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Chikungunya virus:
an emerging problem?
An arthropod-borne virus first isolated from humans in East Africa in
the early 1950s has now arrived in the UK with travellers returning from
the islands of the western Indian Ocean. Here, Sanjiv Rughooputh and
Pamela Greenwell provide a brief overview of an unusual infection.
Chikungunya is the Swahili word for ‘that
which bends up’ and has been used for the
stooped posture of those afflicted by a disease
caused by an arthropod-borne virus first
isolated from humans in 1953 in what is now
Tanzania.1 The so-called chikungunya (Chik)
virus is an alphavirus of the Togaviridae
family. The alphavirus genus has 27 members,
11 of which have been associated with human
infection. Of these 11, eight have been
responsible for serious epidemics. Chik is a
most important virus in terms of the scale of
human illness, as it is found throughout
Africa, India and south-east Asia.2
MORPHOLOGY TO MOSQUITOES
The Chik virus is spherical, approximately
70 nm in diameter, and consists of an
icosahedral capsid surrounded by a tightly
adherent lipid envelope covered with
glycoprotein peplomers. It is a single-
stranded, positive RNA enveloped virus
with a genome size of 11–12 kb.3
The life-cycle of the Chik virus is sylvatic
and involves mosquitoes of the genus Aedes,
wild forest primates and eventually rodents
(Fig 1). Initially, the virus was confined to
‘The illness caused
by Chik virus can be
confused with diseases
such as dengue or
yellow fever, due to the
similarity in symptoms’
624 THE BIOMEDICAL SCIENTIST
FOCUS ON VIROLOGY
rural tropical Africa, where it was epidemic,
but some 30 years ago it started to penetrate
Asian urban areas. With this move, its
transmission involved anthropophilic
populations of the mosquito Aedes aegypti,
which is associated with dengue-like illness
in humans.
A. aegypti can maintain the virus in a
human–mosquito–human cycle. The female
mosquito introduces her proboscis directly
into a capillary beneath the skin, where
saliva containing the virus is injected (Fig 2).
The virus replicates in endothelial cells,
monocytes and macrophages in lymph nodes,
bone marrow, the spleen and liver.
Virions liberated from these cells increase
the viraemia and precipitate the prodromal
symptoms, which are characterised by fever,
chills, headache and muscle ache. After
the incubation period (three to seven days)
other symptoms can develop, and these
include nausea, headache, backache, fever,
vert
verteb
ebrate
rate
art
rthropod
hropod
vert
verteb
ebrate
rate
Fig 1. Diagram of the life-cycle of chikungunya virus, which is sylvatic and involves mosquitoes
of the genus Aedes, wild forest primates and, eventually, rodents.
‘Chik is a most important
virus in terms of the scale
of human illness, as it is
found throughout Africa,
India and south-east Asia’
chills, myalgia, rash, facial oedema, and
severe polyarthralgia affecting mainly the
small joints.
SYMPTOMS TO SURVEILLANCE
Acute Chik fever typically lasts a few days
but can produce prolonged fatigue lasting
several weeks. The arthritis usually resolves
after a couple of weeks. The illness caused
by Chik virus can be confused with diseases
such as dengue or yellow fever, due to the
similarity in symptoms; hence, laboratory
confirmation is paramount. Infection due to
Chik virus is rarely fatal and does not require
hospital admission. Studies by Mourya and
colleagues4 suggest that A. aegypti is more
susceptible to Chik when temperature is
increased.
According to the World Health
Organization (WHO) the virus is not fatal but
can weaken the immune system, providing
opportunities for other diseases to become
art
rthropod
hropod
man
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‘According to the World Health Organization, infection with

Chik virus is not fatal but can weaken the immune system,
allowing other diseases to become established’

Fig 2. The female Aedes aegypti mosquito
introducing its proboscis directly into a
capillary beneath the skin, where saliva
containing the virus is injected.
established. In a recent review,5 Pialoux
and colleagues have reported claims of viral
mutation leading to new complications such
as hepatitis, cerebral meningitis and coma,
which have resulted in several deaths.
However, many of the deaths can be
attributed to the drugs (eg steroids)
prescribed to treat the symptoms. Recently, in
Réunion, a French dependency in the Indian
Ocean, cases of maternofetal transmission
were noted in a study of 35 affected women,
30 of whom delivered an infected baby.
Recently, the Health Protection Agency
(HPA) reported 133 cases of Chik infection
in the UK that had affected travellers
returning from the Indian Ocean islands.
Between March and August 2006, 58 cases
were seen in travellers from Mauritius, six
from the Seychelles, four from Madagascar,
and the remainder from visitors to other
surrounding islands. Only one case was seen
in December 2006, which suggests that the
epidemic was waning; however, health
authorities on the Indian Ocean islands are
monitoring closely for further outbreaks.
According to WHO, the main preventative
measure is to limit proliferation of the
A. aegypti mosquitoes by reducing their
breeding grounds. Furthermore, WHO
suggests that surveillance for suspected
cases should start at airports.
REFERENCES
1 Robinson MC. An epidemic of virus
disease in Southern Province, Tanganyika
Territory, in 1952–53. I. Clinical features.
Trans R Soc Trop Med Hyg 1955; 49:
28–32.
2 Pastorino B, Bessaud M, Grandadam M,
Murri S, Tolou HJ, Peyrefitte CN.
Development of a TaqMan RT-PCR assay
without RNA extraction step for the
detection and quantification of African
chikungunya viruses. J Virol Methods
2005; 124: 65–71.
3 White D, Fenner F. Medical virology
4th edn. San Diego: Academic Press,
1994: 418–32.
4 Mourya DT, Yadav P, Mishra AC. Effect
of temperature stress on immature stages
and susceptibility of Aedes aegypti
mosquitoes to chikungunya virus. Am J
Trop Med Hyg 2004; 70: 346–50.
5 Pialoux G, Gaüzère BA, Jauréguiberry S,
Strobel M. Chikungunya, an epidemic
arbovirosis. Lancet Infect Dis 2007; 7 (5):
ᔢ 319–27.
Dr Sanjiv Rughooputh (rughoos@wmin.ac.uk)
and Dr Pamela Greenwell are members of
the Molecular and Medical Microbiology
Research Group, School of Biosciences,
University of Westminster, London.
Dr Rughooputh is also a member of
Healthcare and Wellbeing Solutions,
Harry House, Palma, Mauritius.

AUGUST 2007 THE BIOMEDICAL SCIENTIST 625