Chronic Cardiovascular and Autonomic Sequelae following Chikungunya Virus Infection: an 18-year Longitudinal Patient Narrative with Clinical Correlation

Abstract

Bruce H Knox

Chikungunya virus (CHIKV) infection is commonly described as an acute mosquito-borne febrile illness characterised by severe arthralgia, rash, and fatigue; however, a substantial minority of patients experience prolonged or chronic sequelae extending well beyond the acute infectious phase[1-4]. This paper presents an 18-year longitudinal patient narrative of cardiovascular and autonomic instability following CHIKV infection acquired during an outbreak in Indonesia in 2008. Within six months of apparent recovery, electrocardiographically confirmed atrial fibrillation emerged and later required catheter ablation. Over subsequent years, blood pressure lability, ventricular ectopy, orthostatic intolerance, and multisystem autonomic symptoms evolved despite structurally normal cardiac findings. Later specialist investigations supported dysautonomia and small-fibre neuropathic involvement. Existing literature recognises chronic inflammatory, neurological, and occasional cardiovascular sequelae after chikungunya, but long-term autonomic dysregulation remains comparatively under-described[2-7]. By integrating lived experience with longitudinal self- observation and medical literature, this paper argues that post-viral recovery may restore rhythm without restoring regulation. The case underscores the importance of long-term functional follow-up, multidisciplinary interpretation, and greater recognition of persistent autonomic manifestations within post-chikungunya care.

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