Table 2. Symptoms and Signs of Patients with Laboratory-Confirmed Chikungunya Virus Infection Compared with Chikungunya Virus-Negative Patients—Veterans Health Administration, 2014.
| System | Symptom or Sign | CHIKV-positive (n = 180) no. (%) | CHIKV-negativea (n = 72) no. (%) | P Value |
|---|---|---|---|---|
| Musculoskeletalb | Oligoarthralgia or polyarthralgia | 159 (88.3) | 45 (62.5) | < .0001 |
| Myalgia | 125 (69.4) | 34 (47.2) | .001 | |
| Back pain | 26 (14.4) | 11 (15.3) | .87 | |
| Neck pain | 24 (13.3) | 11 (15.3) | .69 | |
| Bone pain | 9 (5.0) | 0 (0) | .06 | |
| Systemic | Fever | 152 (84.4) | 51 (70.8) | .01 |
| Generalized malaise or fatigue | 138 (76.7) | 45 (62.5) | .02 | |
| Dermatologic | Rash | 80 (44.4) | 16 (22.2) | .001 |
| Neurologic | Headache | 73 (40.6) | 27 (37.5) | .65 |
| Altered mental status | 17 (9.4) | 5 (6.9) | .53 | |
| Dizziness | 15 (8.3) | 3 (4.2) | .29 | |
| Gastrointestinal | Anorexia | 54 (30.0) | 22 (30.6) | .93 |
| Nausea | 48 (26.7) | 17 (23.6) | .62 | |
| Vomiting | 27 (15.0) | 15 (20.8) | .26 | |
| Diarrhea | 40 (22.2) | 10 (13.9) | .13 | |
| Abdominal pain | 24 (13.3) | 10 (13.9) | .91 | |
| Ophthalmologic | Conjunctival injection | 12 (6.7) | 1 (1.4) | .12 |
| Pulmonary | Cough | 34 (18.9) | 21 (29.2) | .07 |
| Sore throat | 16 (8.9) | 8 (11.1) | .59 | |
| Dyspnea | 14 (7.8) | 7 (9.7) | .61 | |
| Cardiovascular | Chest pain | 21 (11.7) | 7 (9.7) | .66 |
| Edema | 13 (7.2) | 2 (2.8) | .24 | |
| Urologic | Dysuria | 9 (5.0) | 2 (2.8) | .73 |
| Hematologic | Bruising | 3 (1.7) | 1 (1.4) | 1.0 |
| Bleeding | 7 (3.9) | 4 (5.6) | .52 |
Symptoms and signs during acute illness as recorded in medical records of patients during evaluation for CHIKV infection. Denominator includes all patients, regardless of whether pertinent negative symptoms or signs were recorded. CHIKV, chikungunya virus.
a Alternative diagnoses were recorded for 34 of 72 CHIKV-negative patients as follows: infectious, 17 (influenza, 1; pneumonia, 4; dengue, 2 [41 (56.9%) of CHIKV-negative patients had dengue virus test results]; typhoid fever, 1; Q fever, 1; tickborne infection, 1; cellulitis, 1; deep neck space infection, 1; methicillin-resistant Staphylococcus aureus endocarditis, 1; postinfectious arthritis, 2; aseptic meningitis, 1; colitis, 1); rheumatic, 9 (inflammatory arthritis, 4; suspected Sjögren’s syndrome, 1; suspected spondyloarthopathy, 1; mixed connective tissue disease, 1; osteoarthritis and bursitis, 1; myofascial pain, 1); orthopedic, 1 (prosthetic joint loosening); malignant, 2 (lung cancer and viral syndrome, 1; acute myelogenous leukemia, 1); neurologic, 1 (demyelinating polyneuropathy); adverse drug effect, 1; and fever of unknown origin, 3. Over half (53%) of CHIKV-negative patients had no alternative diagnosis recorded or received a diagnosis of viral syndrome of undetermined etiology.
b Of 96 patients with CHIKV infection and recorded arthralgia site (59.3% of 162 with any arthralgia), 59 (61%) reported involvement of the knees, 47 (49%) hands or fingers, 36 (38%) ankles, 32 (33%) shoulders, 30 (31%) wrists, 23 (24%) feet, and 19 (20%) elbows.