Chikungunya virus symptoms can mimic Lyme disease
The Chikungunya virus which is transmitted by mosquitoes is posing a real threat to residents in the United States, particularly those living in Florida and the southern States, as the first locally transmitted cases begin to appear.
The Chikungunya virus (CHIKV) can cause flu-like symptoms, including fevers, headaches, joint pain, muscle aches, nausea, rashes and malaise. The same symptoms we see with Lyme disease. CHIKV symptoms normally develop 3 to 5 days after a person is bitten by an infected mosquito. Not all mosquitoes carry the disease. The two types that can transmit CHIKV, Aedes aegypti and Aedes albopictus, are found in certain regions of the U.S.
While CHIKV is typically not fatal, several dozen individuals have died from the disease. A 22-year-old woman from New Zealand is the most recent victim. She died on February 18, 2015, 4 days after returning from a trip to Samoa, reports Radio New Zealand.
Chikungunya virus symptoms can also mimic chronic conditions, including Rheumatoid Arthritis (RA) and Lyme disease, with symptoms lasting for months, even years in some patients. According to the Pan American Health Organization, “most patients recover fully, but in some cases the joint pain may be chronic.”
Prior to 2013, CHIKV was a concern primarily to people living in Africa, Asia, Europe and the Indian and Pacific Ocean regions. In late 2014, an outbreak occurred in the Caribbean. Nearly 2,000 people who were infected returned to the United States, bringing back the disease. Three hundred of those were Florida residents, which resulted in 11 locally transmitted cases.
“Seven months after the mosquito-borne virus chikungunya was recognized in the Western Hemisphere, the first locally acquired case of the disease has surfaced in the continental United States,” according to the CDC.
“Over the past decade, CHIKV has emerged on a truly global scale. Since 2013, CHIKV transmission has been reported throughout the Caribbean region, in North America, and in Central and South American countries,” state the authors of a study published in the February issue of Vector-Borne and Zoonotic Diseases.
I know firsthand how damaging this disease can be. My father-in-law, who lives in Jamaica, was a healthy, active farmer before contracting the virus. His symptoms came on suddenly, starting with ankle and foot pain so severe he could hardly walk. It then progressed to his knees. With no treatment options for CHIKV, he waited for symptoms to improve. Today, he continues to suffer from chronic arthritic issues. He told me, he was not alone. Dozens of neighbors in his Jamaican community were infected and still experience lasting aches and pains.
A study published in the January issue of Arthritis and Rheumatology raises concerns that “Chikungunya viral arthritis could mimic seronegative rheumatoid arthritis (RA).” Dr. Jonathon Miner, lead author, points out the difficulties in making an accurate diagnosis of CHIKV, as its manifestations are similar to rheumatic diseases and serological testing is limited. Testing is only available through the Centers for Disease Control and Prevention (CDC), several state health departments and one commercial laboratory.
The study describes persistent symmetric polyarthritis in individuals who had traveled to Haiti during a CHIKV outbreak in June, 2014. Eight out of the ten individuals with CHIKV were referred to Saint Louis, Missouri rheumatology clinic where they presented with persistent symmetric polyarthritis. Their patients presented with morning stiffness and chronic arthritis primarily affecting the wrists, hands, ankles and feet. The chronic arthritis consisted of joint swelling rather than joint destruction. Two of their patients had difficulty with ambulation due to pain in their feet or ankles.
There are no preventative vaccines for the Chikungunya virus and no treatments, other than pain management. Dr. Miner’s study found, neither Naprosyn nor Tylenol were very helpful in alleviating pain. And, Prednisone (20 mg PO daily) failed in one patient, because it exacerbated her joint pain and raised a “concern that there could still be a live virus within the joints.”
With a growing number of vector-borne infections sharing similar symptoms and diagnoses based primarily on clinical presentation, it will be increasingly challenging for physicians to distinguish the differences between these diseases.
I agree with Dr. Miner that “rheumatologists consider CHIKV infection when evaluating patients with new, symmetric polyarthritis.” I urge clinicians to also consider Lyme disease when patients present with new, symmetric or asymmetric polyarthritis. A number of other findings including fatigue, headaches, poor concentration, sleep disturbance, irritability, and lightheadedness can help in making the diagnosis of Lyme disease.