Chikungunya FeverChikungunya Fever

Dr.Madhusudan.SDr.Madhusudan.S

• DIAGNOSISDIAGNOSIS

• TREATMENTTREATMENT

• PROGNOSISPROGNOSIS

Clinical DiagnosisClinical Diagnosis

• Chikungunya fever is suspected Chikungunya fever is suspected when a child, presents with fever, when a child, presents with fever, rash and joint symptoms more so rash and joint symptoms more so during an epidemic.during an epidemic.

Chikungunya in ChildrenChikungunya in Children

• Less likely to have joint symptomsLess likely to have joint symptoms

Even when present – milder , Even when present – milder , shorter duration.shorter duration.

• High fever, febrile convulsionsHigh fever, febrile convulsions

• G.I.Symptoms – vomiting,pain G.I.Symptoms – vomiting,pain abdomen,constipation.abdomen,constipation.

• Lymphadenopathy – more commonLymphadenopathy – more common

• Mild haemorrhagic symptoms – Mild haemorrhagic symptoms – epistaxis, petechial rash, positive epistaxis, petechial rash, positive tourniquet test.tourniquet test.

Differential DiagnosisDifferential Diagnosis

• O’nyongnyong,O’nyongnyong,

Mayaro,Mayaro,

Semliki forest.Semliki forest.

Not found in INDIANot found in INDIA

Ross River,Sindbis,Ross River,Sindbis,

West Nile,West Nile,

Barmah forestBarmah forest

Not found in INDIANot found in INDIA

Rubella,Parvovirus Rubella,Parvovirus B19,B19,

Sixth Sixth disease,mumps,disease,mumps,

Hepatitis A & B,Hepatitis A & B,

Lymphadenopathy,Lymphadenopathy,

Salivary, extra Salivary, extra salivarysalivary

Tender Tender hepatomegalyhepatomegaly

Epstein Barr VirusEpstein Barr Virus Gen Gen lymphadenopathylymphadenopathy

& & hepatosplenomegaly.hepatosplenomegaly.

LeptospirosisLeptospirosisCough,chestpain,icterCough,chestpain,icterus,lymphadenopathy,us,lymphadenopathy,hepatomegaly,splenohepatomegaly,splenomegaly.megaly.

Epidemic/endemic Epidemic/endemic typhustyphus

Scrub typhusScrub typhus

Not seen in INDIANot seen in INDIA

G.I/Resp/rash(13%)G.I/Resp/rash(13%)

Eschar/cough/G.I.Eschar/cough/G.I.

Enteric feverEnteric fever

Relapsing FeverRelapsing Fever

(tick borne)(tick borne)

Pain abd,diarrhoea,Pain abd,diarrhoea,

Constipation,Constipation,

HepatosplenomegalyHepatosplenomegaly

G.I./Rash(18%)G.I./Rash(18%)

Henoch Schonlien Henoch Schonlien purpura.purpura.

Serum sicknessSerum sickness

Drug induced Drug induced eruptionseruptions

RF with RF with E.marginatum.E.marginatum.

Palpable Palpable purpura,G.I,purpura,G.I,

Renal(hematuria,HTNRenal(hematuria,HTN))

Urticaria,drug Urticaria,drug exposure.exposure.

Intensely pruritic.Intensely pruritic.

Carditis,chorea,scnodCarditis,chorea,scnoduleule

Dengue-The closest imitatorDengue-The closest imitator

• Found in the same areasFound in the same areas

• Dual infections reported in some casesDual infections reported in some cases

• Overlapping clinical featuresOverlapping clinical features

• Children – greater incidence of Children – greater incidence of haemorrhagic symptoms than adultshaemorrhagic symptoms than adults

DENGUEDENGUE CHIKUNGUNYACHIKUNGUNYA

EndemicEndemicSporadic explosive Sporadic explosive outbursts,vanishes & outbursts,vanishes & reappears.reappears.

Altered taste, post-Altered taste, post-illness bradycardia illness bradycardia and and depression,astheniadepression,asthenia

Rash,conjunctivalRash,conjunctival

injection,arthralgia,injection,arthralgia,

myalgiamyalgia

Shock,hemorrhagic Shock,hemorrhagic symptomssymptoms

Prolonged joint painsProlonged joint pains

Laboratory DiagnosisLaboratory Diagnosis

2-3 days

4-7 days

15 days

3-5wks

2 months

m-yrs

Demonstration of the virusDemonstration of the virus

• Gold standard & most specificGold standard & most specific

• Culture-vero cellsCulture-vero cells

-C6/36 Aedes albopictus cells-C6/36 Aedes albopictus cells

• Intracerebral inoculation in newborn miceIntracerebral inoculation in newborn mice

• PCRPCR

Demonstration of the Demonstration of the antibodiesantibodies

Diagnostic test of choice:Diagnostic test of choice:

• IgM ab capture ELISA IgM ab capture ELISA

• IgG ab indicate past infection and IgG ab indicate past infection and without four fold rise of ab titre do without four fold rise of ab titre do not implicate the disease.not implicate the disease.

Principle of ELISAPrinciple of ELISA

Other InvestigationsOther Investigations

• CBC-LeucopeniaCBC-Leucopenia

• ThrombocytopeniaThrombocytopenia

• ^AST,ESR,CRP^AST,ESR,CRP

• Chronic joint symptoms-synovial fluidChronic joint symptoms-synovial fluid Dec viscosity, poor mucin clot formation, Dec viscosity, poor mucin clot formation,

WBC-2000-5000/mm3 WBC-2000-5000/mm3

TREATMENT-SUPPORTIVETREATMENT-SUPPORTIVE

• Bedrest during feverBedrest during fever

• Antipyretics and tepid spongingAntipyretics and tepid sponging

• Analgesics and mild sedationAnalgesics and mild sedation

• Aspirin avoided-bleeding/Reye’s SyndromeAspirin avoided-bleeding/Reye’s Syndrome

• Arthtritis-continued NSAID,movements,mild Arthtritis-continued NSAID,movements,mild joint exercisesjoint exercises

• Children-lose excessive fluids-ORSChildren-lose excessive fluids-ORS

• Break transmission cycle.Break transmission cycle.

ROLE OF CHLOROQUINEROLE OF CHLOROQUINE

• 12%-Chr joint symptoms-partial 12%-Chr joint symptoms-partial response to NSAIDS.response to NSAIDS.

• Study in France-10 patients Study in France-10 patients 250mg/day for 20 weeks250mg/day for 20 weeks

• 7/10-patient7/10-patient

5/10 doctor5/10 doctor

• Further studies neededFurther studies needed

PROGNOSISPROGNOSIS

• Most recover in few weeksMost recover in few weeks

• 12%months to years12%months to years

• Pregnancy-fever may cause Pregnancy-fever may cause abortions,preterm labour,fetal distress.abortions,preterm labour,fetal distress.

• Infants-90%-recover without sequelaeInfants-90%-recover without sequelae

“ “Thankfully, the disease has proved Thankfully, the disease has proved so mild ; had it been different , so mild ; had it been different , this city, the home to half a million this city, the home to half a million human beings would have become human beings would have become one vast charnel house with nobody one vast charnel house with nobody to bury the dead and few to save to bury the dead and few to save the living”the living” James Mellis,James Mellis,

Calcutta epidemicCalcutta epidemic 1963-641963-64