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Chikungunya 1214578918610346 8

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  • 1. CHIKUNGUNYA Dr.T.V.Rao MD
  • 2. What is Chikungunya
    • Manifest with Crippling Arthritic disease of sudden onset.
    • Name is derived from Swahili – Chikungunya meaning that which bends up
    • Virus isolated in 1953 from serum and Aedes mosquitoes and Culex spp
  • 3. Chikungunya Virus
    • Family – Togaviridae
    • Genus - Alpha virus
    • Chikungunya viral infection manifests with febrile illness
  • 4. Epidemics of Chikungunya
    • Large epidemics were recognized in Transvaal of South Africa, Zambia, India and South east Asia, Philippines .
  • 5. Update - Chikungunya
  • 6. Out Breaks of Chikungunya
    • Out breaks occur during rainy season with increasing densities of Aedes aegypti mosquito
    • Mosquitos bites infect the Humans
    • Laboratory acquired infection can also occur
  • 7. Chikungunya a Mosquito transmitted viral infection
  • 8. Cycle of Infection
  • 9. History
    • Isolated in Aedes aegypti mosquitoes and man in 1952 in Tanzania
    • Appeared in India in 1963
    • Major epidemic outbreaks in Calcutta, madras and other areas
    • Manifested with Major epidemics till 1973
  • 10. Clinical features
    • Incubation 3 – 12 days
    • Fever may rise to 103 0 c to 104 0 c with rigors
    • Viremia lead to fever.
    • Fever leads to release of large amount of Interferons
  • 11. Clinical manifestations
    • Fever,
    • Crippling Joint pains
    • Lymphadenopathy
    • Conjunctivitis
    • A Maculopapular rash
    • May lead to hemorrhagic manifestations,
    • Fever is biphasic with remission after 1 - 6 days of fever.
  • 12. How some Indian patients presented
    • In India but not in Africa, patients presented with Inguinal lymphadenopathy and red swollen ears, and are observed as part of clinical picture.
  • 13. Morbidity and Mortality
    • Fatalities are rare and when they occur are associated with either with young age or with Thrombocytopenia
    • Hemorrhagic version of illness, that can lead to shock
  • 14. Diagnosis
    • The primary differential diagnosis of Chikungunya, should be made from Dengue, and O’Nyong nyong fevers
    • Chikungunya manifest with Myalgia rather than Arthritis.
  • 15. Microbiological Diagnosis
    • Isolation of Virus
    • Amplification of Nucleic acid
    • Routine Diagnosis with serology
    • Detection of IgM antibody provides a specific and reliable means for early diagnosis
    • ELISA and Dot blotting methods are used
  • 16. Treatment
    • Chikungunya fever is not a life threatening infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory drugs along with rest usually suffices. While recovery from Chikungunya is the expected outcome, convalescence can be prolonged (up to a year or more), and persistent joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy
  • 17. Vaccines for Chikungunya
    • An experimental – live attenuated vaccine ( TSI – GSD – 218 ) enveloped by passage of an isolate from Thailand in MRC – 5 cell.
    • At present used in some laboratory workers who can be protected, Vaccine produces neutralizing antibodies
  • 18. How Chikungunya can be Prevented
    • There is neither Chikungunya virus vaccine nor drugs are available to cure the infection.  Prevention, therefore, centers on avoiding mosquito bites.  Eliminating mosquito breeding sites is another key prevention measure.   To prevent mosquito bites, do the following:
    • Use mosquito repellents on skin and clothing
    • When indoors, stay in well-screened areas.   Use bed nets if sleeping in areas that are not screened or air-conditioned.
    • When working outdoors during day times, wear long-sleeved shirts and long pants to avoid mosquito bite.
    •  
  • 19. Control of breeding of Aedes Mosquitos
    •        Source reduction Method
    • (i)                 By elimination of all potential vector breeding places near the domestic or peri-domestic areas.
    • (ii)               Not allowing the storage of water for more than a week.  This could be achieved by emptying and drying the water containers once in a week.
    • (iii)             Straining of the stored water by using a clean cloth once a week to remove the mosquito larvae from the water and the water can be reused.  The sieved cloth should be dried in the sun to kill immature stages of mosquitoes.
  • 20. Use of larvicides
    • (i)                 Where the water cannot be removed but used for cattle or other purposes, Temephos can be used once a week at a dose of 1 ppm (parts per million).
    • (ii)               Pyrethrum extract (0.1% ready-to-use emulsion) can be sprayed in rooms (not outside) to kill the adult mosquitoes hiding in the house.
  • 21. Indian Epidemic
    • The states affected by chikungunya are Andhra Pradesh, Karnataka, Maharasthra, Madhya Pradesh, Tamil Nadu, Gujarat & Kerala. In the year 2006, total number of 1390322 suspected Chikungunya fever cases were reported from the country.
  • 22. Severity of Indian Epidemic
    • Till 10 October 2006, 151 districts of eight states/provinces of India have been affected by Chikungunya fever. The affected states are Andhra Pradesh, Andaman & Nicobar Islands, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, Kerala and Delhi.
    • More than 1.25 million cases have been reported from the country with 752,245 cases from Karnataka and 258,998 from Maharashtra provinces. In some areas attack rates have reached up to 45%.
  • 23. Current Research on Chikungunya
    • Researchers at the Institut Pasteur have managed to retrace the origin and evolution of the Chikungunya virus in the Indian Ocean through complete sequencing of the genome of six viral strains isolated from patients from Reunion Island and the Seychelles, as well as through partial sequencing of the viral protein E1 from 127 patients from the Indian Ocean islands (Reunion,Madagascar, Seychelles, Mauritius, Mayotte). Their study, published in PLoS Medicine, opens up new research paths that should help to explain the magnitude of the epidemic and the occurrence of severe forms of the disease.
  • 24. Created for Health Awareness on Chikungunya Dr.T.V.Rao MD. Email [email_address]