Chikungunya Fever; Defination, Causes, Symptoms, Diagnosis, Treatment

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Chikungunya is a viral disease transmitted by the bite of infected mosquitoes such as Aedes aegypti and Aedes albopictus. It can cause high fever, join and muscle pain, and headache. Chikungunya does not often result in death, but the joint pain may last for months or years and may become a cause of chronic pain and disability. There is no specific treatment for chikungunya infection, nor any vaccine to prevent it. Pending the development of a new vaccine, the only effective means of prevention is to protect individuals against mosquito bites.

Fast facts on chikungunya virus

  • The word “chikungunya” means “to walk bent”.
  • The major symptoms are fever and joint pain.
  • Chikungunya can only be definitively diagnosed by a blood test.
  • There are no vaccines for chikungunya.
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Epidemiology of Chikungunya

Historically, chikungunya has been present mostly in the developing world. The disease causes an estimated 3 million infections each year.Epidemics in the Indian Ocean, Pacific Islands, and in the Americas, continue to change the distribution of the disease. In Africa, chikungunya is spread by a sylvatic cycle in which the virus largely cycles between other non-human primates, small mammals, and mosquitos between human outbreaks. During outbreaks, due to the high concentration of virus in the blood of those in the acute phase of infection, the virus can circulate from humans to mosquitoes and back to humans. The transmission of the pathogen between humans and mosquitoes that exist in urban environments was established on multiple occasions from strains occurring on the eastern half of Africa in non-human primate hosts.This emergence and spread beyond Africa may have started as early as the 18th century.Currently, available data does not indicate whether the introduction of chikungunya into Asia occurred in the 19th century or more recently, but this epidemic Asian strain causes outbreaks in India and continues to circulate in Southeast Asia.In Africa, outbreaks were typically tied to heavy rainfall causing increased mosquito population. In recent outbreaks in urban centers, the virus has spread by circulating between humans and mosquitoes.

Global rates of chikungunya infection are variable, depending on outbreaks. When chikungunya was first identified in 1952, it had a low-level circulation in West Africa, with infection rates linked to rainfall. Beginning in the 1960s, periodic outbreaks were documented in Asia and Africa. However, since 2005, following several decades of relative inactivity, chikungunya has re-emerged and caused large outbreaks in Africa, Asia, and the Americas. In India, for instance, chikungunya re-appeared following 32 years of absence of viral activity. Outbreaks have occurred in Europe, the Caribbean, and South America, areas in which chikungunya was not previously transmitted.

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Causes of Chikungunya

Chikungunya virus (CHIKV), is a member of the alphavirus genus, and Togaviridae family. It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb.It is a member of the Semliki Forest virus complex and is closely related to Ross River virus, O’nyong’nyong virus, and Semliki Forest virus.Because it is transmitted by arthropods, namely mosquitoes, it can also be referred to as an arbovirus (arthropod-borne virus). In the United States, it is classified as a category C priority pathogen, and work requires biosafety level III precautions.

The virus is spread between people by two types of mosquitos: Aedes albopictus and Aedes aegypti. They mainly bite during the day.The virus may circulate within a number of animals including birds and rodents.

There are two main ways that the virus enters an area

  • Local transmission. This occurs when mosquitos in a region bite infected patients and then transmit the virus to others who have not been exposed to the virus before. In 2014, the CDC reported the first local transmission cases of the virus in the U.S. Virgin Islands, Florida, and Costa Rica.
  • Imported cases. These occur when someone travels to an area with an outbreak and becomes infected, and then returns home while still ill. About 28 people a year in the United States have been infected in this way between 2006 and 2013, according to the CDC. In 2014, however, this number increased sharply and between May 2014 and January 2015, over 2,300 travelers returned to the United States with the virus.

Symptoms of Chikungunya

  • Most people infected with chikungunya virus will develop some symptoms.
  • Fever (sometimes as high as 104 °F)
  • The most common symptoms are  joint pain.
  • Acute onset of polyarthralgia, usually bilateral and symmetric, and can be severe and debilitating
  • Headache
  • Muscle pain
  • Symptoms usually begin 3–7 days after being bitten by an infected mosquito.
  • Other symptoms may include headache, muscle pain, joint swelling, or rash.
  • conjunctivitis
  • nausea/vomiting
  • maculopapular rash.
  • Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
  • Most patients feel better within a week. In some people, the joint pain may persist for months.
  • rash
  • swelling around the joints
  • People at risk for more severe disease include newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease.
  • Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis of Chikungunya

  • The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya.
  •  The healthcare provider if you develop the symptoms described above and have visited an area where chikungunya is found.
  • If you have recently traveled, tell your healthcare provider when and where you traveled.
  • Several methods can be used for diagnosis. Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months. Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR).
  • The virus may be isolated from the blood during the first few days of infection. Various reverse transcriptase–polymerase chain reaction (RT–PCR) methods are available but are of variable sensitivity. Some are suited to clinical diagnosis. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources.
  • Four fold HI(Haemagglutination Inhibition) antibody difference in paired serum samples. This turns positive within 5 to 8 days of infection.
  • Detection of IgM antibodies. These antibodies persist upto 6 months of infection, but currently there is no commercial tests available.
  • Virus isolation from serum.
  • Detection of virus nucleic acid in serum by RT-PCR. This needs to be conducted within 5 days of infection.

WHO Criteria for Chikungunya Diagnosis

  1. Clinical criteria: acute onset of fever >38.5°C and severe arthralgia/arthritis not explained by other medical conditions.
  2. Epidemiological criteria: residing or having visited epidemic areas, having reported transmission within 15 days prior to the onset of symptoms.
  3. Laboratory criteria: at least one of the tests mentioned above.

Treatment of Chikungunya

  • There is no vaccine to prevent or medicine to treat chikungunya virus.
  • Treat the symptoms:
    • Get plenty of rest.
    • Drink fluids to prevent dehydration.
    • Take medicine such as acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.
    • Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS until dengue can be ruled out to reduce the risk of bleeding).
    • If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.
  • If you have chikungunya, prevent mosquito bites for the first week of your illness.
    • During the first week of infection, chikungunya virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
    • An infected mosquito can then spread the virus to other people.

What can travelers do to prevent chikungunya?

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There is no vaccine or medicine to prevent chikungunya. The only way to prevent chikungunya is to prevent mosquito bites. Preventing bites can be difficult, but it is important, as you can get sick after just one bite. Follow these steps to reduce the chances that you will be bitten by mosquitoes during your trip.

Prevent mosquito bites:

  • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Use an appropriate insect repellent as directed.
  • Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:
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    • DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon)
    • Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US])
    • Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals)
    • IR3535  (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)
  • Always follow product directions and reapply as directed:
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.
    • Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
    • Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
    • If treating items yourself, follow the product instructions carefully.
    • Do not use permethrin directly on skin.
  • Stay and sleep in screened or air conditioned rooms.
  • Use a bed net if the area where you are sleeping is exposed to the outdoors.

Physiotherapy for Chikungunya

In physical therapy, trained professionals evaluate and treat abnormal physical function related to, for example, an injury, disability, disease or condition.

According to the American Physical Therapy Association (APTA), a physical therapist is a trained and licensed medical professional with experience in diagnosing physical abnormalities, restoring physical function and mobility, maintaining physical function, and promoting physical activity and proper function.

Licensed physical therapists can be found in a range of healthcare settings including outpatient offices, private practices, hospitals, rehab centers, nursing homes, home health, sports and fitness settings, schools, hospices, occupational settings, government agencies, and research centers.

What to expect during physical therapy

Some patients are referred to a physical therapist by their doctor, but other seek therapy themselves.

Whichever way a patient come to a physical therapist, they can expect to:

  • Undergo a physical exam and evaluation, including a health history and certain testing procedures, including evaluation of posture, movement and flexibility, and of muscle and joint motion and performance
  • Receive a clinical diagnosis, prognosis, plan of care and short and long term goals
  • Receive physical therapy treatment and intervention based on the therapist’s evaluation and diagnosis
  • Receive self-management recommendations

Patients often train with a physical therapist in exercises that they can do at home, to help them function more effectively.

Who can benefit from physical therapy

Physical therapists can treat a wide variety of medical conditions, depending on their specialty.

Some conditions that can benefit from this type of treatment are:

  • Cardiopulmonary conditions, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and post-myocardial infarction (MI)
  • Hand therapy for conditions such as carpal tunnel syndrome and trigger finger
  • Musculoskeletal dysfunction such as back pain, rotator cuff tears, and temporomandibular joint disorders (TMJ)
  • Neurological conditions such as stroke, spinal cord injuries, Parkinson’s disease, multiple sclerosis, vestibular dysfunction, and traumatic brain injuries
  • Pediatric conditions such as developmental delays, cerebral palsy, and muscular dystrophy
  • Sports-related injuries, such as concussion and tennis elbow
  • Women’s health and pelvic floor dysfunction, such as urinary incontinence and lymphedema

Other cases that may benefit include burns, wound care, and diabetic ulcers.

Benefits of physical therapy

Depending on the reason for treatment, the benefits of physical therapy include

  • Pain management with reduced need for opioids
  • Avoiding surgery
  • Improved mobility and movement
  • Recovery from injury or trauma
  • Recovery from stroke or paralysis
  • Fall prevention
  • Improved balance
  • Management of age-related medical problems

A sports therapist can help an athlete to maximize their performance through strengthening specific parts of the body and using muscles in new ways.

A healthcare provider or physical therapist can advise individuals about the benefits specific to their personal medical history and their need for treatment.

Types of physical therapy

As with any medical practice, a variety of therapies can be applied to treat a range of conditions.

Physical therapy can help a patient regain movement or strength after an injury or illness.

Orthopedic physical therapy – treats musculoskeletal injuries, involving the muscles, bones, ligaments, fascias, and tendons. It is suitable for medical conditions such as fractures, sprains, tendonitis, bursitis, chronic medical problems, and rehabilitation or recovery from orthopedic surgery. Patients may undergo treatment with joint mobilizations, manual therapy, strength training, mobility training, and other modalities.

Geriatric physical therapy – can help older patients who develop conditions that affect their mobility and physical function, including arthritis, osteoporosis, Alzheimer’s disease, hip and joint replacement, balance disorders, and incontinence. This type of intervention aims to restore mobility, reduce pain and increase physical fitness levels.

Neurological physical therapy – can help people with neurological disorders and conditions such as Alzheimer’s disease, brain injury, cerebral palsy, multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke. Treatment may aim to increase limb responsiveness, treat paralysis, and reverse increase muscles strength by reducing muscle atrophy.

Cardiovascular and pulmonary rehabilitation – can benefit people affected by some cardiopulmonary conditions and surgical procedures. Treatment can increase physical endurance and stamina.

Pediatric physical therapy –  aims to diagnose, treat, and manage conditions that affect infants, children, and adolescents, including developmental delays, cerebral palsy, spina bifida, torticollis and other conditions that impact the musculoskeletal system.

Wound care therapy –  can help to ensure that a healing wound is receiving adequate oxygen and blood by way of improved circulation. Physical therapy may include the use of manual therapies, electric stimulation, compression therapy and wound care.

Vestibular therapy  – aims to treat balance problems that can result from inner ear conditions. Vestibular physical therapy involves a number of exercises and manual techniques that can help patients regain their normal balance and coordination.

Decongestive therapy –  can help to drain accumulated fluid in patients with lymphedema and other conditions that involve fluid accumulation.

Pelvic floor rehabilitation – can help treat urinary or fecal incontinence, urinary urgency and pelvic pain in men and women as a result of injuries or surgery, or because of certain conditions.

Apart from physical manipulation, physical therapy treatment may involve:

  • Ultrasound, to promote blood flow and healing by heating the tendons, muscles, and tissues
  • Phonophoresis, which uses ultrasound to deliver certain medications such as topical steroids. This can decrease the presence of inflammation
  • Electrical stimulation, or E-stim, which uses topical electrodes on the skin to reduce pain and increase functional capabilities. One type of E-stim is transcutaneous electrical nerve stimulation (TENS). At times, anti-inflammatory medications are used with certain E-stim modalities and is referred to as iontophoresis
  • Heat, moist heat and cold therapy
  • Light therapy, in which special lights and lasers are used to treat certain medical conditions

The physical therapist will directly recommend the most appropriate treatment.

 Home remedies for Chikungunya

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  • Try these effective natural home remedies to reduce the ferocity of fever and joint pain to certain extent.
  • The combination of honey and lime juice is helpful in this case.
  • The application of garlic paste in the joint regions is helpful to ease joint pain.
  • The mix of honey (1tsp), warm water (200gram) and celery seeds (3gram) is useful.
  • Eating and crunching carrot is helpful to ease joint pain.
  • Grapes and Cow milk is beneficial in chikungunya.
  • The juice of papaya is good during the disease.
  • The light massage at the joint region is helpful.
  • Stew peppers are rich in anti-inflammatory properties, may be taken to subsidise pain.
  • Vitamin C and leafy green vegetables should be preferred.
  • Easily digestible food should consume
  • Use ginger and turmeric frequently in your diet.
  • Give much more thrust upon liquid diet
  • Coconut water is quite beneficial in such cases.
  • The drinking of wheat grass juice is helpful to ease the various symptoms.
  • Drink fresh fruit juice

Ayurveda for chikungunya treatment

  • Boiled water (1 litre), Tulsi leaves (10) and coriander powder (10gram) for 10 minutes followed by cool it. Consume it after the interval of three hours for the whole day to ease the symptoms of chikungunya.
  • Its fever can be managed by taking Tribhuvan Kriti (125-250mg) twice a day for 5 days.
  • Vettumarana Vati (125-250 mg) may be taken twice a day for 7days, is also helpful to control its symptoms.
  • Take Ashvagandha powder (5gm) with milk to overcome fever.

Yoga for chikungunya prevention

  • For chikungunya patients, practicing of Pranayama and doing some light loosening yogic exercises is helpful.
  • Practice Sitali and Sheetkari Pranayama to minimize the severity of fever.
  • To ease joint pain, one should practice loosening yogic exercises like to and fro of toes, up and down of wrists to by straightening your legs and hands respectively.
  • Practice of Chandrabehdi Pranayama is good to reduce fever.
  • Nadishodhan Pranayama is also helpful.
  • In Naturopathy, hot fermentation of the affected joints is beneficial.
  • Application of ice cold pack over the forehead.
  • Rub your body lightly with soaked water cloth to reduce fever.
  • Consult your nearby Naturopathy physicians for better management of the disease.

Unani for chikungunya treatment

  • Unani medicine is good in the prevention and management of chikungunya fever.
  • Habb-e-lkseer Bukhar (2 pills) with lukewarm twice a day is good to reduce fever.
  • Unani medicine like Habb-e-Asgand (2 pills), twice a day is helpful in reducing fever of chikungunya.
  • In such case, the immunity level of a person gets reduce, for that one should take Khamira Marwareed (4gram) twice a day.
  • Unani repellent like Raughan-i-neem and Raughan-i-Kameela  can be used on the skin.

Homeopathy Medicine For Chikungunya

Most homeopathy medicines are made from natural substances and have zero to few side effects, which makes homeopathy a suitable route to relieve chikungunya symptoms. We have listed some of the commonly used homeopathy medicines below:

  • Rhus Tox – This medication helps in alleviating the joint and back pain experienced with Chikungunya fever.
  • Eupatorium Perfoliatum – Homeopathy doctors prescribe this to treat the severe body pains, chills, and vomiting seen in Chikungunya.
  • Merc Sol – When the joint pains get worse during the night, this medicine is given.
  • Arnica – The joint pains may be accompanied by soreness and blue-black marks on the skin. In such cases, arnica is recommended.
  • Phosphoric Acid – This is used for treating the extreme weakness a patient feels during and after the viral infection.

Please consult a registered homeopathic doctor before taking any of these medications.

Siddha treatment for chikungunya

Siddha medicines are useful in the treatment and management of chikungunya fever. After the consultation of Siddha doctor, following Siddha medicine can be taken. Arumuga chendooram, Nilvembu kudineer, Amukkara Chooranam, Vishnu chakkara mathirai, Trikadugu choornam, Linga chendooram, Bramanandha bairavam, etc.

Complications of chikungunya

Complications can include:

  • Uveitis – inflammation of the layer in the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea.
  • Retinitis – inflammation of the retina.
  • Myocarditis – inflammation of the heart muscle.
  • Hepatitis – inflammation of the liver.
  • Nephritis – inflammation of the kidneys.
  • Hemorrhage – bleeding.
  • Meningoencephalitis – inflammation of the membranes of the brain and adjoining cerebral tissue.
  • Myelitis – inflammation of the spinal cord.
  • Guillain-Barré syndrome – rare peripheral nervous system disease characterized by muscle weakness.
  • Cranial nerve palsies – loss of function in the cranial nerves.

  Prevention chikungunya

Seeing as the major mode of chikungunya transmission is by mosquito bite, the best methods of prevention involve minimizing contact with mosquitos. Steps that can be taken to prevent chikungunya include:

  • Using insect repellent containing DEET (N, N-Diethyl-meta-toluamide) or picaridin on skin and clothing.
  • Wearing clothing that covers the whole body.
  • Staying indoors as much as possible, especially during early morning and late afternoon.
  • Avoiding traveling to areas experiencing outbreaks.
  • Using products containing oil of lemon eucalyptus or PMD (p-Menthane-3,8-diol) can be effective.
  • Using air-conditioning – this deters mosquitos from entering rooms.
  • Sleeping under a mosquito net.
  • Using mosquito coils and insecticide vaporizers.

Although chikungunya is very rarely fatal, the symptoms are distressing and can be long-lived. Avoiding mosquitos is key.

Fact Sheet From World Health Organization

Fact sheet Chikungunya

Chikungunya is a viral disease that is spread by mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash.The disease is transmitted  by the same mosquitoes involved in the dengue transmission (Aedes aegypti and Aedes albopictus); also shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.

  • There is no cure for the disease. Treatment is focused on relieving the symptoms.
  • The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya.
  • The disease occurs in Africa, Asia and the Indian subcontinent. In 2007, disease transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy.
  • On December 2013, PAHO/WHO received confirmation of the first cases of autochthonous transmission of chikungunya in the Americas (Caribbean).

The disease

Chikungunya is characterized by an abrupt onset of fever frequently accompanied by joint pain, other symptoms or pain during chronic phase can include fatigue and depression. In addition,

it includes muscle pain, headache, nausea, and rash. Most patients recover fully, but in some cases the joint pain may be chronic. Serious complications are not common, but in older people, children and pregnant women the disease can get worse.

The virus is transmitted by the bites of infected Aedes aegypti and Aedes albopictus mosquitos, both present in the Americas. After the bite of an infected mosquito, onset of illness occurs usually between 3 and 7 days but can range from 2 to 12 days.

Chikungunya must be distinguished from dengue. While both diseases patients may have diffuse body pain, having Chikungunya the pain is much more intense and localized in the joints and tendons than dengue.

There are no specific drugs to cure the disease. Treatment is directed primarily at relieving the symptoms, including the joint pain. There is no commercial Chikungunya vaccine.

Since 2004, Chikungunya virus has caused massive and sustained outbreaks in Asia and Africa, infecting more than 2 million people, with attack rates as high as 68% in some areas. This situation can put a sudden and heavy burden on health services.

The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit.

In 2013, PAHO/WHO received confirmation of the first cases of autochthonous transmission of chikungunya in the Americas. Before that, hundred people who have travelled from the Americas to Asia and Africa in the past years have become infected with the chikungunya.

PAHO/WHO response 

PAHO/WHO has been working with countries of the region for several years to strengthen preparedness and response for the introduction of this virus.

In 2012, PAHO/WHO, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), published new guidelines on chikungunya. The guidelines for Preparedness and Response for Chikungunya Virus Introduction in the Americas aims to help countries throughout the Americas improve their ability to detect the virus and be prepared to monitor, prevent, and control the disease, should it appear.

PAHO/WHO recommends that countries with the mosquito develop and maintain the capacity to detect and confirm cases, manage patients, and implement social communication strategies to reduce the presence of the mosquito vectors.

Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes. This requires mobilization of affected communities.

During outbreaks, insecticides may be sprayed to kill flying mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae.

For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions.

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