Chikungunya physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2], Alonso Alvarado, M.D. [3]

Chikungunya usually presents with clinical signs such as fever, skin rashes, and joint swelling with effusions that can be detected during a physical examination.

The disease is characterized by an acute onset of high fever, typically more than 39°C (102°F).

• Maculopapular rash
• Nasal blotchy erythema
• Freckle-like pigmentation over centro-facial area
• Flagellate pigmentation on face and extremities
• Lichenoid eruption and hyperpigmentation in photodistributed areas
• Multiple aphthous-like ulcers over scrotum, crural areas and axilla.
• Lymphedema in acral distribution (bilateral/unilateral)
• Multiple ecchymotic spots (children)
• Vesiculobullous lesions (infants)
• Subungual hemorrhage
• Photo urticaria
• Acral urticaria

• Polyarthralgia usually symmetric and often occur in hands and feet
• Periarticular swelling and joint effusion in knees.

• 
  Edematous rash of the face
• 
  Edematous polyarthritis of the hands
• 
  Erythema that blanches with pressure
• 
  Periarticular swelling and joint effusion in knees
• 
  Joint effusion in right knee
• 
  Arthritis in left hand
• 
  Maculopapular rash in trunk and extremities
• 
  Maculopapular rash in extremities, including palms
• 
  Bullous lesions in infant leg
• 
  Infant with maculopapular rash, petechial spots and erythema of upper and lower limbs associated with edema of the extremities
• 
  Maculopapular rash in the trunk
• 
  Maculopapular rash in the feet

• 
  End of the acute stage. Swollen hands and fine desquamation
• 
  Hyperpigmentation
• 
  Tenosynovitis in hands
• 
  Tenosynovitis in ankle
• 
  Elbow hygroma
• 
  Swollen and stiff hands in a 55-year-old man who was infected 5 years earlier

• CDC Chikungunya virus