Introduction

Chikungunya is a viral disease caused by an arthropod borne virus, which is transmitted to humans through the bite of Aedes Aegypti mosquito. There are three genotypes – two in Africa and one in Asia. The infection resembles dengue in features and is mainly reported from African and Southeast Asian countries including India. The name of the disease leads to a misconception that it is related to chickens, but in reality it has nothing to do with chickens. Chikungunya in Kimakonde language (spoken in Tanzania) refers to “to become contorted” owing to its arthritis like symptoms.

Causes

Bite of an Aedes Aegypti mosquito can transmit the Chikungunya virus, causing the disease. This mosquito usually bites during day time. The mosquito likes to rest in cool shaded areas, usually in and around the domestic areas.

Symptoms

• Fever (up to 104℉)

• Chills

• Severe joint pain (Arthralgia)

• Rashes on the trunk or on limbs

• Swelling and stiffness of joints

• Myalgia (muscular pain)

• Headache

• Nausea

• Vomiting

• Conjunctivitis

• Slight photophobia

Fever usually lasts from a couple of days to a week, but other symptoms may persist for several weeks. Duration of symptoms was found to be higher in geriatric patients.

Diagnosis

Laboratory confirmation of Chikungunya is important since its clinical appearance is similar to that of Dengue. Tests which can be performed to diagnose Chikungunya are:

• Virus isolation: Chikungunya virus – specific responses are identified from whole blood samples. This test may take one or two weeks for determining the results.

• RT-PCR: Several Chikungunya specific genes are amplified using nested primer pairs. Results are obtained within two days.

• ELISA: Chikungunya – specific IgM levels are assayed in the blood specimen.

Treatment

There is no particular treatment for Chikungunya, but we do not need to worry since it is cured by immune system. Some of the drugs which may help relieve the symtopms of Chikungunya are:

NSAIDs: These are Non-steroidal anti-inflammatory drugs which relieves the pain and decrease inflammation.

Aspirin is not recommended in Chikunguya

Anti-viral: In patients with arthritis symptoms from more than two weeks, ribavarin can be an effective option.

Non-drug treatment:

• Excess fluid intake can help flush out the infection causing virus from the body

• Avoid hot packs in the initial stage.

• Cold compresses in the initial stages can help decrease the pain and decrease the damage.

• Foods rich in vitamins (such as A, C and E), selenium, chromium and zinc can help strengthen immunity to fight against the infection.

• Plenty of rest may prevent worsening of symptoms.

• Consume easily digestible food.

• Mild exercise may help relieve joint pains

• Combination of honey and lime is found to have soothing effects on the disease

• Avoid spicy food, caffeinated beverages, tobacco and alcohol as these foods weakens the defense system of our body.

WARNING SIGNS

• Fever lasting more than 5 days

• Dizziness

• Uncontrolled vomiting

• Decreased urine output

Prevention

Currently, vaccinations for Chikungunya are in experimental stage. Avoiding a mosquito bite can keep you away from the disease, which can be achieved by:

• Using mosquito nets at day time during sleep.
• Applying insect repellant on skin.
• Covering the body with full sleeves apparels
• Using window nets and curtains at home to prevent mosquito entry.
• Draining still water in pots and coolers to prevent mosquito breeding
• Closing open drainages if any.
• Introducing sea creatures like guppy fish in a pond, which can eat mosquito larvae in stagnated water.

In order to prevent further spread of the disease, an infected person must stay indoors and avoid mosquito bite.

Zika virus belongs to the flavi virus family. It is closely related to dengue and Chikungunya virus. It can be transmitted by the same mosquito that transmits the dengue virus. The virus was first isolated in Rhesus monkey in the Zika forest of Uganda in 1947, which is how it got its name. Human infections were identified in the 1950s and the disease is endemic in parts of Africa and Asia. An outbreak of the Zika virus infection occurred on Yap Island in the Federated States of Micronesia in 2007

Transmission

Zika virus is primarily transmitted to humans through bites from Aedes mosquitoes. Rarely, Zika virus can be transmitted via blood transfusion, prenatal transmission and sexual transmission. The incubation period (time from exposure to symptoms) is typically between two and seven days

Signs and symptoms

Not all people who are infected have symptoms. About one in five people develop symptoms. The infection is characterized by low grade fever, accompanied by a rash. Other symptoms include muscle pain, joint pain with possible swelling, headache, pain behind the eyes and conjunctivitis. Symptoms are often mild, and most people recover without severe complications. Cases of Guillain-Barre disease have been reported. Investigations are ongoing to assess the possibility of microcephaly (small brain) in babies due to maternal infection with Zika virus. Death due to Zika virus is rare. The virus usually remains in the blood of an infected person for a few days but it can be found longer in some people.

Treatment

There is no vaccine or specific antiviral treatment for Zika virus infection. Treatment is to control symptoms that includes resting, intake of fluids to prevent dehydration, intake of pain relievers however, Aspirin and NSAIDs are not advisable.

Prevention 

Prevention and control relies on reducing the breeding of mosquitoes and reducing contact between mosquitoes and people. Basic precautions for protection from mosquito bites should be taken by people traveling to high risk areas. These include use of repellents, wearing light colored, long sleeved shirts and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering. If you have Zika, avoid mosquito bites for the first week of your illness. During the first week of infection, Zika virus can be found in the blood and passed from an infected person to another mosquito through mosquito bites. An infected mosquito can then spread the virus to other people.

Travel advisory

The CDC recommends that pregnant women in any trimester should consider postponing travel to an area where Zika virus transmission is ongoing. If a pregnant woman is considering travel to one of these areas, she should talk to her healthcare provider. If she travels, she should strictly follow steps to avoid mosquito bites during the trip. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to change over time.
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By Dr Suneetha Narreddy | THE HANS INDIA | Feb 05,2016 , 11:52 PM IST