examination:
Temperature: 39.9 °C
Heart Rate: 136 bpm
Blood Pressure: 124/84 mmHg
SpO2: 98 % on room air
Respiratry Rate: 16 breaths per minute
General: Alert, orientated, GCS 15. They looked unwell but were speaking full sentences easily
Skin: Warm, flushed. No rash, bruising or bleeding
HEENT: No signs of infection. No neck stiffness or photophobia (light sensitivity)
Chest/Lungs: Good air entry bilaterally, no wheeze, crackles or rhonchi
Cardiovascular: Sinus tachycardia (fast heart rate), no audible murmurs. Peripheral pulses palpable, good perfusion, no peripheral oedema. Capillary refill <2 seconds
Abdomen, neurological and extremity examination showed nothing of concern
The Doctor diagnosed an acute, undifferentiated febrile illness, most likely a virus such as influenza, COVID-19 or early Dengue. The Doctor did note that the crew member had travelled from a Dengue region.
The crew member was signed off as unfit to work and prescribed Paracetamol for the aching and fever and oral fluids. They were advised to rest, monitor urine output and call the Doctor immediately if they developed a worse fever, abdominal pain, vomiting, bleeding (nose, gums, urine, black stools), reduced urine output, a new rash, shortness of breath, chest pain, dizziness, confusion or fainting.
The Doctor carried out a COVID-19 and Dengue rapid test, with plans for a medical disembarkation for a full blood work-up at the next suitable port and hospital. However the ship was only a few days from setting off for an Ocean transit, so the Doctor utilised his Telemedicine support for a second opinion.
By the next morning, the crew member felt better. The headache had resolved and body aches improved, though they still felt a little dizzy. They were eating and drinking adequately.
With the exception of the temperature at 38.1 °C, all vital signs were within normal parameters.
The tests run onboard showed that the patient was negative for Dengue, COVID-19 and Influenza A and B. Malaria was considered as a possibility, but thought unlikely due to the patient's travel history and symptoms.
The crew member remained off work for 3 days in total and continued to improve with regular reassessments from the Doctor. After consulting with the shoreside Doctor, the decision was made that the crew member was well enough to complete the Ocean transit with the ship.
The crew member went back to work and completed the Ocean transit. However, one month later, the crew member presented to the Doctor again, complaining of continued joint pain in their ankles, knees, wrists and elbows, which was not fully resolved with over the counter pain relief (Ibuprofen and Paracetamol).
On examination, the vital signs were normal. The joints and surrounding ligaments were painful on palpation but there were no other significant clinical findings. Based on the history of a fever for three days, one month before, with the presenting complaint and findings, the Doctor suspected post viral arthralgia (joint pain) as a result of either Dengue or Chikunguyna fever. A shoreside referral was challenging due to the ship's location and itinerary, but the patient did not feel they could remain in work and perform effectively, so wanted to return home to recover fully.
A medical disembarkation was organised and the crew member returned home after a full blood work up at a local hospital. Several days later, the results were returned and were positive for Chikungunya fever.
As the case demonstrates, the on board doctors involved took the symptoms very seriously and fully understood the importance of ‘flu-like symptoms’. Thorough history taking, including travel history (and countries transited) is vital, along with keeping up to date with changes and developments globally.
The expanding geographical incidence of Dengue is a prime example as it probably wouldn’t be your first suspicion in Europe, though cases have been reported as far North as Italy, including cases due to local transmission. Our earlier blog about Dengue explains more.
Happily this case ended well and the crew member made a full recovery and returned to work.
But it’s a useful reminder and an interesting case to reflect on and use as a reminder to think about the wider causes of our old friend ‘flu-like symptoms’!
We hope you’ve enjoyed this case study. Please let us know if you have any ideas for cases you’ve seen or would like to know more about and we’ll continue the theme.The Red Square Medical Team.
Comments