CHIKUNGUNYA: THE OUTBREAK OF CHIKUNGUNYA FEVER

In the present era chikungunya is playing havoc in many parts of our country. Chikungunya virus is an alpha virus closely related to the onyong nyong virus the ross river virus in Australia, and the viruses that cause eastern euine encephalitis and western equine encephalitis. The present paper enumerates nature, treatment options, symptoms and diagnosis of the disease.


KAUL, SHEFALI 1; DWIVEDI, SUMEET2AND DUBEY, RAGHVENDRA2

1, Q.C. Deptt., Plethico Pharma Ltd., Indore, Madhya Pradesh-India

2, Chordia Institute of Pharmacy, Indore, Madhya Pradesh-India

 

ABSTRACT

In the present era chikungunya is playing havoc in many parts of our country. Chikungunya virus is an alpha virus closely related to the onyong nyong virus the ross river virus in Australia, and the viruses that cause eastern euine encephalitis and western equine encephalitis. The present paper enumerates nature, treatment options, symptoms and diagnosis of the disease.

Corresponding Author

Sumeet Dwivedi

AG-184, Sch No. 54

Indore, M.P.- India

Mob. No.-09893478497

E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

INTRODUCTION

Chikungunya is an Africian word meaning doubling up or bend over.  The name is derived from the makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. Marion Robinson and W.H.R. Lumsden first described the disease in 1955. Chikungunya is caused by alpha viruses and transmitted by Aedes aegypti, culex fatigans and mansonia mosquitoes. The virus was first isolated from human in Tanzania during 1953-54. These viruses are isolated from humans, cattle's, horse and other domestic animals. The name chikungunya has lead to a misconception about the disease that it spreads by consumption of chicken.

EPIDEMOLOGY

Chikungunya virus is an alpha virus closely related to the onyong nyong virus the ross river virus in Australia, and the viruses that cause eastern euine encephalitis and western equine encephalitis. The Aedes aegypti mosquito biting human flesh. Chikungunya is generally spread through bites from Aedes aegypti mosquitoes, but recent research by the Pasteur Institute in Paris suggested that chikungunya virus strains from the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmisson by Aedes aegypti  (Tiger mosquito). Concurrent studies by arbovirologists at the University of Texas Medical Branch in Galveston Texas confirmed definitively that enhanced chikungunya virus infection of Aedes albopictus was caused by a point mutation in one of the viral envelope genes (E1). Enhanced transmission of chikungunya virus by Aedes albopictus could mean an increased risk for chikungunya outbreaks in other areas where the Asian tiger mosquito is present. A recent epidemic in Italy was likely perpetuated by Aedes albopictus.

SYMPTOMS

The symptoms of Chikungunya include fever, which can reach 39°C, (102.2°F) a petechial or maculopapular rash usually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints, which can be debilitating. The symptoms could also include headache, conjunctival injection, and slight photophobia. No untoward effects of pregnancy are noticed following the infection. cular inflammation from Chikungunya may present as iridocyclitis, and have retinal lesions as well.

  • Maculopapular rash
  • Nasal blotchy erythema
  • Freckle like pigment on facial area
  • Pigmentation on face and extremities
  • Lichenoid eruption and hyperpigmentation in photodistributed areas
  • Lympoedema in acral distribution (bilateral/unilateral)
  • Multiple ecchymotic spots (Children)
  • Vesiculobullous lessionss)
  • Subungual hemorrage
  • Photo urticaria
  • Acral Urticaria
  • Cephalgia
  • Lumbago
  • Vomiting
  • Epistaxis and haemetemesis
  • Severe pain in the joints
  • High body temperature upto 104 degree F
  • Headache
  • Red eyes
  • Eye sensitive to light
  • Edema in joints
  • Epistaxis
  • Retrobular pain
  • Photophobia
  • Anorexia
  • Tastelessness
  • Abdominal pain
  • Weakness
  • Itching
  • Desquamation

Even though the disease is not fatal, it causes lots of mental agony with physical and financial loss to the affected family.

DIAGNOSIS

The only way to detect the disease is the blood test (ELISA), since, this takes long time, and doctors depend on clinical symptoms.

TREATMENT

Doctors may treat infected persons with NSAIDA. These are only symptomatic treatment, since the disease is self limiting and no specific treatment are there to treat the disease and finally to kill the viral infection. Choroquine is gaining ground as a possible treatment for the symptoms associated with chikungunya and as an antiviral agent to combat the Chikungunya virus.

A University of Malaya study found that for arthritis-like symptoms that are not relieved by aspirin and non-steroidal anti-inflammatory drugs (NSAID), chloroquine phosphate (250 mg/day) has given promising results.  Research by an Italian scientist, Andrea Savarino, and his colleagues together with a French government press release in March 2006 have added more credence to the claim that chloroquine might be effective in treating chikungunya. Unpublished studies in cell culture and monkeys show no effect of chloroquine treatment on reduction of chikungunya disease. The fact sheet on Chikungunya advises against using aspirin, Ibuprofen, naproxen and other NSAIDs are recommended for arthritic pain and fever. Infected persons should limit further exposure to mosquito bites, stay indoors and under a mosquito net. Further, "supportive care with rest is preferred during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms. Arthralgia remains troublesome even after 8 months. In Kerala, patients use honey and lime mix. Some people cite relief from consuming turmeric in low volumes.

SOME FACTS ABOUT THE DISEASE

1.INFECTIOUS AGENTS

§  NAME: Chikungunya virus

§  SYNONYM OR CROSS REFERENCE: Epidemic polyarthritis and rash, Chikungunya fever, CHIK

§  CHARACTERISTICS: Togaviridae (formerly group A arboviruses), genus Alphavirus; spherical, enveloped virions 60 nm in diameter, single-stranded, positive-sense RNA genome

2.HEALTH HAZARD

  • PATHOGENICITY: Self limiting febrile viral disease; characterized by arthralgia or arthritis typically in the knee, ankle and small joints of the extremities, high fever, followed by a maculopapular rash; buccal and palatal enanthema can occur; nausea and vomiting may occur; mild hemorrhaging may be present especially in children; inapperent infections are common, immunity is long lasting
  • EPIDEMIOLOGY: Found in Africa, India, south east Asia and the Philippines
  • HOST RANGE: Humans, primates, other mammals, birds
  • INFECTIOUS DOSE: Not known
  • MODE OF TRANSMISSION: By bite of an infective mosquito
  • INCUBATION PERIOD: Usually 1-12 days
  • COMMUNICABILITY: No evidence of person-to-person transmission

3. DISSEMINATION

  • RESERVOIR: Most likely primates
  • ZOONOSIS: Probable - most likely from primates which generate high viremia but manifest no disease
  • VECTORS: Mosquitoes - Aedes spp.
    Ae. aegypti, Ae. africanus
    Mansoni spp.

4.VIABILITY

  • DRUG SUSCEPTIBILITY: No antiviral available to date
  • SUSCEPTIBILITY TO DISINFECTANTS: Sensitive to 70% ethanol, 1% sodium hypochlorite, 2% glutaraldehyde, Sensitive to lipid solvents
  • PHYSICAL INACTIVATION: Inactivated by moist, dry heat > 58o C; Sensitive to drying
  • SURVIVAL OUTSIDE HOST: Unknown, less than one day in culture medium at 37o C

5. MEDICAL

  • SURVEILLANCE: Monitor for symptoms; confirm by serological analysis and viral isolation in mice or tissue culture
  • FIRST AID/TREATMENT: Mainly supportive therapy
  • IMMUNIZATION: None available to date
  • PROPHYLAXIS: None available

6. LABORATORY HAZARDS

  • LABORATORY-ACQUIRED INFECTIONS: At least 39 reported cases
  • SOURCES/SPECIMENS: Blood
  • PRIMARY HAZARDS: Accidental parenteral inoculation, aerosols

§  SPECIAL HAZARDS: None

7.  RECOMMENDED PRECAUTIONS

  • CONTAINMENT REQUIREMENTS: Biosafety level 2 practices and containment equipment for all activities involving the virus and potentially infectious body fluids or tissues
  • PROTECTIVE CLOTHING: Laboratory coat; gloves when skin contact with infectious materials is unavoidable

§  OTHER PRECAUTIONS: Frequent handwashing

8. HANDLING INFORMATION

  • SPILLS: Allow aerosols to settle; wearing protective clothing gently cover the spill with absorbent paper towel and apply 1% sodium hypochlorite starting at the perimeter and working towards the center; allow sufficient contact time (30 min) before clean up
  • DISPOSAL: Decontaminate all wastes before disposal; steam sterilization, chemical disinfections, incineration
  • STORAGE: In sealed containers that are appropriately labeled.

CONCLUSION

Chikungunya being a viral disease lacks effective treatment in conventional medicine. However, there is a better option in the management of the disease if we search for the Ayurveda and herbal approach. The search of large number of herbs will effectively prevent and treat the disease. Therefore, the researchers, botanist, scientist and pharmacologist will have to pay attention in the search of herbal drugs, which might be used in curing of the diseases.

REFERENCES

Robinson Marion (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; I. Clinical Features". Trans Royal Society Trop Med Hyg 49 (1): 28-32.
Lumsden WHR (1955). "An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53; II. General Description and Epidemiology". Trans Royal Society Trop Med Hyg 49 (1): 33-57.
 Vanlandingham DL, Hong C, Klingler K, Tsetsarkin K, McElroy KL, Powers AM, Lehane MJ,
Higgs S (2005). "Differential infectivities of o'nyong-nyong and chikungunya virus isolates in Anopheles gambiae and Aedes aegypti mosquitoes". Am J Trop Med Hyg 72 (5): 616-21. PubMed.
 Enserink M (2006). "Massive outbreak draws fresh attention to little-known virus". Science 311 (5764): 1085.

Robinson MC (1955). "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. I. Clinical features". Trans. R. Soc. Trop. Med. Hyg. 49 (1): 28-32.

Lumsden WH (1955). "An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. II. General description and epidemiology". Trans. R. Soc. Trop. Med. Hyg. 49 (1): 33-57.

Vanlandingham DL, Hong C, Klingler K, Tsetsarkin K, McElroy KL, Powers AM, Lehane MJ, Higgs S (2005). "Differential infectivities of o'nyong-nyong and chikungunya virus isolates in Anopheles gambiae and Aedes aegypti mosquitoes". Am J Trop Med Hyg 72 (5): 616-21.

Martin Enserink (2007). "Chikungunya: No Longer a Third World Disease". Science 318 (5858): 1860-1861.

Martin E (2007). "EPIDEMIOLOGY: Tropical Disease Follows Mosquitoes to Europe". Science 317 (5844).

 European Centers for Disease Control Report Chikungunya in Italy.

 Chikungunya-History. Retrieved on 2007-05-20.

 BBC: Mosquito virus arrives in Europe, 6 September 2007

 Hindu Times : Action plan to contain chikungunya in Kerala.

P Reiter, D Fontenille, C Paupy (Aug 2006). "Aedes albopictus as an epidemic vector of chikungunya virus: another emerging problem" The Lancet Infectious Diseases 6 (8): 463-464.

Chong, Jia-Rui. "Tropical Virus Kills Italian Man", Tampa Bay Online, 2007-12-29. Retrieved on 2009-01-04. 

Source: American Academy of Ophthalmology Scientific Posters. Poster: 358 Session: 2007. Title: Ocular Manifestations Associated with Chikungunya. Sr Author: Padmamalini Mahendradas MBBS DO DNB. Co Author: Shylaja K Ranganna MD; Rohit Shetty MBBS MD; Kannan M Narayana MBBS DOMS; Rajesh B Babu MD; Ramgopal B MD; Vidhya Arankalle PhD; Rohit Shetty MBBS MD

Edelman, R; C.O. Tacket, S.S. Wasserman, S.A. Bodison, J.G. Perry, J.A. Mangiafico (June 2006). "Phase II Safety and Immunogenicity Study of Live Chikungunya Vrirus Vaccine TSI-GSD-218" (PDF). American Journal of Tropical Medicine and Hygiene 62 (6): 681-685. Retrieved on 2007-12-24.

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