Chikungunya

Chikungunya is a viral disease spread by mosquitoes. The first ever outbreak of chikungunya was reported in Southern Tanzania in 1952. Chikungunya leads to severe joint pain and fever. The symptoms of chikungunya are somewhat similar to dengue and zika (mosquito-borne viral disease), which can lead to chikungunya being misdiagnosed. There is no vaccine at present to provide protection against this disease. However, the best intervention is to protect oneself from mosquito bites. The Aedes mosquito which acts as the vector (carrier) of chikungunya becomes infected when it feeds on the blood of a person infected with chikungunya. It can transmit dengue as well.

There are two main stages or phases of the symptoms of the disease. These include:

• Acute phase
• Chronic phase

The acute phase lasts for 1-2 weeks after which the symptoms subside. In some people, the symptoms may last for about 4-12 weeks (sub-acute stage). However, if the symptoms persist for over 12 weeks, it is known as the chronic phase.

The symptoms of chikungunya emerge within 3-7 days after being bitten by an infected mosquito. The symptoms of chikungunya can range from mild to severe. Often, the disease may be confused with dengue fever, especially in areas where mosquito-borne diseases are common since the symptoms are quite similar. It has also been seen that some people may not show symptoms at all. However, such occurrences are rare. The most prominent symptoms of chikungunya include:

• Sudden onset of fever
  The fever may be of low to high grade and can last for up to two days. Along with the fever, one might experience chills and shiver as well.
• Severe pain in the joints
  The joint pain worsens during the morning and can get aggravated by physical movement. Some people may experience mild body pain while the elderly may find the joint pain to be unbearable. In some people, the joint pain may persist for months but its intensity will get reduced.
• Muscle pain
  Muscle pain and joint pain are the most severe symptoms experienced by people in chikungunya.
• Other symptoms include:
  • Headaches.
  • Nausea.
  • Back pain.
  • Extreme fatigue.
  • Swelling in the joints. (Read more - Arthritis treatment)
  • Mouth ulcers.
  • Hyper-pigmentation. (Read more - How to reduce pigmentation)
  • Vomiting.
  • Rashes on the body.

If the symptoms get unbearable and there is bleeding, a doctor must be consulted immediately.

Being aware of the causes and the risk factors associated with chikungunya is beneficial in coping with it.

Causes

Chikungunya is an infection caused by a virus. It is also known as the Buggy Creek Virus. While the virus is the main cause of the disease, it is transmitted through the bite of the Aedes mosquito. This mosquito bites during the daytime. The Aedes mosquito tends to breed in areas with stagnant water. Air coolers, discarded coconut shells, water storage containers, flower vases, junk items like tyres and pots tend to serve as common breeding grounds for the Aedes mosquito.

Risk Factors

Risk factors for chikungunya include:

• People living in geographical areas, where mosquitoes can breed easily, are at a considerably higher risk of getting the disease.
• The disease could be more severe in newborn babies and the elderly.
• People with medical conditions like high blood pressure, heart diseases or diabetes are also at a higher risk of developing complications.
• Once a person has been infected with chikungunya, they are less likely to suffer from it in the next encounter with the virus.

It is possible to prevent chikungunya by taking certain preventive measures. These include:

• Getting rid of mosquitoes in the surroundings: 
  It should be ensured that there are no places in the surroundings where mosquitoes can breed and spread viral diseases. Hence, hygiene is very important. Any container withing water must be emptied daily or at least 2-3 times in a week. If a person lives in areas where there are weeds and tall grasses growing, then all effort should be made to cut them short. This will prevent the mosquitoes from breeding in damp and shady places. It is important to drain all the stagnant or collected water after rain. The air coolers must be cleaned at least once a week. A common household remedy to prevent mosquitoes from breeding in water coolers is to put 3-4 tablets of camphor in the water after cleaning the cooler.

• Using protection against mosquitoes 
  If there has been an outbreak of chikungunya, people must try to wear protective clothing like full sleeved shirts and full-length pants to reduce the risk of being bitten by Aedes mosquito. Children must be encouraged to wear socks to protect their legs. Mosquito repellents are also a great way of protection against the mosquito bites. This can be applied to all the exposed areas of the body. The repellents should contain DEET, IR3535 or icaridin.

• Controlling an outbreak
  To reduce the risk of an outbreak in small and congested communities, insecticides may be sprayed to kill the mosquitoes. This will prevent the spreading of the disease. If a person has chikungunya then along with proper care one must make sure to keep the environment free from mosquitoes.

• Other measures
  Apart from basic protection, there are several other products available which help in keeping the household free from mosquitoes to minimise the risk of contracting the infection. These include mosquito coils, and insecticide vaporizers. To reduce the chances of indoor biting, it is best to use mosquito nets while sleeping. Nets are also an effective way of protecting infants.

The diagnosis for chikungunya can be established in different ways:

• The initial diagnosis of chikungunya may be based on the place of residence, travel history, and recent exposure to someone who is already infected. The symptoms of chikungunya are quite noticeable.
• However, the dengue and chikungunya viruses are transmitted by the same mosquito and hence may show the same clinical features. Therefore, it is important to get tested for both to receive the targeted treatment.
• The characteristic symptoms of chikungunya (fever and joint pain) also help to diagnose the disease.
• Laboratory diagnosis includes testing of serum or plasma to detect the virus. Lab tests provide accurate results and help in deciding on a proper course of treatment. These tests help in detecting the presence of IgM and IgG antibodies which indicate recent infection.
• There are ways in which chikungunya differs from dengue. Under medical opinion, dengue can have more severe symptoms and life-threatening complications like shock, difficulty in breathing and internal bleeding. It is possible that a person may have dengue and chikungunya at the same time. Dengue is more common than chikungunya but the joint pain caused by chikungunya may last for several months. Chikungunya and dengue are often confused with malaria as well.

There are no specific drugs to cure chikungunya. The treatments target to reduce the symptoms of pain and fever and speed up the recovery. There is no vaccine available to provide definite protection against chikungunya as well. Hence, the treatment is symptomatic.

Paracetamol can be taken to provide relief from fever and pain. Painkillers like aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should not be taken without a doctor’s approval. This is because if the fever is due to dengue then taking aspirin can increase the risk of bleeding.

If a person is on medications for some other health condition then it is essential to consult the doctor before taking medication for chikungunya.

Lifestyle management

In case the care is being provided at home, the person can take care of the following things:

General Care

• Get plenty of rest. Exerting yourself may aggravate the muscle pain and lead to fatigue.
• When feeling slightly, better you may engage in mild movements which will help in reducing the stiffness in the joints. Hence, walking a little bit can help in easing the pain.
• Try to rest in a warm and comfortable environment. Avoid a heated environment at all costs as it may worsen joint pain.
• Paracetamol tablets should not be taken more than 4 times a day to reduce fever.
• Painkillers must be avoided.
• A cold compress can be used to reduce inflammation and swelling. They may also ease the pain.
• Once diagnosed with chikungunya, sleep under mosquito nets as this will help in preventing other mosquitoes from biting you and spreading the virus. Keep yourself hydrated.

Diet

• Drink plenty of fluids. You can also take oral rehydration salts mixed with boiled water to help maintain the electrolyte balance in the body. This is especially important if you have been vomiting or suffering from digestive problems.
• Fluids like juices, buttermilk, coconut water, and fresh vegetable juices can aid in the recovery as they provide vital nutrients.
• It is necessary to have small meals at regular intervals of time to avoid weakness and fatigue. Having foods rich in protein and calories will help in producing energy. However, stay away from processed foods and sugary treats as these will suppress the immunity.
• If you are not having an upset stomach then consuming mildly spiced food is allowed. This will make the food palatable. However, adding too many spices can lead to acid reflux. (Read more - Gastroesophageal reflux disease treatment)
• Fruits rich in Vitamin C have been known to enhance the functioning of the immune system. Hence fruits like oranges, guavas, sweet potatoes, lemon and papayas can help in a speedy recovery.
• Stay away from dehydrating fluids like alcohol, coffee or tea while recovering from chikungunya.

Prognosis

Chikungunya is a viral disease transmitted by mosquitoes. Since there is no cure for it, the best way to go about it is by adopting the prevention approach. There are several steps which a person can take to protect himself/herself from getting chikungunya. However, there is a need for creating awareness about this disease and explaining the importance of hygienic surroundings to prevent outbreaks.

Complications

Complications from Chikungunya are rare. However, if left untreated, it can bring about cardiac and neurological complications. In individuals above the age of 65-70 years, the disease may cause shock and even death. In some people, there may be lasting joint pains and deformities as well.