​Chikungunya

Overview of Chikungunya

• Disease caused by chikungunya virus is endemic in rural areas of Africa.
• Intermittent epidemics take place in towns and cities of both Africa and Asia.
• Aedes aegypti mosquitoes are the usual vectors for the disease in urban areas.
• In 2004, a massive epidemic began in the Indian Ocean region (in particular on the islands of Réunion and Mauritius) and was most likely spread by travelers.
• Aedes albopictus was identified as the major vector of chikungunya virus during that epidemic.
• Between 2013 and 2014, several thousand chikungunya virus infections were reported (and several tens of thousands of cases were suspected) from Caribbean islands.
• The virus was imported to Italy, France, also the United States by travelers from the Caribbean.
• Chikungunya virus poses a threat to the continental United States as suitable vector mosquitoes are present in the southern states.
• Besides this, The disease is most common among adults, in whom the clinical presentation may be dramatic.
• Lastly, The abrupt onset of chikungunya virus disease follows an incubation period of 2–10 days. (2)

Indian epidemiology then other

Causes of Chikungunya

• CHIK virus is an alphavirus in the Semliki Forest complex (Togaviridae) and most closely related to o’nyong nyong (ONN) virus. (4)

Risk factors are things that make you more likely to develop a disease in the first place.

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Pathophysiology of Chikungunya

• In India Aedes aegypti mosquito is the main vector.
• Aedes albopictus is also implicated.
• In Africa there is a sylvian cycle involving forest mosquitoes, humans and possibly other mammals.
• In Asia, sylvatic viral reservoirs have not been defined. (4)

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Sign & Symptoms of Chikungunya

• Fever (often severe) with a saddleback pattern and
• Severe arthralgia is accompanied by chills
• Abdominal pain
• Anorexia
• Conjunctival injection
• Headache
• Nausea
• Photophobia
• Migratory polyarthritis mainly affects the small 1313 joints of the ankles, feet, hands, and wrists, but the larger joints are not necessarily spared.
• Rash may appear at the outset or several days into the illness; its development often coincides with defervescence, which occurs around day either 2 or 3 of the disease.
• The rash is most intense on the trunk and limbs also may desquamate.
• Young children develop less prominent signs also are therefore less frequently hospitalized.
• Besides this, Children also often develop a bullous rather than a maculopapular/ petechial rash.
• Maternal–fetal transmission has reported and, in some cases, has led to fetal death. (2)

Physical examination of Chikungunya

Fever

The disease is characterized by an acute onset of high fever, typically more than 39°C (102°F).

Skin

• Maculopapular rash
• 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-like ulcers over scrotum, crural areas and axilla.
• Lymphedema in acral distribution (bilateral/unilateral)
• Multiple ecchymotic spots (children)
• Vesiculobullous lesions (infants)
• Subungual hemorrhage
• Photo urticaria
• Acral urticaria

Joints

• Polyarthralgia usually symmetric and often occur in hands and feet
• Periarticular swelling and joint effusion in knees. (5)

Diagnosis of Chikungunya

• Routine laboratory investigations are not specific. The ESR may be elevated to 20-50 mm/hr and CRP may also be elevated.
• Isolating the virus or identifying genomic products by PCR in acute phase blood specimens can confirm the diagnosis.
• Serologically specific IgM or other antibodies can be demonstrated by IgM capture ELISA test.
• This test will distinguish the condition form dengue which is also transmitted by the same vector.
• During the prevailing epidemic in south Kerala a few cases of co-infection by chikungunya and dengue have been observed. (4)

Differential diagnosis of Chikungunya

• Malaria
• Dengue fever
• Leptospirosis
• Alpha viral infections
• Post-infectious arthritis
• Juvenile rheumatoid arthritis (5)

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Chikungunya

• Chikungunya virus diagnosed on the basis of serological test such as enzyme linked immunosorbent assays (ELISA) may presence of IgM and IgG anti- Chikungunya antibodies.
• IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months. (1)

Treatment of Chikungunya

• Treatment is symptomatic with relief of pain with ibuprofen, naproxen, aceclofenac or paracetamol.
• Aspirin should avoid. (1)
• Chloroquine phosphate 250mg/day has found useful.
• Nonsteroidal anti-inflammatory drugs
• Sometimes chloroquine for refractory arthritis. (2)

Prevention of Chikungunya

• An experimental live attenuated vaccine has shown to produce high levels of neutralizing antibody in human volunteers but efficacy has not tested.
• Anti-mosquito measures and personal protection with mosquito repellants will reduce the spread. (4)

Homeopathic Treatment of Chikungunya

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Chikungunya:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Eupatorium:

• The leading characteristic is violent aching, bone breaking pains.
• Muscles of chest, back and limbs feel bruised, sore aching.
• Patient is restless, chilly also nauseated.
• Colds, Influenza, Dengue.
• Sluggishness of all organs also functions.
• Useful in broken down constitutions of inebriate.
• Weakness
• Burning heat.
• Sweat; relieves all the symptoms except the headache.
• Sweat scanty (3)

Bryonia:

• Chill with hot head and red face, aggravation especially in warm room.
• Dry burning heat, with agg. of all the symptoms.
• Blood seems hot.
• Painful continued fevers.
• Sweat, either sour or oily
• Complaints from taking cold drinks, in hot weather. (3)

Gelsemium:

• Generally, Chill with aching and languor, mixed with heat or alternating with heat, chill up and down back.
• Cold hands also feet.
• Heat with drowsiness.
• Thirst absent, with trembling.
• Cold sweat.
• Bilious remittent, malarial, typhoid, cerebro-spinal fevers.
• Nervous, shuddering, chill, preceded especially by visual disturbances.
• Lastly, Inco-ordination of muscles, which do not obey the will (3)

Rhus Tox:

• Easily chilled aggravation specifically by least uncovering; with pain in limbs.
• Chill as if dashed with cold water or cold water in the veins; additionally preceded by cough; alternating with heat.
• Chill in single parts.
• Furthermore, Heat, with busy delirium.
• Typhoid.
• Sweat; aggravation especially during and pain; with sleepiness.
• Urticaria during fever.
• Wants to yawn also stretch during chill (3)

Arsenic Alb.:

• Externally cold, with internal burning heat.
• Coldness; in spots.
• Sensitive to cold, yet amel. in open air.
• Chills irregular, shaking, craves hot drinks during chill, Dyspnoea during chill.
• Besides this, Heat as of hot water in veins; or they burn like lines of fire.
• High fever, hectic fever.
• Sweat, with great thirst, either Dyspnoea or exhaustion.
• Sweat cold.
• Waves of icy coldness either in blood vessels or intense boiling heat.
• Intermittent fever, yellow fever. (3)

Aconite:

• Chill passes through him in waves.
• Either Chill or coldness alternating with heat.
• High fever, dry burning heat, in eyelids, nose, mouth, throat, lungs also palms, must uncover.
• Sweat drenching, wants to uncover.
• Sweat especially on uncovered parts or affected parts. (3)

Diet & Regimen​

• Take plenty of fluids like warm water, soups also other liquids.
• Additionally, Take green leafy vegetables
• Take vit C rich fruits like orange, amla, lime.
• Avoid oily also fatty foods.

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References use for Article Chikungunya

1. Textbook of Medicine by Golwala
2. Harrisons Textbook of medicine
3. Phatak materia medica
4. Textbook of Medicine
5. https://www.wikidoc.org/index.php/Chikungunya_differential_diagnosis, clinical examination