CHIKUNGUNYA

TIMOTHY DYCALLE P. MANOS, RN SO

Overview

Chikungunya fever, a disease caused by chikungunya virus, was almost a forgotten disease until recently; when it reemerged in Indian Ocean islands in 2005-2006. Within no time it acquired gigantic proportions affecting few million people in Asian countries, mainly India and Southeast Asian countries. Previously characterized as a self limiting disease, it appeared in more aggressive form during this epidemic. Most of the affected countries being favorite tourist destinations, there was a threat of spread of the disease globally.

AFRICA
Benin Burundi Cameroon

ASIA
Bangladesh Bhutan Cambodia

AMERICAS
Guadeloupe Martinique Saint Barthelemy

EUROPE
Italy France

OCEANIA_PACIFICISLAN DS
Federal States of Micronesia New Caledonia Papua New Guinea

Central African Republic

Comoros Democratic Republic of the Congo Equatorial Guinea Gabon Guinea Kenya Madagascar Malawi Mauritius Mayotte Nigeria Republic of Congo Reunion Senegal Seychelles Sierra Leone South Africa Sudan Tanzania Uganda Zimbabwe

China
India Indonesia Laos Malaysia Maldives Myanmar (Burma) Pakistan Philippines Singapore Sri Lanka Taiwan Thailand Timor Vietnam Yemen

Saint Martin

Chikungunya

In the Makonde language "that which bends up" Is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. The name chikungunya derives from a word in the Kimakonde language, meaning "to become contorted" and describes the stooped appearance of sufferers with joint pain (arthralgia)

Pathogenesis
Family: Togaviridae Genus: Alpha virus Species: Chikungunya virus

Aedes Aegypti Yellow Fever Mosquito

Aedes Albopictus Tiger Mosquito

CHAIN OF INFECTION

Case Presentation

This is a case of a 25 year old male who came in with a chief complain of high grade fever 3 days PTC, patient had Joint pain and general flushing of skin with on and off vomiting. Upon admission Assessment was immediately done by the NOD and ROD Nursing Diagnosis Acute pain related to dieses process

Risk / Predisposing Factors

Vectors: The primary vector is Aedes aegypti, a mosquito that can also transmit the Dengue and Yellow fevers. Though Aedes aegypti originated in Africa, it is now found in tropical areas worldwide. Authorities fear the virus could be spread globally because they have learned it can also be carried by the Asian Tiger mosquito, Aedes albopictus, which is found in Asia, Africa, Europe, the Americas, Australia, and New Zealand. Environment: Environmental factors and community behaviors play a significant role in the outbreak and spread of chikungunya. Heavy rains followed by stagnation of rain water in flower pots, broken and abandoned pots and utensils in and around the houses, abandoned vehicular tires in the vicinity of human dwellings or workplaces or in any other container that allows accumulation and stagnation of water promote the breeding of mosquitoes of the Aedes family.

Clinical Manifestation

Debilitating Arthralgia (joint pain) swelling of joints stiffness of joints Myalgia (muscular pain) headache fatigue (weakness) Nausea and vomiting Rashes fever.

Classification of disease presented

 Chikungunya is caused by Chikungunya Virus or CHIK Virus (CHIKV) and it belongs to the alphavirus family. 27 different types of alpha viruses cause diseases in humans and other mammals. Chikungunya virus is just one of them. Under virus classification Chikungunya Virus is a Group IV virus belonging to the Togaviridae family and Alphavirus genus. There are multiple variants of Chikungunya virus and new variants may appear after genetic mutations. O'nyong'nyong virus - This is an alphavirus which causes disease with symptoms very similar to Chikungunya virus. It is also transmitted by mosquito and the disease symptoms include arthritis, fever and rashes. This virus is so far limited to african countries mainly Uganda. It is not known to be fatal. Ross River virus - This is also an alphavirus which causes rashes and athritis. This virus epidemic is seen in Australia and some of the surrounding islands. This virus is also transmitted by mosquitoes.

Diagnostic Criteria

Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest three to five weeks after the onset of illness and persist for about two months. Reverse transcription polymerase chain reaction (RT-PCR) is one of many variants of polymerase chain reaction (PCR). This technique is commonly used in molecular biology to detect RNA expression levels Virus Isolation

Latest Medical Management

No vaccine or specific antiviral treatment is available. Symptomatic treatment with rest, fluids analgesics (acetaminophen) and anti-inflammatory agents like ibuprofen, naproxen5 may relieve symptoms in acute phase. Aspirin should be avoided. Chloroquine phosphate 250mg/day is helpful in managing prolonged arthralgias. It offers symptomatic relief and also may act as antiviral agent to combat chikungunya virus. Patients with persistent prolonged arthralgias respond better to chloroquine, which may be required up to 3-6months. Prolonged arthralgias may need treatment with, rest, mild exercises (range of motion exercises) which may be helpful in relieving pain and morning stiffness. Excessive exercises may worsen the symptoms.

Prevention tips:

Use mosquito repellent on exposed skin. Wear long sleeves shirts and pants. Have secure screens on windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Additionally, a person with chikungunya fever should limit their exposure to mosquito bites in order to avoid further spreading the infection. The person should stay indoors or under a mosquito net.

Research Focus Effective treatment for Chikungunya is available in homeopathy. Homeopathy has very effective treatment for Chikungunya. After diagnosis of Chikungunya, homeopathic treatment should be started as early as possible. Homeopathic treatment can also be given along with conventional treatment (allopathy) if desired. Conventional treatment consists of only symptomatic treatment of fever, stiffness, joint pain etc. of this viral illness, whereas homeopathic medicines give better and comparatively long lasting relief from the disease. Effective remedy can be chosen by a homeopathic doctor according to clinical picture of that particular case. Homeopathy works effectively in all viral diseases. Homeopathic pills are simply chewed (dissolved) on tongue and are sweet in taste. Homeopathic medicines do not cause gastric irritation, are safe on kidneys and liver even when taken for long duration.

Reference

http://naturalunseenhazards.wordpress.com/2009/09/23/chikungunya-feveryet-another-mosquito-borne-viral-disease-is-coming/ http://wwwnc.cdc.gov/travel/diseases/chikungunya http://apiindia.org/pdf/medicine_update_2008/chapter_27.pdf http://www.wikihow.com/Recognize-Chikungunya-Fever-Symptoms http://www.who.int/mediacentre/factsheets/fs327/en/ http://en.wikipedia.org/wiki/Chikungunya http://www.cdc.gov/chikungunya/transmission/index.html http://homeopathyhelps.com/chikungunya.htm

Nursing Care Plan

INTERVENTION Encourage patient to verbalize about pain NURSING INTERVENTION Administer Mefenamic Acid RATIONALE
Management of this viral disease focuses not onto directly treating the disease but rather control its symptoms. Chikungunya has no specific treatment until now. Supportive therapy will be an excellent option to cater the diseases presentation. Management of the signs and symptoms is the regimen of choice for this viral disease. NSAID (non-steroidal anti inflammatory drugs) are used to relieve arthritis and associated symptoms..

Summary

Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.