Chikungunya, a Re-emerging Viral Fever

Introduction:

There are many diseases that occur due to mosquito bite. Malaria, elephantiasis, Nile virus, chikungunya and dengue fever are the most common. These are known as mosquito-borne diseases. Chikungunya is caused by the chikungunya virus. This infection lasts for 2 to 12 days. But, the pain may last for a few months to years. It may be associated with extremity pains such as in joints of the lower limb and upper limb. It is transmitted from the infected human through Aedes mosquito bites. The saliva of this mosquito contains infected virus, which gets into the blood of healthy individual when it bites. Aedes albopictus and Aedes aegypti mosquitoes are the most common ones responsible for chikungunya disease. This is not a fatal disease.

What Are the Signs and Symptoms of Chikungunya?

In initial stage, symptoms like low grade fever, malaise, reduction in feelings of hunger and occasional vomiting will be present. After five to seven days the patient becomes symptomatic profoundly. Joint ache starts after the initial onset of the infection. It starts with mild difficulties in movement and pain during early morning. As the day starts pain goes off and it is also relieved by some daily activities. These are the symptoms seen in the initial stage of chikungunya fever.

• There are some specific symptoms such as persistent extremity joint pain, rashes on the skin, high grade fever (40 degree Celsius) and headache found in chikungunya fever.

• Joint pain is so severe and takes prolonged time for recovery. Joint pain includes severe pain in the joints mostly lower limb such as ankles, knees, hip joints and in the upper limb such as elbow, shoulder joint and wrist. Backache is rarely seen in this disease.

• Inflammatory signs are also present with joint pain. Redness of the joint and swelling is present in the acute phase. The patient will have severe pain, even on touch. The patient will have difficulties in joint movement. Sometimes, they cannot move their joints due to severe pain.

• The patient may have difficulties in walking, getting up from sitting position, running, etc., and the pain may also reappear during cold or winter season. It is dull, aching and throbbing in nature.

• The patient may find some difficulties in writing, holding objects, picking up any heavy object, driving a car or vehicle and performing fine movements when the upper limb joint is involved. Sometimes, the symptoms are same as dengue fever. So, the difference between these two diseases is required to be investigated. But, some symptoms like joint pain is absent in dengue and that makes the diagnosis more clear.

• Minor symptoms are nausea, vomiting, conjunctivitis and photophobia (hypersensitivity to light in eyes). Sometimes, reduction in taste sensation is also present.

How to Diagnose Chikungunya?

It is best diagnosed with a special blood test known as ELISA blood test (enzyme-linked immunosorbent assay). In the blood test, IgM antibodies are found which lasts for up to six months to one year in blood. Antibodies are produced by our body to engulf or destroy the foreign particles, viruses and toxins. These antibodies are made by some protein compounds and help to provide immunity. This immunity is known as acquired immunity.

Serum test is also positive in first few days after infection. Chikungunya viruses are found in the serum in the first two weeks. Identification of virus is very essential to confirm the diagnosis. Some specific tests are also available to diagnose virus nucleic acid in the serum. But, it comes positive only in the first five days of infection.

The World Health Organization (WHO) is also providing some criteria to confirm the diagnosis. They are as follows:

1. Presence of fever above 38.5 degree Celsius and presence of severe joint or muscle pain without any other medical or orthopedic conditions.
2. The person who visited the epidemic area before 15 days of infection and positive laboratory tests, which are described as above.

What Are the Treatments Guidelines for Chikungunya?

There are many medications and remedies available to treat the pain caused by chikungunya fever. But, there is no specific medication responsible for the cure of chikungunya infection.

1) Hot Water Fomentation: For pain relief, a hot water bag of approximately 35 degree Celsius should be put on the affected area. If a person cannot tolerate this temperature or if there is a chance of burning, he can put some thick cloth between the body and the bag. A person should take hot water fomentation for 30 minutes thrice a day for one month. It works by increasing the blood circulation in the local area as well as relieving the spasm of the muscles. It gives relaxing effect to tensed muscles. It improves the circulation to wash out the waste products such as substance p (neurotransmitters responsible for pain) and increases the healing process by providing nutrients to the affected site. It also will help to relieve pain and inflammation.

2) Massage: Sometimes massage with deep pressure on the joints with pain reliever gel is effective. As it contains Diclofenac gel, linseed oil, camphor, etc., it will relieve pain. It can be used many times in a day.

3) Cold pack: Apply cold packs over affected joint two times in a day for a minimum of 20 minutes to get the beneficial effects. It will cause Lewis's hunting reaction. It means vasodilatation, dilatation of the blood vessels, followed by vasoconstriction that is narrowing of the blood vessels. It will increase the nutritional supply and remove other toxin stuffs from joints. It helps to get relief from inflammation and pain.

4) Painkillers: If a patient is suffering from intense pain, then he or she may use oral painkillers. The patient should use nonsteroidal anti-inflammatory drugs (NSAID) for treating this condition. It works by blocking pain sensation at the brain level and also has anti-inflammatory property.

• Ibuprofen works by inhibition on inflammation and the production of prostaglandins which is an essential element of pain production. The patient should take a dosage of 4 to 6 mg per kg body weight per dose for every 6 or 12 hours depending upon the severity of the disease.

• Naproxen is well established in the treatment of moderate pain. It works by inhibiting the cyclooxygenase production, which is responsible for prostaglandins production for pain. Naproxen dosage initially starts with 500 mg twice daily with an interval of 12 hours, for three days and then 250 mg twice daily for six days.

What Are the Preventive Measures Against Chikungunya Fever?

There are many ways to prevent the occurrence of chikungunya. But, there is no vaccination found against this disease. It is best prevented by killing mosquitoes or avoiding mosquito bites. Mosquitoes that spread the chikungunya virus bite only during day time.

• A person should increase the use of air conditioner, also should close windows and doors to avoid any pollutants entering inside the room. Nowadays, window or door screens are available in different sizes and shapes. They do not allow the entry of mosquitoes. Mosquito net also gives best protection against bites of mosquitoes. They are mostly used in the village and hotels where closing of doors or windows is impossible.

• Water should not be stagnated near houses or hotels. Water accumulation may enhance the production of mosquitoes. Flower vases and baskets should be kept in the garden or outside the house.

• Proper elimination of water is essential in protecting against disease. It can be achieved by flushing of water in gutter continuously, emptying the water pool after bathing, etc.

• In summer, there are fewer mosquitoes. But in the rainy season, mosquitoes grow at higher rates. That time people should wear full sleeves and long pants to protect the whole body against mosquito bites. Also, it is a must to wear socks. Generally mosquitoes are more attracted to dark and bright colored clothes. People should avoid these type of clothes and wear light colored ones.

• People should use mosquito repellant. It contains N, N-diethyl-3-methylbenzamide (DEET). When a person applies it, it decreases the ability of mosquito to recognize the person. 10 % application may provide protection for 1 to 3 hours. It is strictly contraindicated in children below 2 years, because it is chemical and toxic in nature.

• Picaridin, also known as KBR 3023, completely restricts the ability of mosquito to find out the human who has applied this. It has no odor. It is best used in persons who have allergy for specific odor of other repellants.

• IR3535, oil of lemon eucalyptus, DEET and Para-menthane-diol provide protection for a longer period of time. Other repellents are plant oils like geranium, cedar, lemongrass, soy and citronella.

• People can use mosquito coils, which also protect from the bite. Home remedies are also used, such as mix equal quantity of citronella, soybean oil and IR3535 and apply for the whole day. It also works as a mosquito repellant. People should apply sunscreen lotion first on the skin, followed by a repellent cream, for the best protection.

• People may also use environmentally protective insecticides, like larvicidal oil to avoid mosquitoes. A person may use biological controls, such as growing fishes which easily eat the mosquito larvae and provide good protection.

• People can wash their clothes with Permethrin. It is one type of the chemicals which keeps the mosquitoes away from it. Try to purchase clothes which are specially treated with Permethrin.

• Avoid contact with persons who are already infected and have symptoms, such as fever and chronic joint pain. There are high chances of spreading the disease from an infected person to a healthy person through mosquito bites. So, keep distance from an infected person for a few days.

Conclusion:

The only effective method of avoiding Chikungunya from the body is to avoid mosquito bites. There was a terrible period when the Chikungunya virus spread rapidly, killing the majority of those with low immunity. Incomparable work was required to stop the Chikungunya virus from spreading. Simply eliminating the mosquito in large numbers will not help humans recover from this fearsome virus. The best method to guard against diseases of all kinds, including Chikungunya, is to build a strong immune system.