Chikungunya virus is closely related to O’nyong’nyong virus. O’nyong’nyong virus caused a major epidemic of arthritis and rash involving at least 2 million people in Eastern and Central Africa in 1960s. After its mysterious emergence the virus virtually disappeared leaving only occasional evidence of its presence in Kenya.
The chikungunya virus is spread by mosquito bites from the Aedes aegypti mosquito. Mosquitoes become infected when they feed on a person infected with the chikungunya virus. Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus. Infected mosquitoes can then spread the virus to other humans when they bite.
Aedes aegypti (the yellow fever mosquito), a household container breeder and aggressive daytime bitter which is attracted to humans, is the primary vector of chikungunya virus to humans. Aedes albopictus (the Asian tiger mosquito) may also play a role in human transmission is Asia, and various forest-dwelling mosquito species in Africa have been found to be infected with the virus.
Aedes breeds in artificial accumulations of water. It needs only 2ml of water for breeding. It lays eggs singly. They do not fly over long distance, usually less than 100 metres. Eggs can resist desiccation for upto 1year. The eggs will hatch when flooded by deoxygenated water.Aedes can spread the infection to next generation.
Aedes is the first proved vector of a virus disease- Yellow fever. Human blood is preferred over other animals with ankles as a favourite bite area.
SymptomsAfter an incubation period of 3-12 days there is a sudden onset of flu-like symptoms including a severe headache, chills, fever (>40°C, 104°F), joint pain, backache, nausea, vomiting, petechial or maculopapular rash usually involving the limbs and trunks. Migratory polyarthritis mainly affects the small joints of the hands, wrists, ankles and feet with lesser involvement of the larger joints. Joints of the extremities in particular become swollen and painful to the touch. Haemorrhage is rare. There can also be headache, conjunctival infection and slight photophobia.Redness of eyes may be the first symptom. There may be difficulty in looking upwards
In the present epidemic in the state of Andhra Pradesh in India, high fever and crippling joint pain is the prevalent complaint. Fever typically lasts for two days and abruptly comes down. The disease has a biphasic course also. Following 1-6 days of fever, the temperature returns to normal for 1-3 days and then there is a second period of fever for a few days. In the second phase of illness 80 % of people develop maculopapular rash on the trunk and extensor surfaces of the limbs. After 6 to 10 days patients recover completely. However joint pain, intense headache, insomnia and an extreme degree of prostration lasts for a variable period, usually for about 5 to 7 days. Rarely arthralgia and morning stiffness may persist for months.
However joint pain, intense headache, insomnia and an extreme degree of prostration lasts for a variable period, usually for about 5 to 7 days.
Dermatological manifestations observed in a recent outbreak of Chikungunya fever are as follows:
- Maculopapular rash like ulcers over scrotum, crural areas and axilla.
- Nasal blotchy erythema
- Freckle-like pigmentation over centro-facial area
- Flagellate pigmentation on face and extremities
- Lichenoid eruption and hyperpigmentation in photodistributed areas
- Multiple aphthous ulcers
- Multiple ecchymotic spots (Children)
- Vesiculobullous lesions (infants)
- Subungual haemorrhage.
- A few patients develop Leucopenia.
- Elevated levels of aspartate aminotransferace (AST) and C-reactive protein
- Mildly decreased platelet counts.
Diagnosis1.Isolation of the virus from blood. It is possible in the first 4-5 days of illness. Sudden severe headache, chills, fever, joint and muscle pain are the commonest symptoms. The diagnostic tests include detection of antigens or antibodies in the blood, using ELISA (or EIA – enzyme immunoassay) or molecular techniques like polymerase chain reaction (PCR). The antibodies detected by serological assays like ELISA require an IgM capture assay to distinguish it from dengue fever
Differential Diagnosis1. Dengue FeverOf all the arthropod- borne viral diseases, Dengue fever is the most common. This infection may be asymptomatic or may lead to1. Classical Dengue Fever2 .Dengue Haemorrhagic fever without shock3. Dengue Haemorrhagic fever with shock
The main vector is Aedes aegypti mosquito. The illness is characterised by a incubation period of 3 to 10 days. The onset is sudden with chills and high fever, intense headache, muscle and joint pains which prevent all movement. Within 24 hrs retro-orbital pain and photophobia develops. Other symptoms include extreme weakness, anorexia, constipation, colicky pain and abdominal tenderness. Fever is typically but not inevitably followed by a remission of a few hrs to2 days. The rash may be diffuse flushing, mottling, or fleeting pin point eruptions on face, neck and chest during the first half of the febrile period and a conspicuous rash that may be maculopapular or scarlatiform on 3rd or 4th day. Fever lasts for about 5 days.
Dengue haemorrhagic fever is confined exclusively to children less than 15 yrs of age. There may be plasma leakage and abnormal haemostasis, as manifested by a rising haematocrit value and moderate to marked thrombocytopenia.The fever may rise again producing a saddle-back fever curve. There may be generalised lymphadenopathy.
In dengue shock syndrome shock is present along with all the above criteria.
Homoeopathic ProphylaxisAs per the guidelines laid down by Dr. Samuel Hahnemann in the Organon a Genus epidemics has to be found out in the specific area and it could be the best to be found out in the specific area and it could be the best prophylactic remedy.
Many homeopaths consider Eupatorium perfoliatum as a preventive medicine for Chikungunya. The most commonly suggested potency as prophylaxis is 200C of Eupatorium perfoliatum. As per the reports the homoeopathic remedies useful for propylaxis are – Eupatorium Perfoliatum, Gelsemium, Rhustox, Bryonia Alba, Ars alb ,Aconite and Polyporus.
Treatment Chikungunya fever is usually self-limiting and will resolve with time. Symptomatic treatment is recommended after excluding other more dangerous diseases. There is no vaccine currently available for Chikungunya. Supportive care with rest is indicated during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms.
Homoeopathic TreatmentAphorism 100-102 is dealing with the treatment of epidemic diseases. According to Dr.Hahnemann, a carefully observing physician can arrive so nearly at knowledge of the true state of the epidemic from the examination of even the first and second patients and can even find a suitable homoeopathic remedy for it. Dr. Hahnemann recommends investigating each epidemic disease as a new and unknown case and selecting medicine according to its symptom similarity.
Homoeopathy has a very good scope in the treatment of chikungunya. Initially indicated acute remedies may give relief which may be followed by constitutional remedy in order to get rid of post fever arthralgia