After three to seven days of incubation from the time of the mosquito bite, most (72–97%) people infected with chikungunya are symptomatic. Symptomatic individuals primarily present with fever and severe, debilitating joint pain that is bilateral and symmetric. They may also have rash, headache, nausea and vomiting, myalgia, and conjunctivitis.
Most patients feel better in a week to ten days, and death is rare. The most severe cases are seen in people older than 70 years, those who have comorbidities, and newborns. Some people have relapses of polyarthralgia, polyarthritis, tenosynovitis, and/or Raynaud's syndrome months or even years later.
The dengue, Zika, and chikungunya viruses may all be circulating in the same geographic locations, and many of the symptoms are similar. It is possible to be infected by more than one virus. Chikungunya differs from dengue because it has more severe joint pain and is unlikely to present with hemorrhage and shock.
There are no antivirals available and no vaccine. Treatment is supportive and to monitor hemodynamic and hydration status. Aspirin should not be given until dengue can be ruled out because there is a possibility of worsening hemorrhage in dengue. Treatment with other nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or physical therapy may be required.
