Transcript Chikungunya Fever

Chikungunya Fever
Dr.Madhusudan.S
• DIAGNOSIS
• TREATMENT
• PROGNOSIS
Clinical Diagnosis
• Chikungunya fever is suspected when
a child, presents with fever, rash and
joint symptoms more so during an
epidemic.
Chikungunya in Children
• Less likely to have joint symptoms
Even when present – milder , shorter
duration.
• High fever, febrile convulsions
• G.I.Symptoms – vomiting,pain
abdomen,constipation.
• Lymphadenopathy – more common
• Mild haemorrhagic symptoms – epistaxis,
petechial rash, positive tourniquet test.
Differential Diagnosis
• O’nyongnyong,
Mayaro,
Semliki forest.
Ross River,Sindbis,
West Nile,
Barmah forest
Not found in INDIA
Not found in INDIA
Rubella,Parvovirus B19,
Sixth disease,mumps,
Hepatitis A & B,
Lymphadenopathy,
Salivary, extra salivary
Tender hepatomegaly
Epstein Barr Virus
Gen lymphadenopathy
& hepatosplenomegaly.
Cough,chestpain,icterus,
lymphadenopathy,hepat
omegaly,splenomegaly.
Leptospirosis
Epidemic/endemic
typhus
Scrub typhus
Not seen in INDIA
G.I/Resp/rash(13%)
Eschar/cough/G.I.
Enteric fever
Relapsing Fever
(tick borne)
Henoch Schonlien
purpura.
Pain abd,diarrhoea,
Constipation,
Hepatosplenomegaly
G.I./Rash(18%)
Palpable purpura,G.I,
Renal(hematuria,HTN)
Serum sickness
Urticaria,drug exposure.
Drug induced eruptions
Intensely pruritic.
RF with E.marginatum.
Carditis,chorea,scnodule
Dengue-The closest imitator
• Found in the same areas
• Dual infections reported in some cases
• Overlapping clinical features
• Children – greater incidence of haemorrhagic
symptoms than adults
DENGUE
Endemic
CHIKUNGUNYA
Sporadic explosive
outbursts,vanishes &
reappears.
Altered taste, postillness bradycardia and
depression,asthenia
Rash,conjunctival
injection,arthralgia,
myalgia
Shock,hemorrhagic
symptoms
Prolonged joint pains
Laboratory Diagnosis
3-5wks
2-3 days
4-7 days
m-yrs
2 months
15 days
Demonstration of the virus
• Gold standard & most specific
• Culture-vero cells
-C6/36 Aedes albopictus cells
• Intracerebral inoculation in newborn mice
• PCR
Demonstration of the antibodies
Diagnostic test of choice:
• IgM ab capture ELISA
• IgG ab indicate past infection and without
four fold rise of ab titre do not implicate
the disease.
Principle of ELISA
Other Investigations
• CBC-Leucopenia
• Thrombocytopenia
• ^AST,ESR,CRP
• Chronic joint symptoms-synovial fluid
Dec viscosity, poor mucin clot formation, WBC2000-5000/mm3
TREATMENT-SUPPORTIVE
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Bedrest during fever
Antipyretics and tepid sponging
Analgesics and mild sedation
Aspirin avoided-bleeding/Reye’s Syndrome
Arthtritis-continued NSAID,movements,mild joint
exercises
Children-lose excessive fluids-ORS
Break transmission cycle.
ROLE OF CHLOROQUINE
• 12%-Chr joint symptoms-partial response
to NSAIDS.
• Study in France-10 patients 250mg/day
for 20 weeks
• 7/10-patient
5/10 doctor
• Further studies needed
PROGNOSIS
• Most recover in few weeks
• 12%months to years
• Pregnancy-fever may cause abortions,preterm
labour,fetal distress.
• Infants-90%-recover without sequelae
“Thankfully, the disease has proved so
mild ; had it been different , this city,
the home to half a million human
beings would have become one vast
charnel house with nobody to bury the
dead and few to save the living”
James Mellis,
Calcutta epidemic
1963-64