e have been recent outbreaks of CHIKV associated with severe illness. CHIKV causes an illness with symptoms similar to dengue fever. CHIKV manifests itself with an acute febrile phase of the illness lasting only two to five days, followed by a prolonged arthralgic disease that affects the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months, or in some cases years.Signs and symptoms
The incubation period of Chikungunya disease is from two to four days. Symptoms of the disease include a fev
er up to 40 °C (104 °F), a petechial or maculopapular rash of t
he trunk and occasionally the limbs, and arthralgia or arthritis affecting multiple joints. Other nonspecific symptoms can include headache, conjunctival Injection, and slight photophobia. Typically, the fever lasts for two days and then ends abruptly. However, other symptoms—namely joint pain, intense headache, insomnia and an extreme degree of prostration—last for a variable period; usually for about 5 to 7 days. Patients have complained of joint pains for much longer time periods depending on their age.Causes
Chikungunya virus is indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infec
ted mosquitoes, usually of the genus Aedes. Chikungunya virus belongs to alpha-virus under Togaviridae family. It is an "Arbovirus" (Ar-arthropod, bo-borne). CHIK fever epidemics are sustained by human-mosquito-human transmission. The word "chikungunya" is thought to derive from description in local dialect of the contorted posture of patients afflicted with the severe joint pain associated with this disease. The main virus reservoirs are monkeys, but other species can also be affected, including humans.Treatment
There are no specific treatments for Chikungunya. There is no vaccine currently available. A Phase II vaccine trial, sponsored by the US Government and published in the American Journal of Tropical Medicine and Hygiene in 2000, used a live, attenuated virus, developing
viral resistance in 98% of those tested after 28 days and 85% still showed resistance after one year.A serological test for Chikungunya is available from the University of Malaya in Kuala Lumpur, Malaysia.
Chloroquine is gaining ground as a possible treatment for the symptoms associated with Chikungunya, and as an anti-inflammatory agent to combat the arthritis associated with Chikungunya virus. A University of Malaya study found that for arthritis-like symptoms that are not relieved by aspirin and non-steroidal anti-inflammatory drugs (NSAID), chloroquine phosphate (250 mg/day) has given promising results. Research by an Italian scientist, Andrea Savarino, and his colleagues together with a French government press release in March 2006 have added more credence to the claim that chloroquine might be effective in treating chikungunya. Unpublished studies in cell culture and monkeys show no effect of chloroquine treatment on reduction of chikungunya disease. The fact sheet on Chikungunya advises against using aspirin, ibuprofen, naproxen and other NSAIDs that are recommended for arthritic pain and fever.
Epidemiology
Chikungunya virus is an alphavirus closely related to the O'nyong'nyong virus, the Ross River virus in Australia, and the viruses that cause eastern equine encephalitis and western equine encephalitis.
Chikungunya is generally spread through bites from Aedes aegypti mosquitoes, but recent research by the Pasteur Institute in Paris has suggested that Chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by Aedes albopictus (Tiger mos
quito). Concurrent studies by arbovirologists at the University of Texas Medical Branch in Galveston, Texas, confirmed definitively that enhanced chikungunya virus infection of Aedes albopictus was caused by a point mutation in one of the viral envelope genes (E1). Enhanced transmission of chikungunya virus by Aedes albopictus could mean an increased risk for chikungunya outbreaks in other areas where the Asian tiger mosquito is present. A recent epidemic in Italy was likely perpetuated by Aedes albopictus.In Africa, chikungunya is spread via a sylvatic cycle in which the virus largely resides in other primates in between human outbreaks.
On 28 May 2009 in Changwat Trang of Thailand where the virus is endemic, the provincial hospital decided to deliver by Caesarean section a male baby from his Chikungunya-infected mother—Khwanruethai Sutmueang, 28, a Trang native—in order to prevent mother-foetus virus transmission. However, after delivering the baby, the physicians discovered that the baby was infected with Chikungunya virus, and put him into intensive care because the infection had left the baby unable to breathe by himself or to drink milk. The physicians presumed that Chikungunya virus might be able to be transmitted from a mother to her foetus; however, there is no laboratory confirmation for this presumption.
