1. Chikungunya Fever
Dr.Madhusudan.S

2. DIAGNOSIS
TREATMENT
PROGNOSIS

3. Clinical Diagnosis
Chikungunya fever is suspected when a child, presents with fever, rash and joint symptoms more so during an epidemic.

4. 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

5. Mild haemorrhagic symptoms – epistaxis, petechial rash, positive tourniquet test.

6. Differential Diagnosis
O’nyongnyong,
Mayaro,
Semliki forest.
Not found in INDIA
Ross River,Sindbis,
West Nile,
Barmah forest

7. Rubella,Parvovirus B19,
Sixth disease,mumps,
Hepatitis A & B,
Lymphadenopathy,
Salivary, extra salivary
Tender hepatomegaly
Epstein Barr Virus
Gen lymphadenopathy
& hepatosplenomegaly.
Leptospirosis
Cough,chestpain,icterus,lymphadenopathy,hepatomegaly,splenomegaly.
Epidemic/endemic typhus
Scrub typhus
Not seen in INDIA
G.I/Resp/rash(13%)
Eschar/cough/G.I.

8. Enteric fever
Relapsing Fever
(tick borne)
Pain abd,diarrhoea,
Constipation,
Hepatosplenomegaly
G.I./Rash(18%)
Henoch Schonlien purpura.
Serum sickness
Drug induced eruptions
RF with E.marginatum.
Palpable purpura,G.I,
Renal(hematuria,HTN)
Urticaria,drug exposure.
Intensely pruritic.
Carditis,chorea,scnodule

9. 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

10. DENGUE
CHIKUNGUNYA
Endemic
Sporadic explosive outbursts,vanishes & reappears.
Altered taste, post-illness bradycardia and depression,asthenia
Rash,conjunctival
injection,arthralgia,
myalgia
Shock,hemorrhagic symptoms
Prolonged joint pains

11. Laboratory Diagnosis IgG Vir IgM m-yrs 3-5wks 4 2 months 2-3 days

12. Demonstration of the virus
Gold standard & most specific
Culture-vero cells
-C6/36 Aedes albopictus cells
Intracerebral inoculation in newborn mice
PCR

13. 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.

14. Principle of ELISA
ligand Ag AB
Anti AB
Enz

15. Other Investigations CBC-Leucopenia Thrombocytopenia ^AST,ESR,CRP
Chronic joint symptoms-synovial fluid
Dec viscosity, poor mucin clot formation, WBC /mm3

16. TREATMENT-SUPPORTIVE
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.

17. 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

18. PROGNOSIS Most recover in few weeks 12%months to years
Pregnancy-fever may cause abortions,preterm labour,fetal distress.
Infants-90%-recover without sequelae

19. “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