Chikungunya is an epidemic disease, broke out in Bangladesh in 2017. It was first identified in Tanzania 1953. From then it continuously rose as an epidemic disease after some interval in Asia, Africa and even in America.

1. Dr. Shakil Ahmed
BDS (DU), MPH (NSU)

2. Aim of This Presentation
To Highlight:
oChikungunya Virus
oEpidemiology
oClinical Feature
oDiagnosis
oTreatment
oPreventive Measures
oJournal review &
oRecommendation

3. Chikungunya is a mosquito borne viral disease transmitted in
human by an alpha virus that is spread by the infected ‘Aedes
aegypti’ & ‘Aedes albopictus’ mosquitos.
The word “Chikungunya” means “to become contorted”, as the
affected person walks in a stooped posture because of joint pain.

4. Causes of Chikungunya Virus
oChikungunya is Caused by ‘Chikungunya Virus’ (CHIKV).
oChikungunya virus (CHIKV), is a member of the alphavirus genus,
and Togaviridae family.
o It was first isolated in 1953 in Tanzania.
o It is an RNA virus.
o It can also be referred to as an arbovirus (arthropod-borne virus as
the mosquito itself is an arthropod).

5. Transmission of Chikungunya
oChikungunya virus is most commonly transmitted to humans through
the bite of an infected mosquito of the Aedes genus, usually by `Aedes
aegypti’ & ‘Aedes albopictus’
oHuman and non-human vertebrates serve as the Chikungunya virus
reservoir.

6. Epidemiology of Chikungunya
o Chikungunya has been identified in over 60 countries in Asia, Africa,
Europe and the Americas.
o It was first described during an outbreak in southern Tanzania in 1952.
oBeginning in the 1960s, periodic outbreaks were documented in Asia
and Africa.
oHowever, since 2005, following several decades of relative inactivity,
chikungunya has re-emerged and caused large outbreaks in Africa, Asia,
and the America.

7. Epidemiology (Contd…)
oIn 2005, an outbreak on the Island of Réunion was the largest then
documented, with an estimated 272,000 cases on an island with a
population of approximately 770,000.
oIn a 2006 outbreak, India reported 1.5 million suspected cases.
o Chikungunya was recently introduced to the Americas, and from
2013-14 in the Americas, 1,118,763 suspected cases and 24,682
confirmed cases were reported by the PAHO.

9. Chikungunya in Bangladesh
o Chikungunya was first detected in Bangladesh in 2008. (Health and Science
Bulletin, volume 7. march 2009)
o1st outbreak seen in Rajshahi dist. affected 32 people.
o2nd outbreak occured in 2009, in Shathiya Upazilla of Pabna.
oThe 3rd outbreak occured in Bangladesh in 2017.
oInstitute of Epidemiology, Disease Control and Research (IEDCR) noticed
the presence of the disease In Dhaka in 2011.

10. Chikungunya in Bangladesh (Contd..)
oSince May 2017 Dhaka has affected by 27,00 cases of chikungunya
where as From the onset of the outbreak in April 1, 2017, to Sept 7,
2017.
oThe Bangladesh Ministry of Health reported 984 cases confirmed by
real-time and more than 13,176 clinically confirmed cases in 17 of 64
districts.
oA major outbreak has been observed in the capital, Dhaka.

11. Signs & Symptoms
Symptoms appear between 4 - 7 days after the patient has been bitten by
the infected mosquito and these include:
oHigh fever (40°C/ 104°F)
oJoint pain (ankle, knees, wrists or phalanges)
oJoint swelling
oRash
oHeadache
oMuscle pain
oNausea
oFatigue

13. Mortality & Morbidity
oChikungunya is rarely a fatal disease and when they occur are
associated with either young age or with Trombocytopenia.
oHemorrhagic version of illness, that can lead to shock.
oSymptoms are generally self-limiting and last for 2–3 days.

14. Risk Factors
oThe proximity of mosquito breeding sites to human habitation.
oNatural and artificial water-filled container habitats that support
breeding of the mosquitoes.
oHot rainy season.
oImmunocompromised patients.
oViral mutation.
oIncreased air travel, tourism.

15. Diagnosis of Chikungunya
Several methods can be used for diagnosis. such as -
oEnzyme-linked immunosorbent assays (ELISA), may confirm the
presence of IgM and IgG anti-chikungunya antibodies.
oRT-PCR
Note: Chikungunya shares some clinical signs with dengue and can be misdiagnosed in areas where
dengue is common.

16. Treatment of Chikungunya
oThere is no specific antiviral drug treatment for chikungunya.
o Treatment is directed primarily at relieving the symptoms,
including joint pain using anti-pyretics, optimal analgesics
and fluids.
oThere is no commercial chikungunya vaccine till date.

18. Prevention of Chikungunya
oControlling mosquito populations by limiting their habitat.
o Insecticides or biological control agents can be used.
oUsing insect repellents with substances such as DEET, icaridin,
PMD or IR3535.
oWearing bite-proof long sleeves and trousers also offers
protection.
oSecuring screens on windows and doors at house will help to
keep mosquitoes out of the house

19. REVIEW OF A LATEST PUBLISHED PAPER
ON CHIKUNGUNYA

20. PAPER REVIEW…
TITLE:
• “Chikungunya: an emerging viral infection with varied clinical presentations
in Bangladesh: Reports of seven cases”
AUTHORS:
• Muhammad Abdur Rahim* and Khwaja Nazim Uddin *
AFFILIATION:
* Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine
and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka

21. PAPER REVIEW…
JOURNAL DETAILS:
• BMC Research Notes, BioMed Central ( Online)
• Published on : 15 August 2017
• (Rahim and Uddin BMC Res Notes (2017) 10:410 DOI 10.1186/s13104-017-
2723-5)
• https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-2723-5
• bmcresnotes@biomedcentral.com

22. METHODOLOGY:
• A clinical case series study was conducted on admitted patients at the Department of
Internal Medicine, BIRDEM General Hospital in June, 2017
• All patients (n=7, 4 males, 3 females) presenting with fever (recorded temperature ≥
100.4˚F ) and clinically confirmed to have chikungunya by :
 a positive “Anti-chikungunya antibody (IgM) ICT” test OR
 a positive “RT-PCR” test
• A “register” of cases was made and reported
• Varied clinical presentations and laboratory findings among this group of patients
were analysed
• Co-infection with dengue fever was also explored

23. RESULTS:
• A. CLINICAL:
CLINICAL FEATURES NUMBER OF PATIENTS
AFFECTED
Fever 07
Rash 02
Arthralgia/Arthritis
(hands,feet,wrists,knees)
05
Gastrointestinal (vomiting,
diarrhoea)
04
Lymphadenopathy 01
Acute Kidney Injury (AKI) 01

24. RESULTS:
• B. LABAROTARY FINDINGS :
INVESTIGATION NUMBER OF PATIENTS
Positive “Anti-chikungunya antibody (IgM) ICT 07
Positive “RT-PCR” 03
Platelet Count (Thrombocytopenia) None
S.ALT ( Altered Liver Function) 01
S. Creatinine ( Acute Kidney Injury) 01
*Dengue NS1 Positive None

25. CONCLUSION:
• Chikungunya is a relatively new entity in Bangladesh. During the rainy
season, an acute febrile illness with joint pain should raise suspicion
• In spite of being a self-limiting disease, chikungunya may have different
presentations and a protracted clinical course-specifically a prolonged period
of joint pain
• Typical laboratory findings may not be seen in all patients

26. RECOMMENDATIONS:
• Physicians should be aware that exclusion of differential diagnoses such as
dengue fever, zika infection are equally important to establishing a diagnosis
of chikungunya- dengue-chikungunya co-infections
• Intensive public health initiatives including clearing households and
mosquito breeding sites and public awareness are necessary to break the
disease transmission

27. CRITICAL COMMENTS:
• Study sample size (n=7) may not be representative of the total burden of
chikungunya cases in Banmgladesh
• The study could have been conducted over a longer period of time,
coinciding with the chikungunya outbreak till September of that year.