Chikungunya–Short Review

 

Rahamat Unissa*, G. Mounika, T. Sowmya, Goda Tirumala Reddy, Komati Bhanu Rekha, D. Sunitha

Malla Reddy College of Pharmacy, Maisammaguda, Dhulapally, Secunderabad, Osmania University, Telangana, India.

 

ABSTRACT:

Chikungunya virus infection is a rapid-onset, febrile disease with intense asthenia, arthralgia, myalgia, headache, and rash. This mosquito-borne alphavirus infection typically occurs in Africa and Asia, outbreaks have also been reported in Europe and the Americas since the 2000s. Although the fatality rate of this disease almost negligible, but the suffering due to this viral fever has been the main notable point. The aim of this paper is to make a general understanding of the disease as well as the structural identity of the virus with the symptoms and probable treatment or prevention.

 

 

 

INTRODUCTION:

Chikungunya is a mosquito-transmitted infection caused by the chikungunya virus (CHIKV)¹. Chikungunya virus (CHIKV), is a member of the genus Alphavirus, and family Togaviridae. It is an RNA virus with a positive-sense single-stranded genome of about 11.6kb². Because it is transmitted by arthropods, namely mosquitoes, it can also be referred to as an arbovirus (arthropod-borne virus).

 

Symptoms include fever and joint pain³. These typically occur two to twelve days after exposure⁴. Other symptoms may include headache, muscle pain, joint swelling, and a rash³. Most people are better within a week; however, occasionally the joint pain may last for months³. The risk of death is around 1 in 1,000. The very young, old, and those with other health problems are at risk of more severe disease.

 

 

While the disease typically occurs in Africa and Asia, outbreaks have been reported in Europe and the Americas since the 2000s⁴. In 2014 more than a million suspected cases occurred. In 2014 it was occurring in Florida in the continental United States but as of 2016 there was no further locally acquired cases⁵.

 

HISTORY:

The word "chikungunya" comes from the Makonde (or Kimakonde) language, spoken on the Makonde plateau where the disease was first described. It means, "that which bends up," "to become contorted," or "to walk bent over," describing the stooped appearance of patients with joint pain⁶.

 

The disease was first described during an outbreak in Tanzania in 1952. Historically, chikungunya was considered a tropical disease because it had only been documented in Africa, Asia, and India.

 

However, since 2007, outbreaks have occurred in Italy, France, Croatia, and the Caribbean islands. In total, more than 60 countries have identified cases of chikungunya virus.

 

SYMPTOMS^7,8

The virus causes a fever that lasts a few days and joint pain that can last weeks or months.

 

The symptoms of chikungunya virus are similar to those of other diseases such as dengue fever. The symptoms normally appear just a few days after a mosquito has bitten an individual. The most common symptoms are:

·        fever (sometimes as high as 104 °F)

·        joint pain

·        headache

·        muscle pain

·        rash

·        swelling around the joints

 

Less commonly, symptoms can be accompanied by a maculopapular rash (similar to measles or heat rash), conjunctivitis, nausea, and vomiting.

 

DIAGNOSIS:

The only way to diagnose chikungunya is by a blood test.Diagnosis is by either testing the blood for the virus's RNA or antibodies to the virus⁹. Only a blood test can definitively diagnose chikungunya as symptoms are not always easy to tell apart from other conditions.

 

MODE OF TRANSMISSION 10:

Through mosquito bites

·        Chikungunya virus is transmitted to people through mosquito bites. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

·        Chikungunya virus is most often spread to people by Aedesaegypti and Aedesalbopictus mosquitoes. These are the same mosquitoes that transmit dengue virus. They bite during the day and at night.

 

Rarely, from mother to child:

·        Chikungunya virus is transmitted rarely from mother to newborn around the time of birth.

·        To date, no infants have been found to be infected with chikungunya virus through breastfeeding. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where chikungunya virus is circulating.

 

Rarely, through infected blood:

·        In theory, the virus could be spread through a blood transfusion. To date, there are no known reports of this happening.

 

COMPLICATIONS OF CHIKUNGUNYA^2,11:

Complications can include:

·        Uveitis-inflammation of the layer in the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea.

·        Retinitis-inflammation of the retina.

·        Myocarditis-inflammation of the heart muscle.

·        Hepatitis-inflammation of the liver.

·        Nephritis-inflammation of the kidneys.

·        Hemorrhage-bleeding.

·        Meningoencephalitis-inflammation of the membranes of the brain and adjoining cerebral tissue.

·        Myelitis-inflammation of the spinal cord.

·        Guillain-Barré syndrome-rare peripheral nervous system disease characterized by muscle weakness.

·        Cranial nerve palsies-loss of function in the cranial nerves.

 

PREVENTION²

One of the most effective and simple methods of prevention is using mosquito repellent.

Seeing as the major mode of chikungunya transmission is by mosquito bite, the best methods of prevention involve minimizing contact with mosquitos. Steps that can be taken to prevent chikungunya include:

·        Using insect repellent containing DEET (N, N-Diethyl-meta-toluamide) or picaridin on skin and clothing².

·        Wearing clothing that covers the whole body.

·        Staying indoors as much as possible, especially during early morning and late afternoon.

·        Avoiding traveling to areas experiencing outbreaks.

·        Using products containing oil of lemon eucalyptus or PMD (p-Menthane-3,8-diol) can be effective.

·        Using air-conditioning - this deters mosquitos from entering rooms.

·        Sleeping under a mosquito net.

·        Using mosquito coils and insecticide vaporizers.

Although chikungunya is very rarely fatal, the symptoms are distressing and can be long-lived. Avoiding mosquitos is key.

 

CHIKUNGUNYA VACCINE¹³

Currently, there is no vaccine or antiviral treatment, but, in general, the disease is short-lived and rarely fatal. Medication focuses on relieving the symptoms rather than the cause. The National Institute of Health (NIH) are currently funding a phase 2 clinical trial of a chikungunya vaccine. The vaccine consists of so-called virus-like particles (VLPs) rather than inactivated or weakened viruses.

 

VLP-based vaccines can stimulate immune responses similar to those generated by naturally acquired immunity following viral infection. However, VLPs are not infectious and cannot replicate. Since whole viruses are not used to produce VLP vaccines, they do not need to be prepared in high-level biocontainment facilities.

 

TREATMENT⁴

The virus is rarely fatal, but the symptoms can be severe and disabling. Most patients recover from the fever within a week, but the joint pain has been known to persist for months. Even after 1 year, 20 percent of patients report recurring joint pain.

 

There are no specific drugs to treat chikungunya; doctors simply recommend rest and plenty of fluids.

 

Over-the-counter medications will help ease fever and joint pain. These include:

·        naproxen

·        ibuprofen

·        acetaminophen

For longer-lasting aches, physiotherapy may be helpful.

 

CONCLUSION:

Chickunguniya is one of the major public health problems associated with the mosquitoes.Though the treatment pattern is related to dengue, but unlike dengue, the pain is severe. As the carrier of this virus is mosquito, the avoidance of mosquito bite is the main preventive measure to preventchikungunya fever. This can be accomplished by organizing health education programmes about the disease to increase community knowledge and sensitize the community to participate in integrated vector control programmes as the prevention is better than cure.

 

 

REFERENCES:

1.       "Chikungunya Fact sheet". WHO. April 2016. Archived from the original on 27 September 2016. Retrieved 26 September 2016.

2.       Weaver, Scott C; Osorio, Jorge E; Livengood, Jill A; Chen, Rubing; Stinchcomb, Dan T. "Chikungunya virus and prospects for a vaccine". Expert Review of Vaccines.2012; 11 (9): 1087–1101.

3.       "Chikungunya Virus Symptoms, Diagnosis, & Treatment". CDC. 6 April 2016. Archived from the original on 21 September 2016. Retrieved 26 September 2016.

4.       Caglioti, C; Lalle, E; Castilletti, C; Carletti, F; Capobianchi, MR; Bordi, L (July 2013). "Chikungunya virus infection: an overview". The new microbiologica.2013; 36 (3): 211–27.

5.       Staples JE, Fischer M. "Chikungunya virus in the Americas-what a vectorborne pathogen can do". N. Engl. J. Med. 2014;371 (10): 887–9

6.       Centers for Disease Control Prevention (CDC) (29 September 2006). "Chikungunya fever diagnosed among international travelers-United States, 2005–2006". MMWR Morb. Mortal. Wkly. Rep. 55 (38): 1040–2.

7.       Thiberville, Simon-Djamel; Moyen, Nanikaly; Dupuis-Maguiraga, Laurence; Nougairede, Antoine; Gould, Ernest A.; Roques, Pierre; de Lamballerie, Xavier. "Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy". Antiviral Research. 2013; 99 (3): 345–370.

8.       Powers AM, Logue CH. "Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus". J. Gen. Virol.2007; 88 (9): 2363–77.

9.       "Chikungunya Virus Infections". New England Journal of Medicine. 373: 93–95

10.     Burt, Felicity J; Rolph, Micheal S; Rulli, Nestor E; Mahalingam, Suresh; Heise, Mark T. "Chikungunya: a re-emerging virus". The Lancet. 2012; 379 (9816): 662–671.

11.     Powers AM, Logue CH. "Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus". J. Gen. Virol. 2007; 88 (9): 2363–77.

12.     Weaver, Scott C.; Lecuit, Marc. "Chikungunya Virus and the Global Spread of a Mosquito-Borne Disease". New England Journal of Medicine.2015; 372 (13): 1231–1239.

13.     Edelman R, Tacket CO, Wasserman SS, Bodison SA, Perry JG, MangiaficoJA. "Phase II safety and immunogenicity study of live chikungunya virus vaccine TSI-GSD-218". Am. J. Trop. Med. Hyg. 2000; 62 (6): 681–5.

14.     Couderc, T; Khandoudi, N; Grandadam, M; Visse, C; Gangneux, N; Bagot, S; Prost, JF; Lecuit, M (15 August 2009). "Prophylaxis and therapy for Chikungunya virus infection". The Journal of Infectious Diseases. 2009; 200 (4): 516–23.

 

 

 

Accepted on 21.07.2018            © A&V Publications All right reserved