Clinical Syndrome and Therapy

Abstract

Chikungunya virus (CHIKV) is an emerging alphavirus transmitted to humans by Aedes mosquitoes. CHIKV infection is most often symptomatic and the symptoms last from a few days to several years. Experts in France have defined three clinical stages: acute stage (from the first day on which the first symptoms appear (D1) up to day 21 (D21)); post-acute stage (from D21 to the end of the third month); and chronic stage (after 3 months). In the acute stage a high-grade fever occurs suddenly, along with inflammatory arthralgia and arthritis with periarticular edema and sometimes severe pain. Other typical symptoms are: myalgia, headache, backache, macular to maculopapular rash, and lymphadenopathy. Atypical and severe manifestations can occur, such as maternal–neonatal transmission in viremic women during childbirth. Infected neonates exhibit severe manifestations in 50 % of cases. So far, no specific therapeutic agent to treat infected persons is available and the treatment is symptomatic. The main characteristic of the post-acute stage is the persistence or the occurrence of multiple and polymorphic manifestations dominated by inflammatory manifestations. An accurate semiotic analysis allows defining the diagnostic workup that determines the optimization of treatment. In the post-acute stage the objective of treatment is to relieve the patient of pain and inflammation and to limit the consequences of the inflammatory process. The treatment is primarily based on analgesics and nonsteroidal anti-inflammatory drugs. The benefit of physical medicine depends on lesion assessment and the disease’s overall impact (pain, autonomy, quality of life). The expected benefits are pain relief, preserving the range of motion, and muscle tone. In the chronic stage, the diagnostic approach consists of qualifying the nosology of each patient according to the presence or absence of inflammatory symptoms. Chronic inflammatory rheumatisms (CIR) are different from musculoskeletal disorders (MSD). The former has the most severe functional prognosis; the latter are by far the most frequent (95 %). The management of post-chikungunya CIR, with or without joint destruction, systematically requires the advice of a rheumatologist, at best in the context of a multidisciplinary meeting. The management of MSD persisting after 3 months is based on the same principles as the management of post-acute presentations.