I would like details on CHIKUN-GUNYA, a terrible viral fever?
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ALPHAVIRUSES
S.K. Lam and K.B. Chua, WHO Collaborating Centre for Arbovirus Reference and Research (DF/DHF), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur.
Alphaviruses are known to give rise to a spectrum of disease in humans, ranging from silent asymptomatic infections to undifferentiated febrile illness to devastating encephalitis. The following alphaviruses have been associated primarily with fever and polyarthritis.
Chikungunya virus
CHIK is responsible for extensive Aedes aegypti-transmitted urban disease in cities in Africa and major epidemics in Asia. The crippling arthralgia and frequent arthritis that accompany the fever and other systemic symptoms are clinically distinct. Several other togaviruses of the alphavirus genus (Ross River, O’nyong-nyong, etc) have been associated with a similar syndrome. CHIK activity in Asia has been documented since its isolation in Bangkok in 1958. Other countries which have reported CHIK activity include Cambodia, Vietnam, Myanmar, Sri Lanka, India, Indonesia, and the Philippines.
CHIK virus is transmitted in the savannahs and forests of tropical Africa by Aedes mosquitoes of the subgenera Stegomyia and Diceromyia. Aedes aegypti is an important vector in urban epidemics in both Africa and Asia.
Clinical Features
CHIK is an acute infection of abrupt onset, heralded by fever and severe arthralgia, followed by other constitutional symptoms and rash, and lasting for a period of 1-7 days. The incubation period is usually 2-3 days, with a range of 1-12 days. Fever rises abruptly, often reaching 39 to 40 degrees centigrade and accompanied by intermittent shaking chills. This acute phase lasts 2-3 days. The temperature may remit for 1-2 days, resulting in a "saddle-back" fever curve.
The arthralgias are polyarticular, migratory, and predominantly affect the small joints of the hands, wrists, ankles and feet, with lesser involvement of larger joints. Pain on movement is worse in the morning, improved by mild exercise, and exacerbated by strenous exercise. Swelling may occur, but fluid accumulation is uncommon. Patients with milder articular manifestations are usually symptom-free within a few weeks, but more severe cases require months to resolve entirely. Generalized myalgia, as well as back and shoulder pain, is common.
Cutaneous manifestations are typical with many patients presenting with a flush over the face and trunk. This is usually followed by a rash generally described as maculopapular. The trunks and limbs are commonly involved, but face, palms and soles may also show lesions. Pruritis or irritation may accompany the eruption.
During the acute disease, most patients will have headache, but it is not usually severe. Photophobia and retroorbital pain also occur but not severe. Conjunctival injection is present in some cases. Some patients will complain of sore throat and have pharyngitis on examination.
CHIK infection has a somewhat different picture in younger patients. Arthralgia and arthritis occur but are less prominent and last a shorter time. Rash may be less frequent; but in infants and younger children, prominent flushing and early appearance of maculopapular or urticarial eruption may be a useful indicator.
In Asia, several virus isolations have been made from severely ill children diagnosed as having haemorrhagic fever, similar to DHF.
Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from the Aedes aegypti mosquito. 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. Chikungunya is closely related to O'nyong'nyong virus.
Chikungunya is not considered to be fatal. However, in 2005-2006, 200 deaths have been associated with chikungunya on Réunion island.
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. There can also be headache, conjunctival injection and slight photophobia.
While supportive or palliative medical care with anti-inflammatories and analgesics is available, there is no specific treatment for chikungunya. The illness is usually self-limiting and will resolve with time. Symptomatic treatment is recommended after excluding other more dangerous diseases. Vaccine trials were carried out in 2000, but funding for the project was discontinued and there is no vaccine currently available.
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 actual plague in the Indian Ocean and a threat to the Mediterranean coast at present, requiring urgent meetings of health officials of France, Italy and Spain, but nothing seems to be moving that way.
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