What is chikungunya?
Chikungunya is a viral disease that is spread by the same mosquitos that carry dengue and Zika viruses. On occasion, it may pass from the mother to the new-born shortly after birth. It could also be transmitted through infected blood through sharing injection needles, blood transfusion, and organ transplant.
Chikungunya spreads after an adult female Aedes aegypti or Aedes albopictus mosquito bites a person with the illness and gets infected. As the mosquito moves on to its next prey, always a human, it deposits the virus in their body. The disease transmission cycle keeps continuing like this.
Chikungunya disease is found over 110 countries in Asia, Africa, Europe, and the Americas. As of October 2022, there were 108,957 cases of chikungunya in India, according to the European Centre for Disease Prevention and Control. The transmission of this virus is typical in warm and rainy seasons because moist and wet weather is ideal for mosquito breeding.
Chikungunya signs and symptoms can be severe, but there is solid evidence proving that the affected person gains immunity against the virus after illness.
As mentioned earlier, the symptoms of chikungunya are severe and often debilitating. Most people who get infected with this virus have been documented as symptomatic. The incubation period of the virus is around 1 to 12 days, with an average period of 3 to 7 days.
The first few signs of chikungunya are a sudden spike in body temperature and joint pain. Even after the fever subsides, the effects of the virus do not fully fade. The joint pain from chikungunya can often last for months after a patient has recovered. What’s more that people should know about chikungunya disease is that the symptoms are quite like those of dengue and malaria. Death from chikungunya is rare unless one has underlying medical conditions like diabetes, cardiovascular disease, high blood pressure, among others.
Chikungunya can only be contracted once before developing antibodies against the virus. According to the scientific proof so far, people are likely to have lifetime immunity.
The symptoms known to this disease are as follows:
• Fever and chills (between 100 to 104 °C)
• Nausea and vomiting
• Eyes becoming sensitive to bright light (photophobia)
• Muscle aches and pain (myalgia)
• Extreme joint pain (arthralgia)
• Chikungunya rash (maculopapular rash)
• Joint swelling
• Conjunctivitis (also known as pinkeye)
Complications from chikungunya symptoms are relatively rare but have been documented. These include:
Myocarditis: This is the inflammation of the heart muscle and is also known as myocardium. This inflammation can reduce the heart’s ability to pump blood because it essentially weakens the organ. Chest pain, shortness of breath, dizziness, and abnormal heart rate are common in this condition.
Hepatitis: Chikungunya can affect the liver, leading to hepatitis, which damages the liver’s walls and tissues.
Eye issues: Retinitis (inflammation of the retina), retro-orbital pain (pain behind the eyes), and optic neuritis (inflammation of the optic nerve) are possible ocular complications.
Chronic rheumatoid arthritis syndrome: It is possible that the elderly might experience symptoms similar to those of rheumatoid arthritis from chikungunya.
Nephritis: This involves inflammation of the kidneys and can cause long-term damage.
Meningoencephalitis: This is a serious neurological condition where there is inflammation of the brain and the meninges. This has been mostly documented in new-born children, according to the European Centre for Disease Prevention and Control.
Haemorrhage: Uncontrolled bleeding is a complication of chikungunya as well.
Myelitis: This is the inflammation of the spinal cord, which can cause major neurological dysfunction.
Guillain-Barré syndrome: This is a rare disorder where the immune system, triggered by the viral infection, mistakenly attacks the nerves.
Cranial nerve palsies: A complication of chikungunya can be the loss of sensation in the cranial nerves. This complication can inhibit the sensations of taste, smell, hear, and feel.
People who are most susceptible to these complications are usually those with weakened immune systems. Pregnant individuals, especially in the last term of pregnancy, infants and children, older adults above the age of 65 years, and those with medical issues like diabetes and heart disease fall in the vulnerable category. Atypical clinical manifestations, particularly in the older adults, can lead to chronic symptoms and even death.
Diagnosis and treatment
Diagnosis is usually done with an RT-PCR test, which requires a nasal swab. This swab is sent to a laboratory to test whether the chikungunya virus is present in the body. The results are the most accurate in the first week of illness. The viral load might reduce over time; so, anti-body testing is also helpful.
A blood test can be scheduled in which a sample of the blood will be drawn from a vein in the arm. This blood test is typically performed to determine whether a body possesses IgG and IgM anti-chikungunya anti-bodies that are capable of combating the chikungunya virus. The enzyme-linked immunosorbent assay (ELISA) test is used. The IgM anti-body level is especially high during the first 3 to 5 weeks of illness
There are no specific vaccines or anti-chikungunya drugs yet to treat this disease. So, the primary aim is to reduce fever and alleviate discomfort caused by the joint pain.
Bed rest must be maintained, with mosquito netting if possible. To handle the fever and reduce joint pain, it is essential to take medicines like paracetamol every 6 hours or as a doctor advises. Aspirin is not recommended. Sick adults should drink 2 to 3 litres of liquids in a day, while children should keep constantly sipping on fluids to avoid dehydration from the fever.
For prolonged joint pain post-recovery, physiotherapy can be helpful to restore the joint’s full range of motion, and help one reach a better quality of life.
Here are some preventive steps:
• Mosquitos breed the most during the summer and rainy seasons. As a result, controlling skin exposure is critical. When going outside, keep the arms and legs covered.
• To prevent mosquitoes and other insects from entering a home, make sure the windows and doors have mesh covering. Additionally, patch up any mesh holes.
• Sleeping under a mosquito net is also helpful in avoiding mosquito bites.
• It also helps to use mosquito repellent sprays, creams, patches, and devices. Many of these products are reasonably priced and come in multipacks, allowing anyone to use them for an extended period.
• Homes should be scanned for water-holding containers both inside and outside. Empty any hollow containers, such as birdbaths, flowerpots, and trash cans, that may be seen in the garden or backyard. By doing this, people can make sure mosquitoes don’t lay eggs around.