Chikungunya virus symptoms can mimic Lyme disease
A viral disease transmitted by mosquitoes that was once only a concern to people living in subtropical continents, such as Africa and Asia, is now posing a very real threat to residents in the U.S., particularly those living in Florida and the southern States.
(Source: CDC) Two types of mosquitoes, the Aedes aegypti and Aedes albopictus, can transmit the Chikungunya virus. The mosquitoes can be found in certain regions of the U.S.
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.
Alyssa
12/28/2020 (12:03 am)
I’ve had pain and swelling since May 2016 that followed nearly a year of flulike symptoms – fever, fatigue, sore throat, cough, dizziness, loss of taste/smell – and had swollen lymph nodes. The pain started on my dominant hand’s index finger that spread to my hand after 3 months.
In 2019, it spread to the other hand and work/hobbies became impossible, even holding a fork, pinching food, and turning door knobs is difficult. Now it’s in both my feet as well and I am steps away from being truly unable to live independently without any answers as all of my imaging and blood tests are coming back normal.
Should I pursue further investigation for Lyme? Should I ask about CHIKV? I’m 24, eat a healthy diet (as anything unhealthy triggers inflammation and increases aching in my hands and feet), try to at least exercise as regularly as possible (as that’s the least hobby standing), and I’m worried that if I go for a walk outside or go on a long drive, I won’t be able to make it home.
Dr. Daniel Cameron
12/28/2020 (7:35 am)
I advise my patients with these issues to include an evaluation for a tick borne infection as part of their overall care. I don’t typically see CHIKV in my practice.
Ray Cousens
07/21/2019 (5:28 pm)
After spending a week in Arkansas at a remote lake I came home with what seems like mosquito bites. After being home for one day it appears that I have slept for 20+ hours and I am extremely tired and have some dizziness. Is there a reason that I should seek medical help?
Dr. Daniel Cameron
07/22/2019 (12:51 am)
I would advise a medical evaluation that includes tick borne illnesses.
Linda Chamblee
01/09/2018 (9:21 pm)
My 10 yr old daughter has been sick for 3 months and Drs are baffled at what it is. It started with pain all over, stiff neck, joint pain and extreme fatigue. A simple bath wears her out! She had mono 3 years ago but has tested negative for active infection now. They tested for Lyme and got a positive result but negative antibodies test. So Drs say we got a false positive. She says the pain is getting worse and is worse than when she had mono. Is this something Dr.’s would normally test for or do I need to ask for this specific test for chikungunya . Thank you in advance for any insight. It’s awful to watch your child in pain and not know why.
Dr. Daniel Cameron
01/10/2018 (1:27 pm)
Sorry to hear your daughter remains ill. The blog reflects the difficulties doctors can have telling the difference between even the Chikungunya virus and Lyme disease. It would be reasonable to look a second time at Lyme disease given the limitations of the testing.
Linda Chamblee
01/13/2018 (6:27 pm)
Thank you so much Dr. Cameron I will ask for them to test again.
CD Kennedy
08/16/2015 (6:24 pm)
A relative was previously very healthy – perhaps exceptionally healthy. She was bitten by a chikungunya infected mosquito in October and has been afflicted ever since.
Have there been any advances in treatment since you wrote this? Where is the hotbed for research in the US (or world) for chikungunya?
Thanks for your work with Lyme patients. I’ve referred many friends and strangers to you even though I’ve never been your patient. I should have been. I had the classic Lyme bullseye as far back as the mid 70s after a tick bite.
Thanks for your continued work transforming lives.
Dr. Daniel Cameron
08/31/2015 (1:07 am)
I have not heard of any breakthroughs on the chikungunya virus. It always harder to treat a virus. It is also important not to overlook another illness including a tick borne illness if symptoms persist.
Doug mcelroy
06/02/2015 (6:48 am)
Had tick bite may or june 2014. Immediate onset total left side numbness nov 2014. Dec 10 right side overnite onset.numbness that is now terrible pain…blood tider and LP negative. MASSIVE pain and numbness extreme pain.Doctors and Neurologists baffled …Refuse to treat for lyme or possible tick born disease. All test show no loss of strength.I’m breaking and cannot tolerate. Somebody please help. I am on YouTube with 590,000 but now hands are so stiff I can’t play…I must get help or its the end I greatly fear. Somebody please contact me with guidance and helpme get appointment with infectious disease Dr.I’m in Kernersville NC