Review Topic
  • A 33-year-old man presents to the emergency department for headache and joint pain. His symptoms are associated with symmetric arthralgias involving the ankles, knees, and wrists bilaterally, myalgias, and facial puffiness. He returned from West Africa approximately 4 days ago. His temperature is 103.1°F (39.5°C), blood pressure is 135/90 mmHg, pulse is 102/min, and respirations are 19/min. Physical examination is notable for periarticular swelling at the wrist, ankles, and knees, along with a maculopapular rash involving the trunk and extremities. Serologic testing via reverse transcription polymerase chain reaction demonstrates chikungunya viral RNA.
  • Classification
    • icosahedral capid, enveloped, linear, non-segmented, positive sense, single-stranded RNA viruses
    • viruses
      • western equine encephalitis virus
      • eastern equine encephalitis virus
      • chikungunya virus
      • rubella virus
Diagnostic Studies Treatment
  • Caused by the rubivirus
    • can be vertically transmitted to the fetus, causing congenital defects
    • congenital deficits include
      • heart
        • patent ductus arteriosus
        • interventricular septal defect
        • pulmonary artery stenosis
      • eyes
        • cataracts
        • chorioretinitis
      • brain
        • developmental delay
        • microcephaly
        • deafness
      • skin
        • "blueberry muffin" rash 
          • caused by dermal extramedullary hematopoiesis
  • Symptoms
    • headache
    • nausea
    • vomiting
  • Physical exam
    • lymphadenopathy
    • red maculopapular rash 
      • spreads from the forehead to the face, torso, and then to the extremities
      • the rash typically lasts 3 days
    • arthralgia
      • can be seen in young women
  • Rubella-specific IgM antibodies
  • Supportive treatment
  • Preventative
    • live-attenuated vaccine
      • note, it is not recommended for pregnant women
Eastern equine encephalitis
  • Symptoms
    • headache
    • myalgias
    • malaise
    • arthralgias
  • Physical exam
    • fever
    • seizures
    • arthralgia
    • myalgia
    • convulsions
  • Eastern equine encephalitis virus-specific IgM antibody in serum or CSF
  • Supportive treatment
Western equine encephalitis
  • Symptoms
    • headache
    • myalgias
    • malaise
    • arthralgias
  • Physical exam
    • fever
    • erythematous oropharynx
    • palatal petechiae
  • IgM detected in the cerebrospinal fluid
  • Isolation of the viral antibodies in the serum
  • Viral antigen or genomic sequences in the tissue, blood, or CSF
  • Supportive treatment
Chikungunya fever
  • Symptoms
    • headache
    • facial puffiness
    • polyarthralgia
  • Physical exam
    • fever
    • macular or maculopapular rash
  • Chikungunya viral RNA via RT-PCR
  • Chikungunya virus serology
  • Supportive treatment

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