Mrs. RDB, a 68-year-old female, presented with high fever, joint pain and swelling for 1 day. Tests confirmed Chikungunya virus. She was treated with IV fluids, paracetamol, pantoprazole, atorvastatin, vitamins and ondansetron for nausea. Her symptoms improved over 4 days with treatment and she was discharged. She was counseled on Chikungunya, medications, lifestyle changes and follow up in 5 days.

1. CASE PRESENTATION ON
CHIKUNGUNYA
By
R.Anusha
Pharm D V Year
Roll No:170514882007.

2. Patient name: Mrs.RDB
Gender : Female
Age:68 years
IP No:285403
DOA:20/10/18
DOD:23/10/18

3. SUBJECTIVE
• Chief Complaints: Complaints of high grade fever with joint
pains and swelling.
• Present Illness History: Patient presented to ER with
complaints of high grade fever with joint pains and swelling
since one day.
• Past medical/medication history: Nil
• Allergies: NKDA

4. OBJECTIVE
PHYSICAL APPEARANCE:
Height: 162cms.
Weight: 80kg.
B.M.I.: 30.5kg/m2.
VITALS:
B.P: 120/80 mmHg.
R.R: 20 breaths/min.
P.R: 110 beats/min.
Pain score: 3/10.(Body
pain)
Temperature: 103 degree F.

5. Provisional diagnosis:
?Viral pyrexia
Diagnostic test:
Chikungunya PCR positive
FINAL DIAGNOSIS:
Chikungunya fever

6. DRUG CHART
Brand Generic Dose ROA Freq. Category Indication
IV Fluid NS 0.9%NaCl 75
ml/hr
IV On
flow
Electrolyte Hydration
T.DOLO Paracetamol 650
mg
PO TID Antipyretic Fever
Inj.PAN Pantoprazole 40
mg
IV OD PPI Ulcer
prophylaxis
T.ATORVAS Atorvastatin 10
mg
PO HS Statin Dyslipidemia
(CVD
prevention)
T.NEUROBIAN
FORTE
Multivitamin 1 tab PO OD Vitamin
supplement
Nutrition
T.ZOFER Ondansetron 4 mg PO BD Anti-emetic Vomiting

7. SOS/STAT Medications
Brand Generic Dose ROA Freq. Category Indication
Inj.TRAMADOL Opioid
analgesic
50 mg IV STAT Analgesic Pain
Inj.PERFALGAN Paracetamol 500 mg IV STAT Anti
pyretic
Fever
Inj.ZOFER Ondansetron 8 mg IV STAT Anti-
emetic
vomiting

8. TREATMENT GOALS AND GENERAL
MANAGEMENT
• It is important to exclude other serious infections similar to
chikungunya such as dengue, malaria, or bacterial infections.
• Providing intravenous(IV) fluid and electrolyte replacement.
• Treatment is aimed at relieving symptoms.
• To improve quality of life.

9. ASSESSMENT
DAY-1(20/10/18)
• Patient presented to ER with complaints of high grade fever
with joint pains and swelling since one day.
• C/O high grade fever(103)
• ?VIRAL PYREXIA(Pd)
• Initially patient was treated with IV Fluids, analgesic and
antipyretic treatment.
• IV Fluids NS @75ml/hour IV on flow given for fluid and
electrolyte balance/replenishment.

10. • T.DOLO 650 mg PO TID was given for fever(1030) and pain
relief.
• It prevent the release of substances, called prostaglandins,
that increase pain and body temperature.
• Inj.PAN 40 mg PO OD was given for APD.
• T.ATORVAS 10mg PO HS was given for cardiovascular
disease prevention as patient is above 65 years and also
obese.
Day -2(21/10/18)
BP:110/60 mm Hg
PR:88/min

11. • Required investigations were done which revealed
chikungunya PCR +Ve.
• There is no specific anti-viral treatment is available to
chikungunya.
• Treatment is entirely symptomatic.
• Inj. PERFALGAN 500 mg IV STAT was given to reduce high
grade fever and joint pain. Paracetamol is the drug of choice
with use of other analgesics if paracetamol does not provide
relief.
• During the acute stage of the disease, steroids are not usually
indicated because of the adverse effects.
• Aspirin is preferably avoided for fear of gastrointestinal and
other side effects.

12. • Inj. TRAMADOL 50 mg IV STAT was given for joint pains.
• The analgesic properties of Tramadol can be attributed to
norepinephrine and serotonin reuptake blockade in the CNS,
which inhibits pain transmission in the spinal cord.
• T.NEUROBIAN FORTE 1 tab PO OD was given as vitamin
supplement. It keeps well-balanced Vitamins in the body.
• Patient complained about nausea like symptom on day-2. So,
T.ZOFER 4mg PO OD was added for nausea.
• Patient had 1 episode of vomiting , So Inj. ZOFER 8mg IV
STAT was given to control Vomiting’s.
• It works by blocking the action of serotonin, a natural
substance that may cause nausea and vomiting.

13. Day -3 (22/10/18)
BP:110/80 mm Hg
PR:88/min
• Patient was feeling better and temperature decreased :1000 F
• No complaint of Vomiting’s.
• Same treatment was continued and ZOFER was stopped.
Day -4 (23/10/18)
BP:130/80 mm Hg
PR: 80/min
• Patient general condition was fair and afebrile.
• Same treatment was continued.
• Fever reduced and patient is symptomatically better and being
discharged with stable vitals.

14. PLAN
MONITORING PARAMETERS:
• Monitor vitals
• Watch for fever spikes
• Maintain MAP>65mm of Hg

15. Patient counselling
Disease related
Chikungunya is a viral disease which is transmitted to the
humans by infected mosquitoes.
Symptoms appear between 4 and 7 days after the patient has
been bitten by the infected mosquito and these includes:
• High fever, Joint pain and swelling, Rash, Headache, Muscle
pain, Nausea, Fatigue ,Tachycardia.
Chikungunya is rarely fatal.
Symptoms are generally self-limiting and last for 2-3 days , but
in some cases joint pain can last a few months.

16. Drug related:
T.DOLO 650 mg to be taken orally twice daily after food for
3 days, given for fever.
Cap.TRAMAZAC 50mg to be taken orally in case of severe
joint pain.
T.PANTOP 40mg to be taken once daily before breakfast for
15 days, given for acidity.
T.NEUROBIAN FORTE 1 tab to be taken orally once daily
after breakfast for 15 days ,given as vitamin supplement.
T.ATORVAS 10mg 1tab to be taken orally at bed time, given
to continue as a statin
Review after 5 days with reports of CBC,LFT.

17. LIFE STYLE MODIFICATIONS
• Get plenty of rest.
• Drink fluids to prevent dehydration
• To prevent the spreading of disease to other family members
by mosquito control-insect repellent, mosquito nets.
• Mild forms of exercise and physiotherapy are recommended.
• Avoid self medication with aspirin or other pain killers.