CHICKEN GUNIA

[edit] Symptoms
The symptoms of Chikungunya include fever which can reach 39°C, (102.2°F) a petechial or maculopapular rash usually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints which can be debilitating. The symptoms could also include headache, conjunctival injection, and slight photophobia. High fevers and joint pain are found in the current epidemic in the states of Andhra Pradesh and Tamil Nadu, India. The fever typically lasts for two days and then comes down 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. Younger patients recover within 5 to 15 days; middle-agers recover in 1 to 2.5 months. Recovery is longer for the elderly. The severity of the disease as well as its duration is less in younger patients and pregnant women. No untoward effects of pregnancy are noticed following the infection.

Ocular inflammation from Chikungunya may present as iridocyclitis, and have retinal lesions as well.[21]

Dermatological manifestations observed in a recent outbreak of Chikungunya fever in Southern India (Dr. Arun Inamadar, Dr. Aparna Palit, Dr.V.V. Sampagavi, Dr. Raghunath S, Dr. N.S. Deshmukh), Western India (Surat) (Western India reported by Dr. Buddhadev) and Eastern India (Puri) (Dr. Milon Mitra et al) includes the following:

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.
Lympoedema in acral distribution (bilateral/unilateral)
Multiple ecchymotic spots (Children)
Vesiculobullous lesions (infants)
Subungual hemorrhage
Photo Urticaria
Acral Urticaria
Cephalgia
Lumbago
Vomiting
Epistaxis and haemetemesis
Histopathologically, pigmentary changes, maculopapular rash, lichenoid rash, aphthous-like ulcers show lymphocytic infiltration around dermal blood vessels (Inamadar et al). Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.


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.[22]

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 antiviral agent to combat the 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.[23] Research by an Italian scientist, Andrea Savarino, and his colleagues together with a French government press release in March 2006[24] 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 are recommended for arthritic pain and fever.

Infected persons should limit further exposure to mosquito bites, stay indoors and under a mosquito net. Further, "supportive care with rest is preferred during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms."[25] Arthralgia remains troublesome even after 8 months. In Kerala, patients use honey and lime mix. Some people cite relief from consuming turmeric in low volumes.

Preventive measures
The most effective means of prevention are those that protect against any contact with the disease-carrying mosquitos. These include using insect repellents with substances like DEET (also called NNDB or N,N'-Diethyl-3-methylbenzamide), icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535. Wearing bite-proof long sleeves and trousers (pants) also offers protection. In addition, garments can be treated with pyrethroids, a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) also have a certain spacial repellency. Securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day active Aedes aegypti and Aedes albopictus, however, this will only have a limited effect, since many contacts between the vector and the host occur outside. Thus, mosquito control is especially important.