title: That Which Bends Up: A Case Report and Literature Review of Chikungunya Virus.
abstract: We present a case of chikungunya virus (CHIKV) in a 39-year-old female who developed an acute febrile illness marked by polyarthralgia and rash after returning from Saint Lucia. This epidemic-prone pathogen is increasingly likely to be encountered by primary care and hospital physicians in the coming months. The virus was first locally transmitted in the Caribbean in December 2013 and has since spread to 44 countries and 47 US states, affecting a suspected 1.2 million people. A mosquito-borne virus, CHIKV causes a severe and symmetric polyarthralgia that can relapse for months to years, creating debilitating illness and profound socioeconomic consequences. Current treatment is limited to supportive measures, which are dependent on nonsteroidal anti-inflammatory drugs. Research into immunomodulatory agents, antiviral therapies, and vaccines is ongoing. Prevention remains key in slowing the spread of disease. Patient education should focus on personal protective measures, such as insect repellant and remaining indoors, while public health departments should implement strategies to control vector breeding grounds. Given the possibility of relapsing and debilitating disease, general internists should consider CHIKV in the differential diagnosis of a returning traveler with acute onset of fever, polyarthralgia, and rash.
authors.affiliation: Division of Education, Department of Internal Medicine, University of Nebraska Medical Center, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA. shana.peper@unmc.edu.
authors.forename: Shana M
authors.initials: SM
authors.lastname: Peper
authors.affiliation: Division of Education, Department of Internal Medicine, University of Nebraska Medical Center, 982055 Nebraska Medical Center, Omaha, NE, 68198-2055, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Monson
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Trevor
authors.initials: T
authors.lastname: Van Schooneveld
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000821:virology; D065632:Chikungunya Fever / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000821:virology; D006801:Humans; D014195:Travel
keywords: Caribbean; chikungunya; febrile rash; mosquito-transmitted virus; symmetric polyarthralgia