Chikungunya Fever

Dr.Madhusudan.S
• DIAGNOSIS

• TREATMENT

• PROGNOSIS
Clinical Diagnosis

• Chikungunya fever is suspected when

a child, presents with fever, rash and
joint symptoms more so during an
epidemic.
Chikungunya in Children

• Less likely to have joint symptoms

Even when present – milder , shorter
duration.
• High fever, febrile convulsions
• G.I.Symptoms – vomiting,pain
abdomen,constipation.
• Lymphadenopathy – more common
• Mild haemorrhagic symptoms – epistaxis,
petechial rash, positive tourniquet test.
Differential Diagnosis

• O’nyongnyong, Not found in INDIA

Mayaro,
Semliki forest.

Ross River,Sindbis, Not found in INDIA

West Nile,
Barmah forest
Rubella,Parvovirus B19, Lymphadenopathy,
Sixth disease,mumps, Salivary, extra salivary
Hepatitis A & B, Tender hepatomegaly

Epstein Barr Virus Gen lymphadenopathy

& hepatosplenomegaly.
Cough,chestpain,icterus,l
Leptospirosis ymphadenopathy,hepato
megaly,splenomegaly.
Epidemic/endemic Not seen in INDIA
typhus G.I/Resp/rash(13%)
Scrub typhus Eschar/cough/G.I.
Enteric fever Pain abd,diarrhoea,
Constipation,
Hepatosplenomegaly
Relapsing Fever G.I./Rash(18%)
(tick borne)
Henoch Schonlien Palpable purpura,G.I,
purpura. Renal(hematuria,HTN)

Serum sickness Urticaria,drug exposure.

Drug induced eruptions Intensely pruritic.

RF with E.marginatum. Carditis,chorea,scnodule

Dengue-The closest imitator

• Found in the same areas

• Dual infections reported in some cases

• Overlapping clinical features

• Children – greater incidence of haemorrhagic

symptoms than adults
 DENGUE CHIKUNGUNYA

Sporadic explosive
Endemic outbursts,vanishes &
reappears.

Altered taste, post- Rash,conjunctival

illness bradycardia and injection,arthralgia,
depression,asthenia myalgia

Shock,hemorrhagic Prolonged joint pains

symptoms
Laboratory Diagnosis

m-yrs
3-5wks

2 months
2-3 days 15 days

4-7 days
Demonstration of the virus

• Gold standard & most specific

• Culture-vero cells
-C6/36 Aedes albopictus cells

• Intracerebral inoculation in newborn mice

• PCR
Demonstration of the antibodies

Diagnostic test of choice:

• IgM ab capture ELISA

• IgG ab indicate past infection and without

four fold rise of ab titre do not implicate
the disease.
Principle of ELISA
Other Investigations
• CBC-Leucopenia

• Thrombocytopenia

• ^AST,ESR,CRP

• Chronic joint symptoms-synovial fluid

Dec viscosity, poor mucin clot formation, WBC-
2000-5000/mm3
TREATMENT-SUPPORTIVE

• Bedrest during fever

• Antipyretics and tepid sponging
• Analgesics and mild sedation
• Aspirin avoided-bleeding/Reye’s Syndrome
• Arthtritis-continued NSAID,movements,mild joint
exercises
• Children-lose excessive fluids-ORS
• Break transmission cycle.
ROLE OF CHLOROQUINE

• 12%-Chr joint symptoms-partial response

to NSAIDS.
• Study in France-10 patients 250mg/day
for 20 weeks
• 7/10-patient
5/10 doctor
• Further studies needed
PROGNOSIS

• Most recover in few weeks

• 12%months to years

• Pregnancy-fever may cause abortions,preterm

labour,fetal distress.

• Infants-90%-recover without sequelae

“Thankfully, the disease has proved so
mild ; had it been different , this city,
the home to half a million human
beings would have become one vast
charnel house with nobody to bury the
dead and few to save the living”
James Mellis,
Calcutta epidemic
1963-64