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Chikungunya: Indian Perspective

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Chikungunya: Indian Perspective

Baijayantimala Mishra.
Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh-160012, India.
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Mishra B. Chikungunya Fever. Pediatr Oncall J. 2006;3: 59-60.

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Chikungunya fever is a viral disease transmitted to human by the infected mosquito bite. The name has been derived from a Makonde word meaning "that which bends up" reference to some victims' inability to walk up right. 1 The disease was first described in 1952, following an outbreak in the Makonde plateau along the border between Tanganyika and Mozambique. 2 Since then the disease has been observed repeatedly in west, central and southern Africa and many areas of Asia and has been cited as the cause of numerous human epidemics.

Chikungunya Virus:

Chikungunya virus (CHIK virus) is a member of the genus Alpha virus in the family Togaviridae . CHIK virus belongs to the Semliki forest virus group of Alpha virus genus and is closely related to O'nyong- nyong (ONN) virus. The virus is transmitted to humans by the bite of infected female Aedes and Culex mosquitoes. Aedes aegypti, (the dengue fever mosquito), the peridomestic and day biter, serves as the primary vector. The "Asian tiger mosquito" Aedes albopictus, also seems to play role in human transmission in Asia, and has been found as the main vector in the current French Reunion outbreak. 3 Monkeys and possibly other wild animals serve as the reservoir of the virus.

Epidemiology:

The geographic range of Chikungunya is mainly Africa and Asia . The virus was first isolated from serum of a febrile patient in Tanzania in 1953. 2 Thereafter the virus was isolated repeatedly from central, southern and western Africa . The virus appears to be enzootic throughout tropical Africa . CHIK virus appears to have spread from Africa to other parts of world to cause pandemics in both the American and Asian tropics. The affected Asian and southeast Asian countries are Myanmar , Philippines , Vietnam , Malaysia , Pakistan and Pacific islands.

The history of Chikungunya outbreak in India dates back to 1824 whereas the virus was first isolated in 1963 from Kolkata. 4 The viral activity in humans have been observed till 1971 after which it was thought either to be disappeared or lost its pathogenic potentiality. 5 The present outbreak in India started during December 2005 where the country has so far experienced more than 11,00,000 (11 lakh) of Chikungunya infected cases which still continues. 6 The cases were first reported from Andhra Pradesh, one of the worst affected states. Subsequently reports were poured in from several districts of Karnataka, Kerala, Maharashtra , Orissa, Madhya Pradesh, and Tamil Nadu. Even Andaman experienced the first Chikungunya epidemic during June 2006. Presently the outbreak is underway in western parts of India specially Gujarat and Rajasthan.

Simultaneous outbreaks of chikungunya have been observed in several small countries in the south West Indian Ocean such as Mauritius , Mayotte , French Reunion Islands and Seychelles . Even chikungunya has already entered several European countries through the travelers visiting the affected islands. 7

The re-emergence of Chikungunya in unprecedented magnitude in India is a cause of concern. The lack of herd immunity as evidenced from available studies 8,9 appears to be the simplest attributable factor. However, the newly emergent E226V variant of the virus has been attributed for rapid spread during the current French Reunion outbreak. 10 The co-infection with microfilaria which is known to facilitate the Chikungunya transmission has also been postulated as a factor of re-emergence particularly in India. 11

Clinical features:

Chikungunya virus infection can cause a debilitating illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash and joint pain. The incubation period can be 2-12 days with an average of 3-7 days. 12 Acute chikungunya fever typically lasts few days to couple of weeks (average 3 to 5 days). The most significant symptom is arthralgia which affects multiple joints and is usually present in large number of patients. The joints become swollen and painful. In small proportion of cases it may persist for months to years. The rashes when present are most common on the trunks and are macular or maculopapular in nature. Dermatological manifestations observed during the recent outbreak in Karnataka 6 were, maculopapular rash, nasal blotchy erythema, freckle like pigmentation over centro-facial area, flagellate pigmentation on face and extremities, lichenoid eruption and hyper pigmentation in photo distributed areas, and multiple aphthous -like ulcers over scrotum, crural areas and axilla. Multiple ecchymotic spots and vesiculobullous lesions have been observed in children and infants respectively. 6 The symptoms are often confused with dengue fever. However, the association with prolonged joint pain, absence of hemorrhagic manifestations and features of shock points more towards chikungunya. Though chikungunya is a self limiting febrile illness, neurological complications such as meningoencephalitis has also been attributed to this virus in few cases during the first Indian outbreak. 13 The recent French Reunion outbreak also experienced the same. 14

Diagnosis of Chikungunya infection:

Diagnosis is usually made by serum IgM antibody detection by ELISA. 15 Isolation of the virus can also be made from blood or infected tissues of patient in one day old Swiss albino mice or tissue culture system. 4 Polymerase chain reaction (PCR) is also useful with acute samples. 16

Treatment and Prevention:

No specific antiviral drug is available for Chikungunya. The illness is usually self-limiting and resolved with time. Symptomatic treatment is recommended with rest, fluids and non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen, naproxen, acetaminophen or paracetamol during the acute stage of illness to relive symptoms of fever and joint pain. 12 Aspirin should be avoided during the acute stage. Chloroquine phosphate has been shown to improve symptoms in chronic arthritis patients. 17
Presently no preventive medications or vaccines are available for Chikungunya. However, attenuated virus has been shown as a promising vaccine candidate in a clinical trial in volunteers. 18 Preventive measures can be taken to reduce the bite by infected mosquitoes. These can be achieved by using insect repellant on exposed skin surface when out doors particularly during day time or by wearing long sleeved shirts and long pants. The breeding sites of Aedes mosquitoes should be reduced by emptying the standing water collection in containers like water coolers, flower vases, storage tanks and tyres etc. It should also be stressed that simple throwing of water is not sufficient and vigorous scrubbing is required to detach the eggs of Aedes which are laid at the water air interface.
 
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Conflict of Interest
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Last Updated : 01 October 2006 Vol 3 Issue 10 Art #35

Cite this article as: :
Mishra B. Chikungunya Fever. Pediatr Oncall J. 2006;3: 59-60.
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