Chikungunya Treatment in Delhi, India

Chikungunya is a viral fever disease transmitted to humans by infected mosquitoes, primarily Aedes aegypti and Aedes albopictus. The name "chikungunya" comes from a word in the Kimakonde language, meaning "to become contorted," which describes the stooped appearance of sufferers with joint pain. The disease is characterised by an abrupt onset of fever, severe joint pain, muscle pain, headache, nausea, fatigue, and rash. While the disease is rarely fatal, it can cause debilitating symptoms that may last for weeks or even months.

Chikungunya is caused by the chikungunya virus (CHIKV), which belongs to the Alphavirus genus and the Togaviridae family. The virus is primarily spread to humans through the bites of infected mosquitoes. Here are the main points about the causes:

• Mosquito bites: The primary cause of chikungunya is the bite of an infected Aedes mosquito, most commonly Aedes aegypti or Aedes albopictus. These mosquitoes also transmit dengue and Zika viruses.
• Less common transmission: In rare cases, the virus can be spread through blood transfusions, organ transplants, or from an infected mother to her newborn baby.

Several factors can increase the risk of contracting chikungunya:

• Geographical Location: Living in or travelling to areas where chikungunya is endemic increases the risk of infection. These areas include parts of Africa, Asia, the Indian subcontinent, and the Americas.
• Seasonal and Environmental Factors: The risk is higher during the rainy season when mosquito breeding sites are more abundant. Urban areas with standing water, such as containers, clogged gutters, and discarded tires, provide breeding grounds for Aedes mosquitoes.
• Lack of Preventive Measures: Not using mosquito repellent or wearing protective clothing can increase the risk of mosquito bites. Similarly, sleeping without mosquito nets or in unscreened housing also raises the risk of exposure.
• Outbreak Situations: During chikungunya outbreaks, the risk of infection is significantly higher due to the increased presence of infected mosquitoes.
• Population Movement: International travel to endemic areas increases the risk of exposure and can also facilitate the spread of the virus to new regions.

By understanding these causes and risk factors, individuals can take preventive measures to reduce their chances of contracting chikungunya.

Chikungunya symptoms typically appear between 3-7 days after being bitten by an infected mosquito. While the severity can vary, here are the common signs and symptoms to watch out for:

• Fever: This is the most common symptom, often sudden and high (up to 104°F or 40°C).
• Severe Joint Pain: This is the hallmark feature of chikungunya, causing intense pain and stiffness, particularly in the hands, wrists, ankles, and knees. The pain can be debilitating and is often described as aching, throbbing, or migratory (moving from one joint to another).
• Headache: A general headache is a frequent symptom.
• Muscle Pain: General body aches and pains are common, often accompanying the joint pain.
• Fatigue and tiredness: Feeling extremely tired and drained is a common symptom.
• Rash: A maculopapular rash (red bumps with a flat base) may appear on the torso and limbs, typically lasting 2-3 days.
• Nausea and vomiting: Nausea and vomiting can occur, especially in severe cases.

It's important to note that these symptoms can be similar to those of other illnesses like dengue fever or Zika virus infection. If anyone has been in an area with chikungunya transmission and experiences any of these symptoms, especially fever and joint pain, they should seek medical attention promptly.

There's no specific test to diagnose chikungunya based on symptoms alone due to their overlap with other mosquito-borne diseases. However, a doctor can use a combination of factors to diagnose chikungunya, including:

Clinical Evaluation

Healthcare providers assess symptoms such as sudden onset of high fever, severe joint pain, and rash, along with the patient's recent travel history to areas where chikungunya is prevalent.

Laboratory Tests

• Blood Tests: These are essential to confirm the presence of the chikungunya virus or antibodies produced in response to the infection. The main types of tests include:
• RT-PCR (Reverse Transcription Polymerase Chain Reaction): This test detects viral RNA and is most effective during the first week of illness.
• Serological Tests: These tests detect antibodies against the chikungunya virus.
• IgM Antibodies: These are usually detectable from the fifth day of illness and can remain in the blood for several weeks to months.
• IgG Antibodies: These appear later in the infection and can indicate a past infection.

Differential Diagnosis

Since symptoms of chikungunya can be similar to those of other arboviral infections like dengue and Zika, differential diagnosis is crucial. Healthcare providers may need to rule out these conditions through additional testing.

Clinical History and Epidemiological Information

Recent travel to endemic areas, known local outbreaks, and exposure to mosquito bites are important factors that support the diagnosis of chikungunya.

Complete Blood Count (CBC)

While not definitive for chikungunya, a CBC can provide supportive information, such as leukopenia (low white blood cell count) or thrombocytopenia (low platelet count), which are common in viral infections.

Prompt and accurate diagnosis of chikungunya is essential for effective management and to prevent complications.

There is currently no specific medication to cure chikungunya infection. However, treatment focuses on managing the symptoms and improving your comfort while your body fights off the virus. Here's what you can expect:

Supportive Care

• Rest: Getting plenty of rest allows your body to focus on healing.
• Fluids: Staying hydrated is crucial to prevent dehydration, especially with fever and sweating. Drink plenty of water, broths, and electrolyte-rich drinks.
• Pain relievers: Over-the-counter pain relievers like acetaminophen (paracetamol) can help manage fever and joint pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications (like ibuprofen or naproxen) should be used with caution and only with a doctor's guidance due to a potential risk of increased bleeding in some cases.

Additional Considerations

• Joint care: Applying heat or cold packs to affected joints can provide temporary relief from pain and inflammation. Gentle stretching exercises may also be recommended by a healthcare professional as you recover.
• Home remedies: While not a substitute for medical advice, some home remedies like applying topical creams with menthol or using turmeric may offer some relief for joint pain. However, discuss these options with your chikungunya doctor first.

In severe cases

• Hospitalisation: In rare instances, hospitalisation may be necessary for managing severe complications or dehydration.
• Medications for complications: Depending on the complications, specific medications may be needed to address issues like bleeding problems or secondary infections.

Recovery

Most people recover from chikungunya within a week or two. However, some people may experience persistent joint pain or stiffness for weeks or even months. In such cases, physical therapy or stronger pain medications might be recommended by a doctor.

By following these treatment and management strategies, individuals can effectively manage chikungunya symptoms, reduce the risk of complications, and improve their overall recovery experience.

While chikungunya is rarely fatal, there can be some complications associated with the infection. Here's a breakdown of potential complications:

• Chronic arthralgia (joint pain): This is the most common complication, with some people experiencing joint pain and stiffness for months or even years after the initial infection.
• Neurological complications: In rare cases, the virus can affect the nervous system, leading to conditions like encephalitis (inflammation of the brain) or Guillain-Barré syndrome (a disorder affecting the peripheral nerves).
• Ocular complications: Eye problems like conjunctivitis (inflammation of the eye's outer lining) or even temporary vision loss can occur in some cases.
• Bleeding problems: While uncommon, chikungunya infection can increase the risk of bleeding, especially if you take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

Note: Complications are more likely to occur in:

• Newborns and infants: They are more susceptible to severe illness and complications.
• Older adults: Their weakened immune systems may make them more vulnerable to complications.
• People with underlying medical conditions: Those with chronic health issues like diabetes, heart disease, or high blood pressure may experience more severe complications.

Preventing chikungunya primarily involves avoiding mosquito bites and reducing mosquito populations. Here are some effective prevention strategies:

• Avoiding Mosquito Bites

• Use Insect Repellents: Apply repellents containing DEET, picaridin, or oil of lemon eucalyptus on exposed skin.
• Wear Protective Clothing: Wear long-sleeved shirts, long pants, and socks to reduce skin exposure.
• Use Bed Nets: Sleep under mosquito nets, especially if staying in areas without screened windows or air conditioning.
• Stay Indoors During Peak Mosquito Activity: Mosquitoes that transmit chikungunya are most active during early morning and late afternoon.

• Reducing Mosquito Breeding Sites:
• Eliminate Standing Water: Remove or regularly empty containers that collect water, such as flower pots, buckets, old tires, and bird baths, as these can become breeding grounds for mosquitoes.
• Clean Gutters and Drains: Ensure that water does not stagnate in gutters, drains, and other outdoor areas.
• Use Larvicides: Apply larvicides to large water bodies that cannot be drained to kill mosquito larvae.
• Community-Level Efforts:
• Public Health Campaigns: Participate in community efforts to educate people about mosquito control and chikungunya prevention.
• Government Interventions: Support local government initiatives aimed at controlling mosquito populations through spraying and other measures.
• Travel Precautions:
• Check Travel Advisories: Before travelling, check for any chikungunya outbreaks in the destination area.
• Follow Precautionary Measures: Take all necessary precautions to avoid mosquito bites while travelling to endemic areas.
• Personal and Household Protection:
• Install Screens: Use window and door screens to keep mosquitoes out of living spaces.
• Use Air Conditioning: When possible, use air conditioning to deter mosquitoes from entering homes.

By following these preventive measures, individuals can significantly reduce their risk of contracting chikungunya and help control the spread of the virus in their communities.

How is Chikungunya transmitted?

Chikungunya is primarily transmitted to humans through the bites of infected Aedes mosquitoes, particularly Aedes aegypti and Aedes albopictus.

Can Chikungunya be transmitted from person to person?

No, chikungunya cannot be directly transmitted from person to person. It is spread through mosquito bites.

How long does it take for Chikungunya symptoms to appear after being bitten by an infected mosquito?

Symptoms typically appear 3 to 7 days after being bitten by an infected mosquito, but the incubation period can range from 2 to 12 days.

Is there a vaccine for Chikungunya?

Currently, there is no vaccine available for chikungunya. Research is ongoing to develop an effective vaccine.

Can someone get Chikungunya more than once?

It is generally believed that once a person recovers from chikungunya, they develop lifelong immunity and are unlikely to get the disease again.

What should someone do if they suspect they have Chikungunya?

If someone suspects they have chikungunya, they should seek medical attention for proper diagnosis and symptom management. Rest, hydration, and over-the-counter pain relievers can help alleviate symptoms.

Can Chikungunya affect pregnant women and their babies?

Pregnant women can contract chikungunya, and there is a risk of transmission to the baby around the time of delivery. Pregnant women should take precautions to avoid mosquito bites.

What measures can travellers take to avoid getting Chikungunya?

Travellers should use insect repellent, wear long-sleeved clothing, sleep under mosquito nets, and stay in accommodations with screened windows or air conditioning when visiting areas where chikungunya is prevalent.

Can pets get Chikungunya?

Chikungunya is primarily a human disease, and there is no evidence that pets such as dogs and cats can get chikungunya.

What should be done if someone in the household has Chikungunya?

If someone in the household has chikungunya, it is important to prevent mosquito bites to avoid spreading the virus to others. Use mosquito nets and repellents, and ensure the patient is well-protected from mosquito exposure.

Are there any long-term effects of Chikungunya?

While most people recover fully, some may experience long-term joint pain or arthritis like symptoms that can last for months or even years.

How can communities help in controlling the spread of Chikungunya?

Communities can help by eliminating mosquito breeding sites, participating in public health campaigns, and supporting local government initiatives aimed at mosquito control.

Is Chikungunya a seasonal condition?

Chikungunya transmission can be seasonal, with higher rates typically occurring during or after rainy seasons when mosquito populations are at their peak.

What areas are most affected by Chikungunya?

Chikungunya is most prevalent in tropical and subtropical regions, including parts of Africa, Asia, the Indian subcontinent, and the Americas.

Can Chikungunya be mistaken for other diseases?

Yes, chikungunya can be mistaken for other diseases such as dengue fever and Zika virus because they share similar symptoms like fever, joint pain, and rash. Proper medical diagnosis is essential for accurate identification.

Reviewed By Dr. Vandana Garg, Senior Consultant - Internal Medicine on 24 June 2024.