Chikungunya fever.

Dr Esther
  Introduction
Outline  Etiology and transmission
 Epidemiology
 Pathogenesis
 Clinical mnifestation
 Diagnostic tests
 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.
  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
Etiology and to 10 days they transfer it to other humans while taking a blood
meal.
Transmission  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
  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.
Epidemiology
 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.
  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
Pathogenesis adaptive immunity with 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.
  Symptoms usually begin 3–7 days after being bitten by an infected
mosquito.
Main Symptoms:
 Sudden onset,
 Combining high fever,
 Arthralgias
 Arthritis
 Rash.
Clinical
Other symptoms
manifestation  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.
 Diagnostic tests

 Full blood count

 Liver functioning tests
 Erythrocyte sedimentation rate
 Basic metabolic panel
 Serology test
 Molecular testing
 Musculoskeletal imaging
 A. Non- Pharmacologic
 Get plenty of rest.
 Drink fluids to prevent dehydration.
 Proper nutrition should be ensured.
 Excessive movement of acutely inflamed joints should be avoided;
 Physiotherapy
Treatment 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.
 Primary
1. Avoidance of mosquito bites.
 reducing time of outdoor exposure
 wearing long sleeves;
 consistent use of mosquito repellents
Prevention  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 of
mosquitoes 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.
.
GRACIAS