Chikungunya Fever

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Chikungunya Fever

• Dr.Madhusudan.S

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• DIAGNOSIS
• TREATMENT
• PROGNOSIS

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Clinical Diagnosis

• Chikungunya fever is suspected when a
  child, presents with fever, rash and joint
  symptoms more so during an epidemic.

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Chikungunya in Children

• Less likely to have joint symptoms
• Even when present milder , shorter
  duration.
• High fever, febrile convulsions
• G.I.Symptoms vomiting,pain abdomen,constipation
  .
• Lymphadenopathy more common

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• Mild haemorrhagic symptoms epistaxis,
  petechial rash, positive tourniquet test.

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Differential Diagnosis

Onyongnyong, Mayaro, Semliki forest. Not found in INDIA
Ross River,Sindbis, West Nile, Barmah forest Not found in INDIA
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Rubella,Parvovirus B19, Sixth disease,mumps, Hepatitis A B, Lymphadenopathy, Salivary, extra salivary Tender hepatomegaly
Epstein Barr Virus Gen lymphadenopathy hepatosplenomegaly.
Leptospirosis Cough,chestpain,icterus,lymphadenopathy,hepatomegaly,splenomegaly.
Epidemic/endemic typhus Scrub typhus Not seen in INDIA G.I/Resp/rash(13) Eschar/cough/G.I.

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Enteric fever Relapsing Fever (tick borne) Pain abd,diarrhoea, Constipation, Hepatosplenomegaly G.I./Rash(18)
Henoch Schonlien purpura. Serum sickness Drug induced eruptions RF with E.marginatum. Palpable purpura,G.I, Renal(hematuria,HTN) Urticaria,drug exposure. Intensely pruritic. Carditis,chorea,scnodule

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Dengue-The closest imitator

• Found in the same areas
• Dual infections reported in some cases
• Overlapping clinical features
• Children greater incidence of haemorrhagic
  symptoms than adults

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DENGUE CHIKUNGUNYA
Endemic Sporadic explosive outbursts,vanishes reappears.
Altered taste, post-illness bradycardia and depression,asthenia Rash,conjunctival injection,arthralgia, myalgia
Shock,hemorrhagic symptoms Prolonged joint pains

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Laboratory Diagnosis
IgG
IgM
Vir
m-yrs
3-5wks
4
2 months
2-3 days
15 days
4-7 days
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Demonstration of the virus

• Gold standard most specific
• Culture-vero cells
• -C6/36 Aedes albopictus cells
• Intracerebral inoculation in newborn mice
• PCR

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Demonstration of the antibodies

• Diagnostic test of choice
• IgM ab capture ELISA
• IgG ab indicate past infection and without four
  fold rise of ab titre do not implicate the
  disease.

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Principle of ELISA
ligand

Ag
AB
Anti AB
Enz
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Other Investigations

• CBC-Leucopenia
• Thrombocytopenia
• AST,ESR,CRP
• Chronic joint symptoms-synovial fluid
• Dec viscosity, poor mucin clot formation,
  WBC-2000-5000/mm3

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TREATMENT-SUPPORTIVE

• Bedrest during fever
• Antipyretics and tepid sponging
• Analgesics and mild sedation
• Aspirin avoided-bleeding/Reyes Syndrome
• Arthtritis-continued NSAID,movements,mild joint
  exercises
• Children-lose excessive fluids-ORS
• Break transmission cycle.

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ROLE OF CHLOROQUINE

• 12-Chr joint symptoms-partial response to
  NSAIDS.
• Study in France-10 patients 250mg/day for 20
  weeks
• 7/10-patient
• 5/10 doctor
• Further studies needed

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PROGNOSIS

• Most recover in few weeks
• 12months to years
• Pregnancy-fever may cause abortions,preterm
  labour,fetal distress.
• Infants-90-recover without sequelae

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• Thankfully, the disease has proved so
  mild had it been different , this city,
  the home to half a million human beings
  would have become one vast charnel house
  with nobody to bury the dead and few to
  save the living
• James
  Mellis,
• Calcutta
  epidemic
• 1963-64