Chikungunya

Saturday, June 6th, 2009

Chikungunya was first detected and confirmed in TANZANIA in 1952-53 by isolation of chikungunya virus. This virus was first isolated from patients with suspected dengue fever. Chikungunya is a local word in Makonde language, meaning doubling up owing to excruciating joint pains. In India the first outbreak was in Kolkata in 1963-64 and another in Chennai in 1965 which gave rise to 3, 00,000 cases in Chennai city alone. Later there was no epidemic of chikungunya for 40 long years.

The disease has reappeared after 40 long years. In 2005-06 again there was an outbreak in 151 districts in 8 states like Andaman and nicobar island, AP, Delhi, Maharashtra, Gujarat, Karnataka, MP, Tamil Nadu and Kerala. More than 1.25 million cases have been reported in the country with majority of cases from Karnataka and Maharashtra. The latest outbreak was in coastal Karnataka in the month of April- May 2008 affecting a large number of people. Affected people are still having residual joint pains, non specific enthesopathy and musculoskeletal ache and pains.

AGENT:

Chikungunya virus is a member of the genus aphavirus in the family Togaviridae.

MODE OF TRANSMISSION:

Only by infected mosquito bite-female Aedes egypti. Air borne spread not yet confirmed.

VECTOR:

Aedes Egypti Mosquito

Aedes Egypti Mosquito

Female AEDES EGYPTI mosquito is responsible for the spread, can also be transmitted by culex and mansonia mosquitoes. Aedes mosquitoes are smaller than other mosquitoes and they breed only in artificially stagnated fresh water, i.e. water tanks, water stored flower pots, buckets filled with water, etc. Aedes mosquitoes are easily distinguished by white stripes on a black body. Because of the striped or banded character of their legs, they are sometimes referred to as ‘tiger mosquitoes’.

Characteristics of Aedes mosquitoes

  1. IT BITES ONLY IN THE DAY TIME.
  2. Aedes bites at a time many persons and then rests. (Female anopheles bites at a time only one person and then rests). Hence the spread of Chikungunya is faster than Malaria.
  3. Aedes breeds only in artificial accumulations of water in and around human dwellings such as water found in discarded tins, broken bottles, fire buckets, coconut shells, earthern pots, tree holes,clean, fresh water. The other mosquitoes like Culex breeds in dirty water collections, stagnant drains, septic tank and Mansonia mosquitoes breeds on breeds on ponds and lakes containing certain aquatic plants.

Incubation period: 4-7 days.

CLINICAL FEATURES:

Symptoms – Usually symptoms differ from place to place / patient to patient depending upon the age and stamina of the sufferer.

Severity – more in old age, undernourished people, people with existing joint diseases.

First day:
Sudden onset with fever, chills, cephalalgia, anorexia, lumbago and severe arthralgia.

Second – third day:
Fever continues, joint pain affecting hand joints (MCP), foot, toes, painful to touch. Unable to move. In 60-80 % of patients have a morbilliform rash occasionally with purpura on the trunk and limbs.

Third – fifth day:
Fever subsides. Skin lesion may recur. Joint pain increases especially small joints of hands and feet. Early morning stiffness, swelling and redness of the joints may be noted. The intensity of the joint pain varies from person to person. Patients with preexisting joint diseases may have severe manifestations compared to the people with normal joints.

After one week:
Some recover. But the recovery will not be like common viral fever. The joint pain will especially ankle pain, swelling, sensitive feet etc.

Other features: (not in all patients)
Adenopathy, bleeding form the nose, redness of the eyes, headache, vomiting or diarrhea, subungual hemorrhage, mouth ulcers.

General condition improves within one week in majority of the patients.

Clinical classification of cases:

  1. Acute case- less than 7 days.
  2. Sub acute case- 7-14 days.
  3. Chronic case- More than 14 days.

Dermatological Manifestation in Chikungunya

  • Freckle like pigmentation over face.
  • Vesicobullous lesions in children.
  • Nasal blotchy erythema.
  • Loss of appetite, coated tongue,
  • Skin rash- maculopapular, most intense on trunk and limbs and may desquamate.
  • Hyperpigmentation in central part of face. Some times pigmentation of Nose.
  • Pruritus.
  • Erythematous rashes of body and limbs.
  • Scrotal ulcers.

Musculoskeletal Manifestation
Patients are divided into 3 grades according to the functional efficiency
Grade I: active, mobile and independent.
Grade II: Not active, mobile.
Grade III: Bed ridden and dependent for ADLs.

1. Arthropathy/ Enthesopathy/ Tendinitis: Ankle and foot, Knee, spine, Wrist, shoulder, Phalanges, Tendoachillis, Hamstrings, Evertors of foot, Extensor pollicis brevis and Abductor Pollicis Longus and Rotator cuff.

2.Functional and ambulation limitations : Bathing, Grooming, Dressing are the most common activities of Daily living affected.
Washing clothes and grinding the most common instrumental activities of daily living affected.

3. Migratory polyarthralgia.

Neuro Psychiatric problems:

  1. Persistent Somatoform Pain disorder- Never neglect symptoms, therapeutic dialogue (communication- verbal and nonverbal, listening and touch. Address fear, emotional conflicts and psychological problems. Encourage gradual reentry in to routine work.
  2. Adjustment disorder: subjective distress and emotional disturbance interfering with social functioning, arising in a period of adaptation to a serious physical illness.
  3. Depression: mostly in women, sadness of mood, lack of intrest, easy fatiguability, insomnia, loss of appetite, hopelessness and worthlessness, lasting for more than two weeks .
  4. Insomnia: Common symptom in acute phase, lasts for 2 days to one week. Management of pain and reassurance alone needed in most of the cases.

LABORATORY INVESTIGATIONS.

  1. BLOOD: Few patients develop Leucopenia. In some there will be thrombocytopenia. But thrombocytopenia is not severe as in Dengue.
  2. SEROLOGICAL TESTS: Detection of antibodies to chikungunya virus in the blood. IgM ( ELISA)
  3. Antigen detection with molecular technique like Polymerase chain reaction. ( PCR)

Differential diagnosis with differentiating features:

  1. Other Viral fever- no residual joint pains and short convalescence.
  2. Malaria – Blood test for MP( flourescent/smear), intermittent fever.
  3. Dengue fever- Low total count, palatelet count, altered BT,CT, PTT( in Hemorrhagic complications.
  4. Leptospirosis- altered liver function tests, rise in serum creatinine ( in complicated), Urine- RBC’S.
  5. Urinary tract infection – Urine micro will reveal more number of pus cells.

PREVENTION OF CHIKUNGUNYA:
Prevention of mosquito breeding:

  • Controlling the breeding sites of mosquito by avoiding water stagnation in and around houses.
  • Keep covered, water stored in buckets and tanks
  • Water from flower pots should be changed at least once a week
  • Fogging and killing them (for adult mosquito) especially in daytime since they are active during daytime.
  • Using bleaching powder and other pesticides / chemicals in stored water (to clear larva and pupa).
  • All containers storing water should be covered with a tight lid
  • Water stored in barrels, drums etc should be replaced by fresh stock (at least) once a week
  • Discarded container-like objects like tyres, coconut shells, bottles, etc should be disposed off or destroyed.
  • Water fountains should be kept dry once a week
  • Rain water collected on terraces/roofs should be cleared (at least) once a week
  • Mosquitoes can be controlled by using net, mesh, coils, liquids, sprays, creams, etc.

Prevention of Chikungunya through Homoeopathy:
The concept of Preventive strategy in Homeopathy is as old as the Homeopathic system of medicine itself. Many of the Homoeopathic literatures like Organon of medicine, Lesser writings, M L Tyler’s drug pictures will give us a definite and clear strategic plan of epidemic disease preventive and curative management. Hahenmann’s guidelines regarding the selection of genus epidemicus should be followed strictly.
Homoeopathic medicines are useful in prevention and also in reducing the severity of the illness and have some disease modifying action if taken well in advance. Homoeopathic preventive medicines are given for 5-7 days and need to repeat these medicines after 3 weeks. Constitutional medicine will give protection for a longer period.

HOMOEOPATHIC MANAGEMENT OF CHIKUNGUNYA AND POST CHIKUNGUNYA ARTHRALGIA:

ACUTE PHASE: Less than 7 days.
Apis, Arnica, Bell,Benzoid acid, Bry, Cham, Colchicum, Eupat, Formica, Gaultheria, Hymosa, ledum, Guiacum, , Rhus tox.

SUBACUTE PHASE: 7-14 days
Actea spicata, Caulophyllum, Phytolocca, Rhododendron, Rhus tox

CHRONIC PHASE- after 2 weeks.
Bry, Calc, Calc flour, Ledum, Kalmia, Medo, Puls, Ruta

Post chikungunya enthesopathy: Pain in soles, feet, Heel tendons, tennis elbow etc..: Arnica, Formica, Kali bich, Phyto, Rhodo.

Therapeutics for post chikungunya arthralgia with few joints affection:

  1. Pain in the hands- Caulophyllum, Colchicum, Rhux tox.
  2. Pain in the fingers – Caulophyllum, Rhodo,
  3. Pain in the finger joints- Ant crud, Caulo, Caust.
  4. Pain in the ankle- Ledum pal, Guaiacum, Oleum j, Verat vir,
  5. Pain in the foot- Rhus tox, Hepar, Ledum, Ruta.
  6. Pain in the joints of feet- Bry, Calc, Guaicum, Staphy
  7. Pain in the sole- Caust.
  8. Pain in the heel – Ammon Mur, Aranea diadema, Calc, Puls, Rhodo.
  9. Pain in the toes- Benz acid, Caulo, Phyto, Rhodo, Rhus tox
  10. Swelling of multiple joints- Act spicata, Bell, Bry, Colch, Hep, Ledum, Sulph.
  11. Swelling of the wrist joint- Act spicata, Apis, Lact acid, Rhus tox.
  12. Swelling of the hand- Apis, colch,
  13. Swelling of the fingers- Act spic, Apis, Bry, Kali bich, Phyto, Rhus tox
  14. Swelling of the finger joints- Bry, Calc, Caulo, Cham, Lactic acid, Lyco, Nit acid, Phyto, Rhus tox.
  15. Swelling of the ankle- Apis, Chel, Kalm, Med
  16. Swelling of foot- Apis, Ars, Bry, caust, Led, Lyco, Med, Puls, Silicea.

Dermatological manifestations:
Ars alb, Apis, Bovista, Puls, Natrum mur, Rhus tox, Sulph.

Neuropsychiatric manifestations:
Somatoform pain disorder: Chamomilla, Moschus, Lac caninum, Ignatia, Natrum Mur.

25 Responses to Chikungunya

  1. balasubramanya

    kindly suggest the exact combination of homeo medicines for chikungunia

  2. admin

    Dear Balasubramanya,
    Homoeopathic treatment for chikungunya and related arthralgia is based on symptomatology. There are more than 50 medicines in Homoeopathy for the symptomatology of chikungunya. Depending on the most distressing symptom a medicine is chosen and given in appropriate dosage. For E.g. In post chikungunya arthralgia( joint pain) the location, sensation , aggravating factors etc are taken in to consideration.

  3. Nataraj S

    fabulous information on chikungunya.
    Homoeopathic system has prevented many from swallowing pain killers. Thanks to this most harmless and gentle system of medicine. Special congratulations to Dr Prasanna Kumar for throwing more light on Homoeopathic management of chikungunya.

  4. S K Kalra

    I went through hundreds of articles on Chikangunya. Some are too deep some too oblique. Article by Dr Prasanna is perfect and practical one. Kudos!

  5. Dr Blany Lobo

    Extremely goog article, short, precise, brilliant. Keep it up!
    DR BLANY LOBO, M.D ( Hom)

  6. shabarish

    The article published by you is very good
    Hi i am shabarish from bangalore i was suffering from viral infection and chicken gunia from june 2009, fever is gone, but there are some joint pains in hands, feet, in how many it will cure please respond to this query

  7. Dr Prasanna Kumar K

    Dear Paramesh,
    Now you are having Post chikungunya arthralgia. The intensity of pain and your sufferings will come down as days progress. Homoeopathic medications too will help you to reduce the discomfort. You can consult any qualifed Homoeopathic doctor, so that your case will be evaluated in a systematic manner.

  8. dr.lalithagayathry

    Dear sir,
    Very useful article with quick referrence…thanks for ur effort.
    Homoeopathy rocks.

  9. Dr Prasanna Kumar K

    Hello Dr Lalitha gayathri,
    Thank you and continue to give constuctive ideas if any, to improve this site for the Homoeopathic community.

  10. vpsingh chhabra

    very informative.I want to suggest that many pateints have musculo skeletal problems lasting for months. they can be benefited with physiotherapy treatment to great extent.

  11. Madhav

    Hello Prasanna,

    I had chikungunya around 20th of Oct, high fever of around 104 F, and severe join pains, fever got reduced
    to normal within 2 days, but I do have lot of pain even now, primarily in both the ankles and lower flange of right hand middle finger, please suggest me a right combination.

    Thanks
    Madhav

  12. Dr Prasanna Kumar K

    dear VPSINGH, CHHABRA,
    THANKS FOR UR COMMENTS. Kindly give some information on role of physiotherapy in post chikungunya arthralgia patients. It will be very useful for our readers.

  13. Zana Kovalik

    I enjoyed this very much! Just charming! Your composing manner is pleasing and the way you managed the subject with grace is notable. I am intrigued, I presume you are an expert on this subject. I am subscribing to your updates from now on.

  14. jai tilak singh

    Dear Dr. Prasanna,
    The article was very informative. My wife as well as me suffered from this dreaded fever for three days with severe body pain. Since last 20 days we have severe joint pain in the knees, ankle and sole and it is severe in the morning.
    This article has cleared many of my doubts.
    Plesae keep up the good work.
    Regards,
    J.T. Singh
    Certified Financial Planner

  15. RAMESH

    excellent article. This article should be added as a chapter to latest textbook of medicine. congratulations to DRS who made the chikungunya, a simple problem.

  16. Subba Rama Reddy

    sir..
    My mother is suffering from joint pains till 3months. allopathy medicines are not suitable to her body. The pains are only at hands and legs joints. The pains are coming very much at the time of morning. So kindly please suggest me the best medicine in homeopathy to save my mum from joint pains.
    Thanking you sir.

  17. Dr Prasanna Kumar K

    Dear Subba rama reddy,
    For your mother illness, you may have to consult a qualified Homoeopathic dr. In Homoeopathy treatment is decided after detailed evaluation of the patient. In your native place you can consult the Homoeo dr.

  18. Tkrishna

    Your article is one of the best I have seen on Chikungunia.
    My brother had chikungunia Aabout 1 mth back .but still he has pain in ankle jts and finger jts.kindly advice the medicine he must take.

    T krishna .Bhopal

  19. Dr Prasanna Kumar K

    Dear Krishna,
    For planning effective Homoeopathic medicines i require quite a lot of informations. In my website there is an article ” how to present your illness to a Homoeo dr”. Kindly go through it and let me know all the details.

  20. Aize Cadag

    Dear Dr. Kumar,

    I was diagnosed with chikungunya last month November 11th 2012. The symptoms started November 7th, but until now, i still have the symptoms, Pain on the muscles under my feet and on my hand, back of the knee and pain on walking. Any suggestion please?

    Thank you…

  21. gauri Kulkarni

    Dear sir,
    I am doing a research on physiotherapy treament in chiken gunia patients kindly let me know if you have any related articles

  22. antony pais

    Hello sir,
    Thanks for publishing such an informative article in your website. I have referred so many sites on chikungunya , but no where i could get such an information as provided in your website. My mother had chikungunya like fever and she was almost swallowing painkiller daily. Now after reading your article i consulted a homeo dr in my place and he has done a good job my treating my mother effectively. thanks once again.

  23. Paranthaman

    I contracted chikungunya in feb 2012 and by aug 2012 I had pain only in left ankle, but I sufferred a bout of diarrhea for 6 days in aug 2012 and most of my joints have been paining since then.. Left ankle, right ankle, right heel tendon, left knee, fingers, wrists, elbow and shoulders.. i ve been takin pain killers and also homeopathy from dec2012 but there is no improvement in my condition..

  24. Rohit.B.Surti

    I have a chikengunia suffering since last 9 month. basically i have joint pain and stifness of body. give me a suggation
    thanks

  25. Rohit.B.Surti

    I have a chikangunia and maleria both to gather on the month of oct 2012. now 9 month has been passed every thing is clear but till i havve aproblem of jont stifness
    and i can not walk properly. give me guidance.
    thanks

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