Chikungunya Fever

Chikungunya fever.
• Introduction
• Etiology and transmission
• Epidemiology
• Pathogenesis
• Clinical mnifestation
• Treatment
• Prevention
Introduction
• Chikungunya fever is a self-remitting febrile viral illness, associated with
frequent outbreaks in tropical countries of Africa and Southeast Asia caused
by Chikungunya virus
• The term “Chikungunya” often refers to both the virus (CHIKV) and the illness
or fever (CHIKF) caused by this virus.
• It was derived from the African dialect Swahili and translates as “to be bent
over.”
• In Congo, it is referred to as “buka-buka,” which means “broken-broken.”
• These terms refer to the “stooped-over posture” exhibited by individuals with
the disease as a consequence of severe chronic incapacitating arthralgias.
Etiology and Transmission
• it is a vector borne viral disease caused by Chikungunya virus .

• Chikungunya virus is spread to people through mosquito bites and is
not transmitted by direct person-to-person contact.
• The mosquitoes breed on stagnant water and bite during daytime
with peaks in early morning and late afternoon.
• Mosquitoes acquire the virus from humans, and after a period of 8 to
10 days they transfer it to other humans while taking a blood meal.
• The virus circulates in blood of infected person for several days at
approximately the time when the person gets the fever
• Chikungunya virus is an arthropod-borne virus (arbovirus) that belongs to
the family Togaviridae and to the genus Alphavirus.
• Aedes aegypti and Aedes albopictus mosquito are the most common
vectors.
• The virus is maintained in nature by 2 cycles: sylvatic and urban.
• Sylvatic cycle: Aedes mosquitoes transmit the disease to primates, rodents,
and birds. Humans get infected when travelling in forested areas.
• Urban cycle: the mosquitoes transmit the disease among humans
Epidemiology
• Chikungunya virus was first isolated in Tanzania in 1952.
• Occasional outbreaks have since occurred in Africa, Asia, and the Indian
subcontinent.
• The largest outbreak occurred on Réunion Island in the Indian Ocean, where
around 35% of the island’s 750,000 inhabitants were infected in 2005 and
2006.
• Since then,the disease has spread to all continents,reaching the Americas via
the Caribbean islands in 2013.
• Increased mobility of people across countries, adaptation of the virus to a
more widespread vector (Aedes albopictus), and climate changes have
favoured global dissemination of the disease.
Pathogenesis
• Chikungunya virus replicates in fibroblasts, skeletal muscle progenitor cells,
and myofibers
• Upon infection with chikungunya, the host's fibroblasts produce type-1
alpha and beta interferon.
• Chikungunya evades host defenses and counters the type-I interferon
response and turns off the host cell's ability to transcribe DNA.
• The initial innate inflammatory response is followed 1week later by
adaptive immunitywith T cell and antibody-mediated responses.
• This response coincides with the infiltration of immune cells into infected
joints and surrounding tissues
• The majority of cases resolve after the initial phase; however, a subset of
patients may develop chronic disease with arthritis and arthralgias.
• In the acute phase of chikungunya, the virus is typically present in the
areas where symptoms present, specifically skeletal muscles, and joints.
• In the chronic phase, the inability of the body to entirely rid itself of the
virus, lack of clearance of the antigen, or both, contribute to joint pain.
• The inflammation response during both the acute and chronic phase of
the disease results from interactions between the virus and monocytes
and macrophages.
• Chikungunya virus disease in humans is associated with elevated serum

levels of specific cytokines and chemokines.
Clinical manifestation
• Symptoms usually begin 3–7 days after being bitten by an infected mosquito.
Main Symptoms:
• Sudden onset,
• Combining high fever,
• Arthralgias
• Arthritis
• Rash.
Other symptoms
• Headache
• Fatigue
• Digestive complaints,
• Conjunctivitis.
• Rarely, neurological disorders; meningoencephalitis, flaccid paralysis and neuropathy.
• Acute phase:
• Viral stage: first 5-7 days, viremia occurs,
• Convalescent stage: lasting approximately ten days, symptoms improve and the
virus cannot be detected in the blood.
• Typically, begins with a sudden high fever that lasts from a few days to a week, and
sometimes up to ten days. Following the fever, strong joint pain or stiffness occurs.
The joint pain can be debilitating, often resulting in near immobility of the affected
joints.
• Chronic disease:
• Following acute infection, chikungunya may cause long-term symptoms. This
condition has been termed chronic Chikungunya virus-induced arthralgia.
• Common predictors of prolonged symptoms are advanced age and prior
rheumatological disease.
Treatment
A. Non- Pharmacologic
• Get plenty of rest.
• Drink fluids to prevent dehydration.
• Proper nutrition shouldbe ensured.
• Excessive movement of acutely inflamed joints should be avoided;
• Physiotherapy
B. Pharmacologic
• Acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.
• Tramadol in cases where neuropathic pain is present.
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs), In chronic disease.
Prevention
Primary
1. Avoidance of mosquito bites.
• reducing time of outdoor exposure
• wearing long sleeves;
• consistent use of mosquito repellents
• use of permethrin on clothing;
• decreasing conditions in or around the household that may favour the
breeding of larvae
• use of mosquito nets and air conditioning;
• redoubling efforts while travelling in endemic areas
Secondary prevention
1. Community education to identify the burden of the problem and to set
actions to prevent proliferation ofmosquitoes and avoid exposure.
2. Especially in non-endemic areas, infected individuals should stay away
from biting mosquitoes while they are ill,to prevent new local
outbreaks.
3. Travellers need to be educated about their risk and the basic
precautions they should take. They also need to identify symptoms and
seek care if required.
4. Sanitary authorities need to be aware of the risk of transmission via
blood transfusion and assess the need for donor screening in epidemic
situations.
.
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Chikungunya fever.

• it is a vector borne viral disease caused by Chikungunya virus .

• Chikungunya virus disease in humans is associated with elevated serum

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