This acute infection is of abrupt onset, characterized by fever and severe arthralgia, followed by other constitutional symptoms and rash, and lasting for a period of 1-7 days. The incubation period is usually 2-3 days, with a range of 1-12 days. Fever rises abruptly, often reaching 39 to 40 degrees centigrade and accompanied by intermittent shaking chills. This acute phase lasts 2-3 days. The temperature may remit for 1-2 days, resulting in a “saddle-back” fever curve.

    The arthralgias are polyarticular, migratory, and predominantly affect the small joints of the hands, wrists, ankles and feet, with lesser involvement of larger joints. Pain on movement is worse in the morning, improved by mild exercise, and exacerbated by strenous exercise. Swelling may occur, but fluid accumulation is uncommon. Patients with milder articular manifestations are usually symptom-free within a few weeks, but more severe cases require months to resolve entirely. Generalized myalgia, as well as back and shoulder pain is common.

Aedes albopictus

Aedes aegypti

    Cutaneous manifestations are typical with many patients presenting with a flush over the face and trunk. This is usually followed by a rash generally described as maculopapular. The trunks and limbs are commonly involved, but face, palms and soles may also show lesions. Pruritis or irritation may accompany the eruption.

    During the acute disease, most patients will have headache, but it is not usually severe. Photophobia and retro orbital pain also occur but not severe. Conjunctival injection is present in some cases. Some patients will complain of sore throat and have pharyngitis on examination.

    CHIK infection has a somewhat different picture in younger patients. Arthralgia and arthritis occur but are less prominent and last a shorter time. Rash may be less frequent; but in infants and younger children, prominent flushing and early appearance of maculopapular or urticarial eruption may be a useful indicator
.