CHIKUNGUNYA FEVER

Dr. sayeedMBBS(DMC)

AIM

To highlight Chikungunya virus,epidemiology,clinical feature,diagnosis, treatment, preventive measurers and recommendation.

SCOPEWhat is Chikungunya?Chikungunya virus.HistoryTransmissionClinical featureMorbidity & mortalityDiagnosisDiffential diagnosisTreatmentDiffenence between chikungunya & dengue feverPreventionRecommendationConclusion

What is Chikungunya ?Chikungunya name derived from Swahili

word “that which bends up. in reference to the stooped posture Manifest with Crippling Arthritic disease of sudden onset.Virus isolated in 1953 from serum and Aedes

mosquitoes and Culex spp

Chikungunya a Mosquito transmitted viral infection

Chikungunya Virus Group-ssRNA Family –

Togaviridae Genus - Alpha

virus Species-

Chikungunya virus

Chikungunya viral infection manifests with febrile illness

HistoryThe disease was first described by Marison

Robinson and W.W.R Lumsden in 1955,following an outbreak in 1952 in Tanzania(between Mozambique and Tanganyika)

Since its discovery in 1952, chikungunya virus outbreak have occurred occasionally in Africa,South Asia and Southeast Asia.

TransmissionChikungunya fever is primarily transmitted

by bites of mosquitoes of the genus Aedes,the same mosquito that transmits Dengue fever.only female mosquitoes are infective.

Of two vectors in Asia,Aedes aegypti is believed to be the principal vector .

Human and non-human vertebrates serve as the chikungunya virus reservoir.

Clinical FeatureFever : A period of fever may be

followed by an afebrile phase and then recrudescence of fever

Arthritis: Adults are susceptible to arthritis which causes early morning pain and swelling most often in the small joints.

Back painHeadache Maculopapular rashAnorexia, nausea and vomitingMyalgia

Who are at greater riskElderly peopleNewbornsWomen in generalDiabeticsImmuno-comprommised patientsPatients with severe chronic illness

Morbidity and MortalityFatalities are rare and when they occur are

associated with either with young age or with Thrombocytopenia

Hemorrhagic version of illness, that can lead to shock

DiagnosisIsolation of VirusDemonstrating of four fold or greater rise in

antibody titre.ELISA testing for IgM antibody.Diagnosis by RT-PCR TestThe antibody titre will be positive after 5th

day of illness only.

Diffential diagnosisDengueGroup A streptoccusLeptospirosisRubellaMeaslesPost infectious arthritisOther alphavirus infections e.g. Sindbis

viurs,O’nyong-nyong virus,Ross river virus and Mayaro virus

TreatmentChikungunya fever is not a life threatening

infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory drugs along with rest usually suffices

Rest to the patient and mild movements of joints

Liberal fluid intake or iv fluidsAnalgesics and NSAIDSAntipyretic

Difference between Chikungunya & DengueClinical signs chikungunya dengueFever Common Common

Rash Day 1- Day 4 Day 5-Day 7

Retroorbital pain rare common

Arthralgia Constant rare

Myalgia common common

Arthritis Common,edematous absent

Tenosynovitis common absent

Hypotension possible common

Minor blededing rare common

Thrombocytopenia

Early and mild Delayed and moderate to severe

How Chikungunya can be PreventedThere is neither Chikungunya virus vaccine nor drugs are

available to cure the infection.  Prevention, therefore, centers on avoiding mosquito bites.  Eliminating mosquito breeding sites is another key prevention measure.   To prevent mosquito bites, do the following:

Use mosquito repellents on skin and clothing When indoors, stay in well-screened areas.   Use bed nets

if sleeping in areas that are not screened or air-conditioned.

When working outdoors during day times, wear long-sleeved shirts and long pants to avoid mosquito bite.

 

Chikungunya case in BangladeshFirst indentified outbreak of chikungunya in

Bangladesh,2008 (Health and Science Bulletin,volume 7.March 2009)

39 case in Rajshahi and Chapainawabganj- confirmed from laboratory at ICDDR,B. (Nov 23,2011)

RecommendationPreventive measures for vector controlAwareness of CHIKV through mass media,

TV, Radio, News paperInvolvement of NGOs in integrated systemic

approchSpecial campaigns for public awarenessAssurance to the public about the disease

morbidity and mortalityPlanned approach, besides knowledge and

awareness of early warning signs, for prevention.

ConclusionIn recent years there have been explosive

outbreak of chikungunya fever in several parts of the sea region.Although the disease is self-limiting, morbidity, can be very high in major outbreaks resulting in heavy social and economic toll.Integrated vector management through the elemination of breeding sites,use of anti-adult and anti-larval measures and personal protection will contribute to prevent an outbreak.