Chikungunya Fever

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Chikungunya (CHIK-V) Fever 

• An acute febrile illness associated with polyarthralgias, caused by the infection of the arthropod-borne alpha-virus, Chikunguyna virus (CHIK-V).    
• The virus is transmitted to humans primarily through the bite of an infected mosquito
• The term Chikungunya is derived from the Makinde word meaning “that which bends up” 
• The first discovery of the CHIK-V was in 1952 in Tanzania, Africa with the first outbreak noted in 1999 in Malaysia affecting 27 people .
• The virus re-emerged in 2004 in countries of the Indian Ocean and has since then, spread to new locations leading to millions of cases throughout countries globally.
  

Aetiology

• The Aedes Aegypti and Aedes Albopictus mosquitos are the main vectors of the virus.
• The human being becomes the reservoir of infection and transmitted from human to human via the infected mosquito.
• These mosquitos bite mainly in the daytime and are also known to transmit the dengue virus 

Risk Factors 

• There has been increased prevalence in densely populated, urbanized areas, since humans are the only reservoir of the virus.
• Poor living conditions and maintenance of peridomestic environment including pooling of water in water recipients or tyres and inappropriate waste disposal.These are all sources of Aedes mosquito species.
• Migration and Travelling; the CDC estimated approximately 9 million people travel between the United States and the Caribbean each year, increasing the risk of transmission

Clinical Features 

• The incubation period for Chikunguyna fever is noted to be between 3-7 days starting with fevers greater than 38.9°C which can last up to 2 weeks and are biphasic in nature 
• Following the fever, majority of infected people develop severe polyarthralgias which are usually symmetric
• Pains are most commonly in the wrists, elbows, fingers, knees and ankles but are not limited to these.
• Pain and Joint swelling are often incapacitating and result in severe disabilities which can last for months.
• The development of a maculopapular rash is often associated
• Additionally, the individual may experience cervical lymphadenopathy, headaches, fatigue, nausea, vomiting, conjunctivitis and myalgia.
• In the acute stage of infection, blood tests may reveal abnormalities such as leukopenia, thrombocytopenia, hypocalcemia and moderate increase in liver function test results
• Asymptomatic cases have also been reported

Musculoskeletal Implications 

• In the chronic phase of the infection, individuals may experience musculoskeletal symptoms for several weeks to months
• Joint manifestations such as joint effusions, hygromas, bursitis and axial pain can be identified in areas with previously occurring injuries
• Carpal Tunnel syndrome and Raynaud phenomenon in chronic phase have been noted 
• Carpal or Cubital Tunnel syndromes are often a result of hypertrophic tenosynovitis of the anterior wrist

Other Complications

• Cardiac complications were also reported in a number persons infected with the chikunguyna virus resulting in cases of myocarditis and cardiomyopathy. In many cases, these conditions have been noted to resolve spontaneously 
• Chikungunya fever is rarely fatal however there are cases of death has been reported resulting from severe complications or by a weakened immune system

Global Health Issue

                                 Map of local Transmission of Chikunguyna virus as of March, 2015.

The global expansion of the virus demonstrates the effortlessness with which the virus can spread and infect the human population.

This will in effect can directly reduce productivity and place a burden on the economy on a global level given the long period of illness

References

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