A 32-year-old woman from Delhi presents on day 4 of fever with severe myalgia, arthralgia affecting wrists and ankles, and a maculopapular rash over trunk and extremities. She has mild thrombocytopenia (platelets 95,000/μL) and normal liver function. Serology shows IgM antibody positive for Chikungunya. She is haemodynamically stable with no bleeding manifestations. What is the most appropriate next step in management?

Explanation

## Clinical Context This patient has confirmed Chikungunya (IgM positive) presenting in the acute febrile phase with characteristic features: severe arthralgia, myalgia, and rash. Haemodynamic stability and absence of bleeding signs indicate non-severe dengue/Chikungunya. ## Management Approach for Acute Chikungunya **Key Point:** Chikungunya is a self-limited viral illness with no specific antiviral therapy. Management is entirely supportive. **High-Yield:** Unlike dengue, Chikungunya does NOT cause dengue haemorrhagic fever or dengue shock syndrome in the acute phase. The main morbidity is prolonged arthralgia (post-Chikungunya arthritis), which can persist for months to years. ### Rationale for Supportive Care 1. **NSAIDs** — First-line analgesics for myalgia and arthralgia in Chikungunya 2. **Hydration** — Oral rehydration if tolerating; IV fluids only if unable to maintain oral intake 3. **Paracetamol** — Alternative if NSAIDs contraindicated 4. **Outpatient follow-up** — Safe discharge if haemodynamically stable, no warning signs, platelet count >50,000/μL, and reliable follow-up **Clinical Pearl:** Avoid aspirin and NSAIDs in dengue (risk of bleeding), but they are safe and beneficial in Chikungunya. The distinction is critical. ### Why NOT ICU Admission? - Patient is haemodynamically stable - No bleeding manifestations - Platelet count >50,000/μL (threshold for spontaneous bleeding risk) - No respiratory distress or organ dysfunction - ICU admission reserved for dengue shock syndrome, severe bleeding, or organ failure ## Differential Management: Dengue vs Chikungunya | Feature | Dengue (Severe) | Chikungunya (Acute) | |---------|-----------------|--------------------| | Haemorrhage risk | High (DHF/DSS) | Rare | | Arthralgia | Mild, transient | Severe, prolonged | | Thrombocytopenia | Often <100,000/μL | Mild to moderate | | Specific therapy | Supportive only | Supportive only | | ICU admission | For shock/bleeding | Not indicated | **Mnemonic — CHIKV Management: SAP** — **S**upportive care, **A**nalgesics (NSAIDs), **P**atient education on chronic arthritis risk.