Chikungunya

Definition

Chikungunya fever (or chikungunya) is a viral disease transmitted by a mosquito bite. Its name comes from the Tanzanian language makondée which means “bent man’s disease” or “bone-breaking disease”. It refers to the attitude of the infected person who suffers from acute pain in the joints and is obliged to adopt a hunched posture.
In Brazil, particularly in the northeast, it is estimated that the chikungunya virus first developed during the year 2014. Prior to that date, cases of chikungunya were rare or non-existent in Brazil.

Chikungunya is considered a rheumatological infectious disease.

Epidemiology

– The chikungunya virus mainly leads to epidemics in Africa and sometimes in Asia as well. But since 2013, the chikungunya virus has also been present in the American continent, and in January 2017 more than 1.7 million cases were registered in the American continent, especially in Latin America.

– In Colombia, from July 2014 to April 2015, around 25 fatal cases of chikungunya were registered, according to the National Institute of Health (INS). The chikungunya virus was detected in Colombia in July 2014.

– In May 2017, a chikungunya epidemic was observed in the Brazilian state of Minas Gerais. Cases were observed mainly in cities or villages far from the state capital, Belo Horizonte, as mentioned by the newspaper Folha de S.Paulo Brasil on May 30, 2017. The city of Governador Valadares was particularly affected. From January 1, 2017 to May 29, 2017, the state of Minas Gerais registered 15,988 suspected cases of chikungunya virus infection. The city of Governador Valadares also discovered several deaths probably caused by chikungunya.

Causes

Chikungunya is caused by an arbovirus called CHIKV, an RNA virus, this is an alphavirus. The chikungunya and dengue viruses are very similar in their structures.
Transmission
The disease is transmitted by female Aedes mosquitoes, namely Aedes aegypti and Aedes albopictus . Aedes aegypti is also responsible for transmitting dengue  and Zika . These mosquitoes are very active in Africa, the Indian Ocean, Asia, the Indian subcontinent, the Americas and the Caribbean. Some cases have even been reported in Europe, especially in Var in 2010, in northeastern Italy in 2007. This was due to acclimatization in recent years Aedes albopictus, on the shores of the Mediterranean. The mosquito  Aedes albopictus , unlike  Aedes aegypti , also lives in temperate regions such as Europe (eg Italy), this is one of the origins of several cases of epidemics in recent years.
When a mosquito bites a person infected with chikungunya, it is able to carry the CHIKV virus and transmit it to a healthy individual through the bite.

Incubation period
The disease usually manifests itself after an incubation period of 2 to 10 days, with a period that can extend up to 12 days. This means that it can take a period of 12 days between when a person is bitten by a mosquito and the first symptoms appear.
Note that 95% of individuals affected by the CHIKV virus will manifest symptoms of chikungunya fever, a particularly high rate compared to dengue, where this percentage varies between 40% and 50%.

According to a study presented at a conference on tropical diseases (ASTMH congress) in Atlanta in the United States in November 2016, mosquitoes ( Aedes variety ) carrying chikungunya can also be carriers of Zika and transmit the disease to humans in a single sting.

Symptoms

Chikungunya is characterized by acute joint pain, especially in the joint girdles, such as in the fingers, wrists, ankles, knees, or feet. These pains cause the patient to adopt a lying and still position for many hours. Joint pain can be extremely painful and severely penalize the individual in his daily life, since he has great difficulty even in grasping an object, for example.
The pains are often accompanied by a bout of fever (above 39°C), headaches , aches and red spots on the skin. Sometimes gastrointestinal symptoms may occur.

Onset and Duration of Symptoms
These symptoms appear suddenly, often 4 to 7 days after the mosquito bite. In most patients, chikungunya symptoms improve after two to three weeks.
If the symptoms last longer than 3 months, it is called a chronic chikungunya infection (chronic phase of the disease). Of the 3 main viruses transmitted by the Aedes aegypti mosquito (chikungunya, dengue and zika), it is estimated that chikungunya is the only disease that in some cases leads to a chronic phase. The other two diseases have symptoms that last a maximum of ten days.

It is noteworthy that children with chikungunya rarely complain of joint pain. Among them, the manifestation of the disease generally resembles a simple flu , associated with mild gingival bleeding. In babies, however, the disease can be intense.

According to the Brazilian Ministry of Health, which incorporated a list of symptoms in September 2016, chikungunya can lead to hair loss that can manifest itself weeks or months after the initial or acute symptoms of the disease. The reason behind this drop is that the body focuses mainly on fighting the disease (caused by a virus) and neglects other secondary activities such as hair growth. In the vast majority of cases, this hair loss subsides over time, this is a reversible process.

Diagnosis

There are several methods for diagnosing the presence of anti-chikungunya IgM and IgG antibodies in the body. Serological tests such as enzyme-linked immunosorbent assays (ELISA) are among these protocols. It is also possible to use reverse transcriptase chain reaction (PCR) techniques using appropriate serological or virological approaches.

Without these tools, the mild symptoms of Chikungunya can induce medical error, and he may end up diagnosing dengue fever, especially if this disease is common in your area.

Complications

In the elderly, joint pain can last for several months or even a year. It is the same for people who have weakened joints like athletes who have had fractures or sprains in the past, or even people who suffer from osteoarthritis or previous rheumatic disease. In children, the disease can block the jaw and complicate chewing.

The effects of the disease are also harmful for people with heart problems, respiratory problems, kidney failure and diabetic people. Likewise, chronic alcoholics can suffer from fatal hepatitis if infected with chikungunya. In 2005, during the outbreak on Réunion Island, doctors noticed severe neurological forms of the disease in some patients, resulting in peripheral nerve damage and meningoencephalitis.

Special attention should be given to pregnant women at risk of transmitting the CHIKV virus to their newborns.

The chikungunya virus can lead to Guillain-Barre syndrome, other viruses such as the flu or zika can also cause this syndrome. Guillain-Barre syndrome is a potentially life-threatening condition that primarily affects the respiratory system.

Treatments

There is still no treatment to cure chikungunya. Treatment consists of reducing symptoms with analgesics, antipyretics and fluid intake to fight the patient’s dehydration. For more severe cases, doctors recommend taking corticosteroids in decreasing doses.
If symptoms persist (more than 6 months), the doctor may use specific arthritis medications called DMARD.

Skin manifestations and fever often disappear after a few days, although joint pain may last for several weeks. To recover their motor functions more quickly, the patient can attend physiotherapy sessions.

Some doctors may use biologic (or immunobiologic) medications to decrease joint inflammation. Be aware that the chikungunya agent acts as a trigger of inflammatory processes in the joint.

Diet
Foods rich in magnesium are recommended to strengthen the immune system of healthy people. For patients, the addition of 10 grams of magnesium chloride in a 1.5 liter or 2 liter bottle of water reinforces the body’s defense against the virus. The patient has to drink a glass of this fluid every 30 minutes and then every hour after the fourth glass until the end of the bottle. Good rehydration compensates for fluid loss due to fever and sweating.

Rest is also beneficial, as it allows the body to regenerate. In 2006, one third of the population of Reunion Island was affected by CHIKV, causing 203 deaths and a total cost of €43,900,000. Absenteeism due to this illness is estimated at €17,400,000, with statistics 6 days of work lost out of 10 during this period.

Tips

Chikungunya comes from the bite of Aedes aegypti and Aedes albopictus mosquitoes. Disease prevention therefore relies on removing mosquito habitat.

– Around your house, be sure to remove standing water, which are the areas where females lay eggs. These places include tarps or tires lying around in the backyard, containers or pots left in yard waste, gutters and drainpipes.

– Cover the pool when not in use.

– The most dangerous times for mosquito bites are sunrise and sunset. Pay special attention to these moments, wearing clothes that cover your body and avoiding places likely to be infested by mosquitoes.

– Use mosquito nets, including your child’s room at night.

– Otherwise, opt for electric diffusers that generally protect for 8 to 10 hours. Be careful not to make prolonged use in the children’s room.

– Do not hesitate to use natural repellents of essential oil diluted in sweet almond oil applied to the skin. You can choose from thyme , citronella , pyrethrum, lavender , geranium and lemon balm . It is important to observe precautions for pregnant women and children.

– Chikungunya is not related to malformation of babies (eg hydrocephalus), unlike zika.

Read also: Dengue –  Aedes aegypti

News

Sources & references:
Presentation given November 8, 2015 by Dr. Chopra, from the University of Pune (India), at the annual meeting of the American College of Rheumatology (ACR), in San Francisco (California).
Disclaimer: This activity is not sanctioned by, nor a part of, the American College of Rheumatology. Ministry of Health (Brazil), presentation on November 7, 2017 by Dr. Arvind Chopra of the University of Pune, India, at the annual meeting of the American College of Rheumatology (ACR) in San Diego, California.

Responsible person involved in the writing of this file:
Xavier Gruffat (pharmacist and editor-in-chief of Create health.com.br).

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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