Chikungunya A92.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 12.11.2024

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Synonym(s)

Chikungunya fever; chikungunya infection; Chikungunya virus infection

Definition
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Arbovirus infections include endemo-epidemic alpha-virus infection caused by the Chikungunya virus.

Pathogen
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Enveloped double-stranded RNA virus of the genus Alphavirus in the family Togaviridae, belonging to the Semliki Forest virus complex.

Occurrence/Epidemiology
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First described in Tanzania and Uganda (1952), occurs in East and West Africa, India, Southeast Asia, Philippines, Pacific and Indian Ocean islands. 2005 major outbreak in La Reunion and Mauritius. 2006 outbreak in India (approximately 1.25 million infected).

Also occurred for the first time in Italy in 2007 (Ravenna) with approximately 197 cases.

Deaths have been described (exact numbers are missing).

Etiopathogenesis
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Urban (human-human) and sylvatic cycles (animal-human). Reservoir animals are monkeys and rodents. Transmission of the virus through the bite of Aedes aegypti and albopictus mosquitoes (Asian tiger mosquito); Culex, Anopheles and Mansonia mosquitoes are also under discussion. Transmission from person to person (diaplacental transmission has also been described).

Clinical features
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Incubation period: 3-7 (maximum 2-12) days, biphasic course:

Abrupt onset with high fever, chills, fatigue, severe pain in joints and muscles (approx. 1-7 days)

Remission (2 days duration).

Renewed rise in fever, severe arthralgia of the small joints, headache, maculo-papular exanthema with healing under scaling, petechiae on the hard palate, conjunctivitis, swelling of the lymph nodes, gastrointestinal symptoms.

Healing after 1-2 weeks, but arthralgias can persist for months.

Long lasting immunity.

Diagnosis
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lymphopenia, thrombopenia, anaemia, increase in CRP, LDH, AST, ALT, CK

Serology (ELISA): Detection of IgM and IgG antibodies (5 days and later after onset of symptoms)

PCR (in blood): < 5 days after onset of symptoms

Cell culture.

Differential diagnosis
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O'nyong-nyong and dengue fever as well as other alpha and flaviviruses; COVID-19 infections, rheumatoid arthritis, autoimmune diseases.

Complication(s)
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Persistent arthralgias

pericarditis, myocarditis

Neurological disorders, meningitis

Hepatitis

very rarely hemorrhagic fever.

Therapy
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Only symptomatic therapy: non-steroidal anti-inflammatory drugs, chloroquine.

Synergistic effects of interferon-alpha and ribavirin are described in the treatment.

Prophylaxis
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Mechanical mosquito protection, especially repellents (e.g. Icaridin, Zanzarin); insecticides.

Note(s)
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  • Remember! Pathogen detection required to be reported according to § 7 of the Infection Protection Act, as the pathogen can be a possible trigger of haemorrhagic fever; the doctor is only required to report suspected cases of haemorrhagic fever.

  • Notice! Chikungunya means in the Bantu language: "the bent walking one".

Literature
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  1. Borgherini G et al (2007) Outbreak of chikungunya on reunion island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 44: 1401

  2. Charrel RN et al (2006) Toscana virus RNA in Sergentomyia minuta files. Emerg Infect Dis 12: 1299

  3. Charrel RN et al (2007) Chikungunya outbreaks--the globalization of vectorborne diseases. N Engl J Med 356: 769
  4. Mourya DT, Mishra AC (2006) Chikungunya fever. Lancet 368: 186

  5. Pialoux G et al (2007) Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 7: 319

  6. Simon F et al (2007) Chikungunya Infection: An Emerging Rheumatism Among Travelers Returned From Indian Ocean Islands. Report of 47 Cases. Medicine (Baltimore) 86: 123

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 12.11.2024