A 33-year-old female is experiencing recurrent fevers, diffuse arthralgias, and pruritic rash which appears maculopapular. She denies any eye complaints. Exam reveals diffuse joint pain to palpation, with no conjunctivitis. She says her symptoms appeared within 5 days of returning from a medical mission trip to Central America. A tourniquet test is negative for petechiae. What is the likely complication of this disease?

A. Break bone fever

B. Cardiomegaly

C. Chronic arthralgia

D. Hemorrhagic disease

E. Hepatosplenomegaly


Correct Answer: C. Chronic arthralgia

A. INCORRECT Break bone fever
Dengue is the cause of break bone fever and hemorrhagic disease. This patient’s symptoms are more consistent with chikungunya.  Chikungunya is a viral disease transmitted by mosquitos.  The most common symptoms are fever and joint pain.  Most improve in the short-term, however in some patients, chronic arthritis can result.  Rash is present in 40-50% of cases and is maculopapular.

B. INCORRECT Cardiomegaly
Cardiomegaly can be due to Trypanosoma cruzi, which does not cause arthralgias.  This patient’s history is more consistent with chukungunya.  Chikungunya is a viral disease transmitted by mosquitos.  The most common symptoms are fever and joint pain.  Most improve in the short-term, however in some patients, chronic arthritis can result.  Rash is present in 40-50% of cases and is maculopapular.

C. CORRECT Chronic arthralgia
This patient displays signs of Chikungunya, a mosquito-transmitted virus. Aedes aegypti transmits this disease during the daytime, resulting in a 95% of disease rate in patients bitten. The most common symptoms are fever and polyarthralgia. Acute patients often experience a relapse of joint pain that may be severe. 

D. INCORRECT Hemorrhagic disease
Dengue is the cause of break bone fever and hemorrhagic disease. This patient’s symptoms are more consistent with chikungunya.  Chikungunya is a viral disease transmitted by mosquitos.  The most common symptoms are fever and joint pain.  Most improve in the short-term, however in some patients, chronic arthritis can result.  Rash is present in 40-50% of cases and is maculopapular.

E. INCORRECT Hepatosplenomegaly
Hepatosplenomegaly is rare in chikungunya and more commonly found in malaria. Malaria also has a longer incubation period. This patient is likely suffering from chikungunya.  Chikungunya is a viral disease transmitted by mosquitos.  The most common symptoms are fever and joint pain.  Most improve in the short-term, however in some patients, chronic arthritis can result.  Rash is present in 40-50% of cases and is maculopapular. [/read]


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