Spectrum of Clinical Manifestations and Laboratory Findings in Chikungunya Infection: A Cross-sectional Observational Study

Dr. Mohammed Abu Yusuf Chowdhury, Dr. Najmus Salehin
Critical Care, Dengue

30

Mar 26

Abstract

Background:
Chikungunya has reappeared as an important viral illness in Bangladesh. Patients show wide variation in symptoms and lab findings. Early recognition is needed to reduce suffering and avoid confusion with dengue.

Objective:
To describe the clinical features and laboratory findings of RT-PCR confirmed chikungunya patients.

Methods:
This cross-sectional observational study was done over six months from April to September 2025. Fifty RT-PCR confirmed chikungunya patients attending an outpatient chamber were included. Clinical details and laboratory reports were recorded and analyzed.

Results:
Most patients had sudden high fever and severe joint pain. CRP was raised in almost all cases. Platelet count was usually normal. Some findings helped to differentiate chikungunya from dengue.

Conclusion:
Chikungunya commonly presents with high fever and disabling polyarthralgia. Laboratory tests support diagnosis but are not definitive. Clinical awareness remains the key.

Keywords: Chikungunya, Arthralgia, Fever, CRP, Bangladesh

Introduction

Chikungunya is a viral disease spread by Aedes mosquitoes. It mainly affects tropical countries. Bangladesh has seen repeated outbreaks in recent years. The disease causes sudden fever and severe joint pain. Many patients suffer for weeks or months.1 Chikungunya often looks like dengue at first. Both cause fever and body pain. This creates confusion for doctors, especially in outpatient settings. However, chikungunya usually causes more severe joint pain and less bleeding problems.2 Laboratory tests can help but are not always conclusive. RT-PCR confirms the infection but is not always available everywhere. Knowing the common clinical and lab patterns helps early diagnosis and proper care.3 This study was done to describe the real-world clinical and laboratory profile of chikungunya patients in Bangladesh.4

Objectives

  1. To identify common clinical features of chikungunya infection
  2. To analyze laboratory abnormalities in RT-PCR confirmed cases
  3. To help differentiate chikungunya from dengue in routine practice

Materials and Methods

Study Design

This was a cross-sectional observational study.

Study Period

April 2025 to September 2025.

Study Place

Outpatient department chamber patients.

Study Population

Fifty patients with RT-PCR confirmed chikungunya infection.

Inclusion Criteria

  • RT-PCR positive for chikungunya
  • Age above 18 years
  • Attending outpatient chamber

Exclusion Criteria

  • Dengue positive patients
  • Patients with known chronic inflammatory joint disease
  • Incomplete laboratory records

Data Collection

A structured clinical sheet was used. History of fever, joint pain, rash, eye redness, headache, and vomiting was recorded. Joint involvement was noted carefully.

Laboratory tests included:

  • Complete blood count
  • ESR
  • CRP
  • Serum SGPT

Data Analysis

Data were analyzed using simple percentages and averages. No advanced statistical tools were used.

Results

Demographic Profile

Most patients were adults. Both males and females were affected. The majority presented within the first week of illness.

Clinical Manifestations

  • Sudden high-grade fever was present in 90% of patients
  • Severe joint pain and body ache were seen in almost 100%
  • Fatigue was reported by 50%
  • Skin rash was found in 45%
  • Red eyes were present in 20%
  • Vomiting occurred in 20%

In a few patients, joint pain started before fever. This was an important observation.

Joint Involvement

The most commonly affected joints were:

  • Ankle
  • Metatarsal joints
  • Knee
  • Wrist
  • Elbow

Pain was often symmetrical and severe. Many patients had difficulty walking.

Laboratory Findings

  • CRP was raised in almost all patients, with an average value around 50 IU
  • Leukopenia was found in 20% of cases
  • ESR was not significantly raised
  • Platelet count was normal in most patients
  • Mild thrombocytopenia was seen in 10%, but counts remained above 100,000
  • SGPT was raised in 10% of cases, but values stayed below 70 IU

Discussion

This study shows that chikungunya in Bangladesh mainly presents with fever and severe joint pain. These findings match earlier studies from South Asia and Africa. Joint pain was the most disabling symptom. Some patients developed pain even before fever. This feature is helpful in early suspicion of chikungunya. Unlike dengue, platelet count remained mostly normal. Bleeding signs were absent. CRP was consistently high, showing strong inflammation. ESR was not very helpful.5 Liver enzyme elevation was mild and uncommon. This suggests that liver involvement in chikungunya is usually limited. Differentiating chikungunya from dengue is important. Severe polyarthralgia, normal platelet count, and high CRP favor chikungunya.6

Conclusion

Chikungunya infection commonly presents with sudden fever and severe joint pain involving multiple joints. Elevated CRP and mild leukopenia support the diagnosis. Platelet count usually remains normal. Awareness of these features helps early diagnosis and avoids confusion with dengue.

Recommendations

  • Clinicians should suspect chikungunya in patients with fever and severe joint pain
  • CRP can be used as a supportive test
  • Public awareness should be increased during outbreaks

Acknowledgement

The authors thank all patients for their cooperation and the laboratory staff for technical support.

Authors

Chief Investigator:
Dr. Mohammed Abu Yusuf Chowdhury
Professor of Medicine
Chittagong Medical College Hospital (CMCH)

Co-Investigator:
Dr. Najmus Salehin
Assistant Professor of Medicine
Chittagong Medical College Hospital (CMCH)

References

  1. Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med. 2015;372:1231-1239.
  2. World Health Organization. Chikungunya. WHO Fact Sheet. Geneva; 2023.
  3. Burt FJ, Chen W, Miner JJ, et al. Chikungunya virus: an update on the biology and pathogenesis. Lancet Infect Dis. 2017;17:e107-e117.
  4. Dash PK, Tiwari M, Santhosh SR, et al. Clinical spectrum of chikungunya in India. J Med Virol. 2011;83:944-949.
  5. Rahman M, Rahman K, Siddique AK, et al. First outbreak of chikungunya in Bangladesh. Emerg Infect Dis. 2019;25:234-237.
  6. Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review. Clin Infect Dis. 2009;49:942-948.