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Health Blog by Dr.Uday Nair




What is Chikungunya?

Chikungunya is a viral disease spread by mosquitoes. Chikungunya symptoms include severe and persistent joint pain, body rash, headache and fever. Initial symptoms are similar to dengue fever. It is usually NOT life threatening. But the joint pains can last for a long time and full recovery may take months. Usually patient gets life long immunity from infection and hence re-infection is very rare.

What causes Chikungunya Fever?

Chikungunya disease is a viral disease transmitted in humans by the bite of infected mosquitoes. Aedes aegypti mosquito (also called yellow fever mosquito) is the primary transmission agent of Chikungunya Virus. This is usually found in tropics and hence Chikungunya is predominantly seen in asian countries. In recent cases, another mosquito species named Aedes albopictus is found to be a carrier. Aedes aegypti bites during day time and hence day time mosquito bite is the main reason for transmission.
Presence of stagnated water in and around human inhabitation is one of the main causes of increased aedes mosquito population. This in turn causes a large number of mosquito bites leading to the rapid spread of Chikungunya virus.

What are the symptoms of Chikungunya fever?

Chikungunya typically starts with one or more of the following symptoms - chills, fever, vomiting, nausea, head ache and joint pain. The fever can reach upto 104 degree celsius. The attack is sudden and sometimes it is accompanied with rashes. Severe joint pain is the main and the most problematic symptom of Chikungunya. In some infections, no symptoms are seen and this behavior is seen predominantly in children.
After the mosquito bite it takes one to 12 days before the symptoms are seen. In many cases the only differentiating factor for symptoms is the acute joint pain.
Some of the physical symptoms of Chikungunya include,
  • Redness in eye and difficulty in looking at light.
  • Severe fever with headache and joint pain.
  • Rashes may also appear usually on limbs and trunks

What are the Diagnostic tests for  Chikungunya
  • Chikungunya is diagnosed by ELISA blood test. Blood test is the only reliable way to identify Chikungunya since the symptoms are similar to much more deadly dengue fever. Also co-occurance of these diseases are seen in many places.
    Chikungunya is confirmed when symptoms such as fever and joint pain seen along with one of the following,
    • Four fold HI(Haemagglutination Inhibition) antibody difference in paired serum samples. This turns positive within 5 to 8 days of infection.
    • Detection of IgM antibodies. These antibodies persist upto 6 months of infection, but currently there is no commercial tests available.
    • Virus isolation from serum.
    • Detection of virus nucleic acid in serum by RT-PCR. This needs to be conducted within 5 days of infection.

    WHO Criteria for Chikungunya Diagnosis

    1. Clinical criteria: acute onset of fever >38.5°C and severe arthralgia/arthritis not explained by other medical conditions.
    2. Epidemiological criteria: residing or having visited epidemic areas, having reported transmission within 15 days prior to the onset of symptoms.
    3. Laboratory criteria: at least one of the tests mentioned above.

      What are theTreatment options for Chikungunya Disease

      There is no antiviral drug or medicine specifically for Chikungunya. But since chikungunya is cured by immune system in almost all cases there is no need to worry. Treatment usually is for the symptoms and include taking sufficient rest, taking more fluid food and medicines to relieve pain (paracetamol for example). Aspirin should be avoided.
      Honey and lime mix is found to have soothing effect on the disease. Avoiding specific medicines is actually recommended for quick recovery. Also very mild exercise to joints can help ease the pain.
      Currently there is no vaccination against Chikungunya. Research is ongoing on the development of DNA vaccination against Chikungunya.
      Usually the disease starts to decrease in intensity after 3 days and it may take up to 2 weeks for recovery. But in elderly the recovery is very slow and may take upto 3 months. In some cases the joint pain can last even upto a year!
Ayurveda treatment of Chikungunya
    Since there is no medicine for Chikungunya in allopathy, people increasingly turning to traditional indian medicines (ayurveda). Ayurveda treatment of Chikungunya uses herbal drugs. Some of the kashayams (concoctions) prescribed are Amrutharista, Mahasudarshana Churna, panchathiktha kashayam, Sudarshan Churnam, Dhanvantaram Gutika and Amruthotharam Kashayam. Ancient ayurveda describes a similar condition called Sandhijwara which is similar to Chikungunya in its symptoms (joint pain). Hence some of the medicines can sooth joint pain.

  • At the same time there are reports of fake medicines in which steroids are added. These can cause severe side effects in long term. Hence the best advice is to take rest and drink plenty of fluid food!

    Homeopathic treatment of Chikungunya

    According to homeopathic experts effective drugs are available to prevent as well as to speed up recovery from Chikungunya. In some of the south indian cities this type of treatment is tried out. It is claimed that the medicine Eupatorium perf can prevent Chikungunya infection. Other medicines prescribed for the disease include Pyroginum, Rhus-tox, Cedron, Influenzinum, China and Arnica.

  • Is their a Prevention for  Chikungunya Fever


    Currently there is no vaccine for Chikungunya. There is only way to prevent Chikungunya fever - don't get bit by a mosquito! This is easier said than done in a tropical area such as India. Some of the following precautions can help reduce the risk of mosquito bites.

    Reducing the risk of mosquito bite

    • Use mosquito net when sleeping during daytime.
    • Wear dress which covers most of the body. Also there are repellents available which can be applied on dress materials.
    • Use mosquito coils or repellents(which contains Picaridin, oil of lemon eucalyptus or DEET). But you should be aware that prolonged use of these are not recommended. Also ensure adequate ventilation when these are used.
    • Use curtains or window nets which prevent entry of mosquitos to the house.
    • Use of cream or spray that can be applied on skin. This masks body odour and effectively you are invisible from mosquito. Very handy if you are visiting an area where Chikungunya is reported.
    Another way to reduce the mosquite bite is to take steps to reduce its breeding. This needs to be a community effort since only one individual alone cannot achieve much. Some of the following steps can be taken to reduce mosquito breeding in your area.

    Reducing mosquito  breeding 

    • Drain all the water collected around your house (for example in a pot or water cooler).
    • Ensure that drainages etc. are either closed or chemicals are applied which kill mosquito larvae (larvicides).
    • Another technique is to collect water in a container and once mosquitos lay eggs in it destroy them. This technique can be quite effective if multiple people apply it at their area.
    • If there is a pond which contains stagnant water, biological method is best. Fish varieties such as guppy can be introduced in the pond which will eat all the mosquito larvae.

    Note that most infection happens occur outside the house and hence mosquito control is the most effective way to prevent Chikungunya outbreak. It is also important that patients with infection don't get bitten by mosquito.

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