Chikungunya

Symptoms Of Chikungunya  

The symptoms of chikungunya typically appear 2 to 12 days after a person has been bitten by an infected mosquito. The most common symptoms of chikungunya include:

• Abrupt onset of fever or chills
• Severe joint pain and swelling
• Joint stiffness
• Knee pain 
• Shoulder pain
• Muscular pain
• Headache
• Nausea
• Rashes and redness of the skin
• Fatigue or tiredness
• Abnormal bleeding tendency
• Skin blistering

Causes Of Chikungunya 

Chikungunya is a viral disease that is transmitted to humans through the bite of infected mosquitoes, primarily the Aedes aegypti and Aedes albopictus species.

When an uninfected mosquito bites a person infected with Chikungunya virus (CHIKV), the virus enters the mosquito's body. After a few days, the virus spreads to the mosquito's salivary glands. 

When the mosquito bites another person, the CHIKV enters the bloodstream and spreads throughout the body, infecting various tissues, including muscle cells and immune cells. In the new person, the virus multiplies and reaches high levels in their blood, causing symptoms of chikungunya.

This virus can enter the body through the skin, when we breathe (respiration), through the mouth (ingestion), through sex (vaginal, oral, anal) or close sexual contact, or to an unborn baby through the placenta or birth canal.

The virus primarily targets cells in the joints, leading to inflammation and severe joint pain.

Risk Factors For Chikungunya 

While anyone can contract chikungunya, the following risk factors may increase the likelihood of infection or the severity of the disease:

• Staying or traveling to regions where chikungunya is endemic or experiencing outbreaks.

• Living in areas with inadequate mosquito control measures, such as stagnant water sources or poor sanitation.

• Spending time outdoors, especially in areas with high mosquito populations. Mosquito exposure is more likely during the daytime, particularly around dawn and dusk when Aedes mosquitoes are most active.

• Wetter and hotter months of the year.

• Individuals who have not been previously infected with chikungunya.

• Infants, young children, older adults, and individuals with weakened immune systems or underlying health conditions.

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There might be times when you might have wondered why mosquitoes bite you more than others. Well, this could be because of:

• 'O' Blood type 

• Mosquito attracting genes

• Pregnancy 

• Consumption of alcohol

The rationale behind this is that alcohol consumption, pregnancy, and even physical activity raise your metabolic rate, causing you to exhale more carbon dioxide, which in turn attracts more mosquitoes.

Diagnosis Of Chikungunya 

The diagnosis of chikungunya involves a combination of clinical evaluation and laboratory tests. Here are the key steps involved in diagnosing chikungunya:

1. Medical history and physical examination

The healthcare provider will begin by taking a detailed medical history, including information about recent travel to regions where chikungunya is prevalent and symptoms you may be experiencing. A physical examination to check for signs of the disease will also be performed.

2. Symptoms

Chikungunya is characterized by symptoms like sudden onset of high fever, joint pain, muscle pain, headache, rash, and fatigue. These symptoms can be similar to those of dengue and Zika, making it important to consider the possibility of chikungunya based on the presence of symptoms and the geographical location.

3. Laboratory Tests

The most commonly used tests for the diagnosis of chikungunya include

a. Reverse Transcription-Polymerase Chain Reaction (RT-PCR): This test detects the genetic material (RNA) of the chikungunya virus in a blood sample. It is most effective during the first week of illness when the virus is actively replicating.

b. Antibody tests: Also known as serological tests, are designed to identify the existence of antibodies in the bloodstream, which typically develop after an infection. These tests employ either indirect immunofluorescence (IFA) or enzyme-linked immunosorbent assay (ELISA) methods.

The purpose of these tests is to detect the presence of anti-chikungunya antibodies, specifically IgM (which is detectable from five days to several weeks after infection) and IgG (which remains present from two weeks to several years after infection).

It's important to note that antibody tests do not detect current infections but indicate previous exposure to the virus.

4. Other tests

In most situations, it is advisable to undergo a complete blood count (CBC). This can provide your doctor with information about the severity of the infection and the presence of other conditions like anemia caused by the infection.

Don’t ignore the symptoms and get tested.

Prevention Of Chikungunya 

Presently there is no approved vaccine for the prevention of chikungunya. 

Two vaccine candidates, one made from a modified measles virus and another using virus-like particles, have completed initial tests. More research and trials are underway before the vaccine is approved for public use.

In the absence of a vaccine, the most effective way to avoid chikungunya is by taking measures to protect yourself from mosquito bites.

1. Preventive measures to avoid mosquito bites

• Wear long-sleeved shirts and long pants when working outdoors during the day to reduce the risk of mosquito bites.

• Install window and door screens to keep mosquitoes out of your living areas.

• Avoid outdoor activities during times when mosquitoes are most active.

• Use mosquito nets or screens around beds to create a barrier against mosquitoes.

• Consider using mosquito zapping devices, such as electric bats, to control the mosquito population.

• To minimize mosquito attraction, switch your outdoor lights to yellow "bug" lights. While not repellent, these lights tend to attract fewer mosquitoes compared to regular lights.

• Apply mosquito repellents that contain DEET, picaridin, IR3535, Para-menthane-diol (PMD), or oil of lemon eucalyptus.

Pro Tip: Apply sunscreen before applying mosquito repellent.

2. Tips for babies and children

• Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under the age of 3.

• Avoid applying insect repellent on a child's hands, eyes, mouth, cuts, or irritated skin.

• When using insect repellent for children, adults should first spray it onto their own hands and then apply it to the child's face.

• After returning indoors, wash your children's skin with soap and water to remove any repellent, and wash their clothing before they wear it again.

• Avoid using sprays in pressurized containers that children may accidentally inhale or get into their eyes.

3. Products for preventing mosquito bites

• Mosquito repellent bands: Worn on the wrist, they come in chemical (DEET-impregnated) and natural (essential oils) varieties.
  
  
• Mosquito patches: Stickers stuck on clothes (collars, sleeves, skirts, shorts) available in chemical and herbal forms.
  
  
• Body lotion or mosquito sprays: Synthetic repellents (DEET, permethrin) or natural repellents (citronella) for protection.
  
  
• Mosquito repellent sticks: Similar to incense sticks, loaded with repellents, used in open spaces like gardens, terraces, or balconies.
  
  
• Mosquito nets: Conventional option with fine wire mesh (18 x 18 strands per inch) for beds or window screens.
  
  
• Additional repellent products: Apart from these repellents, there are products like blankets, floor cleaners, electric zappers and table-top fumigation machines, which help keep mosquitoes away.

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4. Tips to prevent mosquito breeding

• Avoid excessive watering of potted plants and ensure that trays are emptied to prevent them from becoming breeding grounds.

• Regularly change the water for indoor plants and decorative items that can collect water, such as bird baths, tabletop fountains, flower vases, and fish tanks.

• Empty water from trays under air conditioners, refrigerators, and other containers like pet or bird feeding bowls.

• Clean these containers at least once every 15 days to disrupt the mosquito breeding cycle, which typically lasts around 15-20 days.

• When not in use, turn over empty pails and buckets, and cover containers with tight-fitting lids to prevent mosquitoes from breeding.

• Use dustbins with properly fitting lids and dispose of trash daily, as uncovered trash cans attract mosquitoes.

• Implement regular fogging with mosquito repellents or larvicides, and consider spraying pesticides like DDT in potential mosquito breeding areas.

Are you wondering why there are lots of mosquitoes in your house even when you keep it clean?  Want to know if your house is a mosquito magnet?

Doctor To Visit

If you notice a high fever accompanied by chills and mosquito breeding in your vicinity, it is advisable to consult a doctor. Additionally, if you encounter a combination of symptoms like high fevers, joint pain, headaches, muscle pains, or a rash, it is crucial to seek medical attention without hesitation.

Medical professionals who specialize in diagnosing and treating chikungunya are:

• General physician

• Internal medicine specialist

• Infectious disease specialist

• Pediatrician (for children and adolescents)

A general physician will examine your symptoms. If they confirm a diagnosis, they may refer you to an Internal Medicine specialist who provides comprehensive care for adult patients, managing complex cases and addressing underlying health conditions.

Infectious disease specialists also play a crucial role in quickly and accurately diagnosing and treating infectious diseases like chikungunya. 

A pediatrician can be consulted for medical treatment and preventive healthcare services for children and adolescents.

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Treatment Of Chikungunya 

The main treatment for Chikungunya fever focuses on relieving symptoms, such as drinking enough fluids, resting, and using paracetamol for pain and fever relief. The treatment can be broadly divided into two phases:

1. Acute phase

After a silent incubation period of 2 to 4 days, patients generally display the chikungunya symptoms that may persist 3–7 days during the acute phase of the disease. The following treatment protocols are usually followed during this phase:

Rest should be one of the main recommendations as physical activities tend to aggravate the joint pain, contributing to local wear and thus to prolonging the clinical condition. 

• Certain local measures like the application of cold compresses or ice packs and pain relief gels to the affected joints can reduce swelling and pain.
  
  
• The two most commonly used medications prescribed for mild to moderate pain are Paracetamol and Metamizole. NSAIDs like ibuprofen and aspirin are usually avoided because of the risk of bleeding.
  
  
• In the case of severe-intensity pain, Paracetamol or Metamizole might be combined with opioids like Tramadol.

2. Post acute phase

While most patients start showing signs of recovery after a week, in some cases chronic and incapacitating joint pain can persist. 

• In the case of moderate to severe pain that is not responding satisfactorily to the medications in use, other drugs must be recommended. Among these options are disease-modifying antirheumatic drugs (DMARDs), like methotrexate, hydroxychloroquine or sulphasalazine.
  
  
• Once the pain subsides, the pain relief medications are suspended; conversely, if the pain persists, corticosteroids like prednisolone might be prescribed at an anti-inflammatory dose. 
  

Note: Special considerations are made for pregnant women and children in terms of medication choices. 

Listen to our expert talk about the most common mosquito-borne diseases like malaria, chikungunya & dengue including their prevention and treatment. Watch this video

Home-care For Chikungunya 

Certain herbal remedies that may help alleviate the symptoms of chikungunya. It's important to note that these remedies may provide relief but should not replace medical treatment or advice.

Here are some herbal remedies that may help manage the symptoms of chikungunya:

1. Turmeric (haldi): Turmeric is an effective natural remedy for alleviating chikungunya-related pain. It contains curcumin, a compound with potent antioxidant and anti-inflammatory properties. It can be consumed as a spice in cooking or taken as a supplement. 

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2. Ginger (adarak): Ginger can help relieve pain and discomfort associated with chikungunya. 

It can be consumed as tea, or as an ingredient in various dishes. To make ginger tea, simply steep fresh ginger slices in hot water for several minutes. It can also be taken in supplement form.

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3. Sonth: Sonth, or dried ginger is known for its anti-inflammatory and pain-relieving effects. It can be consumed as tea or added to food for relief from chikungunya symptoms.

4. Coconut Water (nariyal paani): Coconut water has a positive impact on the liver, which is often targeted by the Chikungunya virus. Consuming coconut water can aid in a quicker recovery and help reduce chikungunya symptoms.

5. Basil (Tulsi): Basil, also known as tulsi, can help lower body temperature and boost the immune system. Chewing basil leaves or drinking tea made from boiling basil leaves in water can provide relief and aid in the recovery process.

6. Papaya leaf extract: Papaya leaf extract is believed to have immune-boosting properties and may help increase platelet count. It is typically consumed as tea or juice. Fresh papaya leaves are crushed or ground, and the juice is extracted. It can be consumed orally, but the dosage and frequency should be discussed with a doctor.

7. Garlic (Lehsun): Garlic possesses antiviral and immune-boosting properties and alleviates symptoms associated with chikungunya. Garlic can be consumed raw, cooked, or in supplement form. However, it's important to note that consuming excessive amounts of garlic may cause digestive discomfort, and it can also interact with certain medications. It's best to consult with a doctor before using garlic as a remedy.

8. Giloy: Also known as Guduchi, is an ayurvedic herb with immunity-enhancing and anti-inflammatory properties. It can be taken as juice or decoction.

9. Spirulina: Spirulina is a type of blue-green algae rich in nutrients. It is often used as a dietary supplement due to its high protein content and immune-enhancing properties. 

Diet for better recovery from Chikungunya

1. Consume nutrient-rich foods: Include a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats in your diet. These foods provide essential nutrients, antioxidants, and fiber to support your immune system and promote overall well-being.

2. Increase intake of anti-inflammatory foods: Chikungunya can cause joint pain and inflammation. Include foods with anti-inflammatory properties in your diet, such as turmeric, ginger, garlic, berries, leafy greens, fatty fish (like salmon and mackerel), and nuts.

3. Include foods rich in vitamins and minerals: Foods that are high in vitamin C, vitamin D, vitamin E, and zinc can help boost your immune system. Citrus fruits, berries, kiwi, bell peppers, spinach, nuts, seeds, and legumes are good sources of these nutrients.

4. Focus on healthy fats: Include sources of healthy fats like avocados, olive oil, nuts, and seeds in your diet. These fats have anti-inflammatory properties and can support your overall health.

5. Limit processed foods and added sugars: Minimize your consumption of processed foods, sugary snacks, and beverages as they can weaken the immune system and promote inflammation.

6. Probiotics: Probiotics such as yogurt, pickles, tempeh (Fermented Soybeans) etc are rich in probiotics, the good bacteria that support gut health and help stimulate the immune system to fight off disease. 

Other tips that can help in alleviating symptoms:

1. Stay hydrated: Drink plenty of fluids such as water, herbal teas, and fresh fruit juices to stay hydrated and help flush out toxins from your body. Also, proper hydration makes it easier for immune-boosting nutrients to get to where they need to go (cells) in your body.

2. Take proper rest: Get plenty of rest to allow your body to recover and conserve energy. Avoid strenuous activities that may worsen your symptoms.

3. Epsom salt baths: Soothing bath with Epsom salt is a commonly used home remedy for various conditions, including muscle aches and pains. Dissolve about two cups of Epsom salt in a bathtub filled with warm water and soak in it for 15-20 minutes. This may provide temporary relief and help relax the muscles.

4. Cold Compresses: Applying cold compresses or ice packs to swollen joints or areas of pain can help reduce inflammation and provide temporary relief from discomfort.

Complications Of Chikungunya 

Most individuals with chikungunya experience a self-limiting illness and recover within a few weeks. However, individuals with pre-existing health conditions or weakened immune systems may be at a higher risk of developing the following complications:

• Eye issues such as conjunctivitis (often known as pink eye, is an inflammation or infection conjunctiva), optic neuritis (swelling of the optic nerve), iridocyclitis (inflammation of the iris), retinitis (inflammation of the retina), uveitis (inflammation of the uvea) etc.

• Persistent joint pain

• Chronic Arthritis (long-term joint inflammation and leads to chronic arthritis). 

• Cardiovascular issues such as myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the pericardium), and heart failure.

• Hepatitis (liver inflammation)

• Skin lesions (or fluid-filled blisters)

• Hemorrhage (loss of blood, inside or outside the body)

• Myelitis (inflammation of the spinal cord)

• Cranial nerve palsies (lack of function of a nerve)

• Guillain-Barré syndrome (an autoimmune disorder affecting the nerves).

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Alternative Therapies For Chikungunya 

It's important to note that these therapies should be used in conjunction with conventional medical care and under the guidance of a healthcare professional. Here are some alternative therapies that may be considered:

1. Physiotherapy: Chikungunya can cause joint pain and stiffness. Physiotherapy techniques such as gentle stretching exercises and range-of-motion movements can help improve chronic CHIKV-associated severe pain and joint mobility.

2. Acupuncture: Acupuncture involves inserting thin needles into specific points on the body. Some studies suggest that acupuncture may help alleviate pain and inflammation associated with chikungunya. Seek out a licensed acupuncturist for this treatment.

3. Aromatherapy: Essential oils such as lavender, chamomile, and eucalyptus may have soothing and anti-inflammatory properties. They can be used in a diffuser, added to a warm bath, or diluted with a carrier oil and applied topically. However, it's important to note that essential oils should be used with caution and diluted properly, as they can be potent and may cause skin irritation or other adverse effects