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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.