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CHIKUNGUNYA
Chikungunya
is a relatively rare form of viral fever
caused by an alphavirus
that is spread by mosquito
bites from the Aedes
aegypti mosquito,
though recent research by the Pasteur Institute in
Paris claims the virus has suffered a mutation that
enables it to be transmitted by Aedes
albopictus (Tiger mosquito). This was the cause of
the plague in the Indian
Ocean and a threat to the Mediterranean coast at
present, requiring urgent meetings of health officials
in France, Italy,
and Spain.
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. The disease was first
described by Marion Robinson[1]
and W.H.R. Lumsden[2]
in 1955, following an outbreak on the Makonde Plateau,
along the border between Tanganyika
and Mozambique,
in 1952. Chikungunya is closely related to O'nyong'nyong
virus[3].
Chikungunya is generally not
fatal. However, in 2005-2006, 200 deaths have been
associated with chikungunya on Réunion
island and a widespread outbreak in India
(especially in Tamil Nadu, Karnataka, Kerala,
and Andhra
Pradesh). Andhra Pradesh saw a huge outbreak which
spread to neighbouring states. As of September 2006,
after the flood and heavy rains in Rajasthan
in August 2006, India,
thousands of cases have been detected in Rajsamand, Bhilwara,
Udaipur,
and Chittorgarh
districts and also in adjoining regions of Gujarat
and Madhya
Pradesh.
The European Network for
Diagnostics of "Imported" Viral Diseases (ENIVD)
claims new phylogenetic variants of virus which are
fatal have been identified on Réunion.
As of October
12, 2006
in the southern Indian state of Kerala, 125 deaths are
attributed to Chikungunya and majority of the
casualties were reported in the district of Alapuzha
[mainly in Cherthala Taluk]. This latest outbreak in
Alappuzha is supposed to have transferred from
Parassala, the southernmost point of Kerala state
where a recent outbreak was reported before the
episodes of Alappuzha started. Kerala government has
termed this as an epidemic outbreak, whereas the Tamil
Nadu government has denied that the deaths caused in
the state were due to chikungunya.
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- Symptoms
The Aedes aegypti
mosquito
- 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 infection, and slight photophobia.
In the present epidemic in the states of Andhra
Pradesh and Tamil Nadu, India, high fever and
crippling joint pain are the prevalent complaint. The
fever typically lasts for two days and abruptly comes
down. However, other symptoms, namely joint pain,
intense headache, insomnia
and an extreme degree of prostration last for a
variable period, usually for about 5 to 7 days.
- Dermatological
manifestations observed in a recent outbreak of
Chikungunya fever in Southern India (Dr. Arun Inamadar,
Dr. Aparna Palit, Dr.V.V. Sampagavi, Dr. Raghunath S,
Dr. N.S. Deshmukh), Western India (Surat) (Western
India reported by Dr. Buddhadev) and Eastern India (Puri)
(Dr. Milon Mitra et al) includes the following:
- Maculopapular
rash
- Nasal blotchy erythema
- Freckle-like
pigmentation over centro-facial area
- Flagellate
pigmentation on face and extremities
- Lichenoid eruption and
hyperpigmentation in photodistributed areas
- Multiple aphthous-like ulcers
over scrotum,
crural areas and axilla.
- Lympoedema in acral
distribution (bilateral/unilateral)
- Multiple ecchymotic spots
(Children)
- Vesiculobullous lesions
(infants)
- Subungual hemorrhage
- Photo Urticaria
- Acral Urticaria
- Pedal oedema (swelling of legs)
is observed in many patients, the cause of which
remains obscure as it not related to any
cardiovascular, renal or hepatic abnormalities.
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Treatment
- There is no specific treatment
for Chikungunya. Vaccine
trials were carried out in 2000, but funding for the
project was discontinued and there is no vaccine
currently available. A serological
test for Chikungunya is available from the University
of Malaya in Kuala
Lumpur, Malaysia.
- Chloroquine
is gaining ground as a possible treatment for the
symptoms associated with Chikungunya and as an
antiviral agent to combat the Chikungunya virus.
According to the University
of Malaya, "In unresolved arthritis
refractory to aspirin
and nonsteroidal anti-inflammatory drugs, chloroquine
phosphate (250 mg/day) has given promising
results." [1]
Research by Italian scientist, Andrea
Savarino, and his colleagues in addition a French
government press release in March 2006 [2]
have added more credence to the claim that chloroquine
may be effective in treating Chikungunya. The CDC fact
sheet on Chikungunya advises against using Aspirin.
Ibuprofen, Naproxen and other non-steroidal
antiinflammatory drugs 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 indicated during the acute joint
symptoms. Movement and mild exercise tend to improve
stiffness and morning arthralgia,
but heavy exercise may exacerbate rheumatic
symptoms." [3]
- The Homoeopathic system of
medicine claims to have medicines as well as
preventives against this disease.The effect of these
medicines are not scientifically proved. They claim to
have used these effectively in recent out breaks in
Kerala state of India.
- The unani medicines (Herbal) are
giving much relief in joint pains. [4]
- Ayurvedic medicine for Chicken
Gunia is getting cured within a week. Three medicines
are required: Sudarsan Churna – 2 spoons, Yogiraj
Googgle – 2 tabs (these two medicines are available
in all Ayurvedic shops), Dry red grapes - (4 pieces)
should be boiled in 250 ml of COW's Milk (not awain)
add little (25-50 ml) water also (so that gas will not
be formed). No need to add sugar. The milk should be
drunk and the dry grapes should be eaten (remove the
seeds). It can be taken same as above i.e, two times.
All these should be taken in the morning in empty
stomach, and in evening before bed (1 hour before). If
you follow it continuously for one week you can see
the difference. Although the disease goes away the
remaining medicines should be taken till it finishes. [5]
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Epidemiology
- Chikungunya was first described
in Tanzania,
Africa in 1952.
An outbreak of chikungunya was also discovered in Port
Klang in Malaysia
in 1999
affecting 27 people [6] [7].
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Preventive
measures
- The most effective means of
prevention are those that protect against any contact
with the disease-carrying mosquitos. These include
using insect repellent containing DEET
or permethrin,
wearing long sleeves and pants, and securing screens
on windows and doors. It's also important to empty
stagnant water where mosquitoes breed. [8].
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Linguistic
derivation
- According to Lumsden's initial 1955
report about the epidemiology
of the disease, the term chikungunya is derived from
the Makonde
root verb kungunyala, meaning to dry up or become
contorted. In concurrent research, Robinson glossed
the Makonde
term more specifically as "that which bends
up." Subsequent authors apparently overlooked the
references to the Makonde
language and assumed that the term derived from Swahili,
the lingua
franca of the region. The erroneous attribution of
the term as a Swahili word has been repeated in
numerous print sources; Google
lists over 15,000 results in a search for "chikungunya
swahili". Many other spellings and forms of the
term are in common use including "Chicken
guinea" and Chickengunya.
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