CHIKUNGUNYA

Tropical medicine
Submitted to Ainura Maam
infectious department

Sabnam roshul
Group 2
Sem 9th
 CONTENT

1. Etiology
2. Epidemiology
3. Pathophysiology
4. Clinical features
5. Diagnosis
6. Treatment
7. Prevention
 ETIOLOGY

• Chikungunya virus is spread to people by the bite of an infected mosquito. The most common
symptoms of infection are fever and joint pain. Other symptoms may include headache, muscle
pain, joint swelling, or rash. Outbreaks have occurred in countries in Africa, Americas, Asia,
Europe, and the Caribbean, Indian and Pacific Oceans. There is a risk the virus will be spread to
unaffected areas by infected travelers. There is currently no medicine to treat chikungunya virus
infection. Travelers can protect themselves by preventing mosquito bites. When traveling to
countries with chikungunya virus, use insect repellent; wear long-sleeved shirts and pants; and
stay in places with air conditioning or that use window and door screens.
 EPIDEMIOLOGY

• Chikungunya virus (CHIKV) is a mosquito-borne alphavirus. The virus was first isolated from
the serum of an infected patient during a large outbreak of a debilitating arthritic disease in 1952
in Tanzania
• CHIKV originated in Africa over 500 years ago and was subsequently introduced to Asia. The
initial genetic analysis of the common CHIKV African lineage showed that the virus diverged
into three genotypes, named West African (WA) and East/Central/South African (ECSA), and
Asian. The ECSA can be further divided into the sublineage Indian Ocean lineage (IOL). These
genotypes are now spread worldwide, with ECSA and Asian genotypes being those
predominately found
• The virus is maintained in a rural enzootic transmission cycle, which occurs between various
sylvatic Aedes (Stegomyia) mosquitoes and animal reservoirs, with nonhuman primates acting as
the main reservoir host . However, just like DENV and ZIKV, Chikungunya virus has become fully
adapted to the urban cycles and no longer requires the presence of nonhuman primates and a
sylvatic cycle for their maintenance. Thus, the urban transmission cycles of CHIKV, especially in
densely inhabited tropical areas, usually result in large outbreaks, where a sustained low level of
virus circulation is enough to maintain these viruses in the population.
• It is believed that CHIKV infection has a low fatality rate, but since a large outbreak that occurred
in 2005–2006 on the Indian Ocean island of Réunion, CHIKV infection assumptions have been
made suggesting that CHIKV may have evolved to a more severe form of the disease with central
nervous system (CNS) involvement and fulminant hepatitis cases being reported
• This mutation, found in over 90% of viral sequences from Réunion Island, was associated with a
slight increase in transmission by Ae. albopictus, showing an enhanced ability of the virus to
replicate in insect cells that are naturally low in cholesterol . Thus, this mutation may have
facilitated virus transmission, added to the fact that the virus was introduced in a region where the
population was naïve (not previously exposed to CHIKV) and where mosquito population control
measures were not enough to stop the virus from spreading.
 PATHOPHYSIOLOGY

• CHIKV infects multiple cell types, including dendritic cells, macrophages, synovial fibroblasts,
endothelial cells, and myocytes. In humans, it also infects osteoblasts, contributing to the joint
pathology and erosive disease seen in chronic arthritis patients
• In the virion surface, heterodimers of the structural proteins E1 and E2 proteins trimerize to form
the “viral spikes”, the glycoprotein E2 is responsible for receptor binding, and E1 for membrane
fusion . Given that CHIKV infects a wide range of cell types, cellular proteins interacting with
the virus are diverse. Thus, multiple attachment factors and putative receptors for CHIKV and
other alphaviruses have been documented . Already known CHIKV mammalian cell receptors
include prohibitin (PHB)
• Alphaviruses enter host cells by a process dependent on clathrin-mediated endocytosis More
recently, micropinocytosis (which are large uncoated vesicles involved in the unspecific uptake
of extracellular material) was identified as an entry pathway for CHIKV into human muscle
cells.
• It seems that the engulfment of apoptotic blebs is an important infectious mechanism. It was
demonstrated that in HeLa cells, as well as primary fibroblasts, CHIKV triggered apoptosis
through intrinsic and extrinsic pathways, resulting in the formation of apoptotic cell blebs (an
irregular bulge in the plasma membrane that eventually blebs off). By hiding inside these
apoptotic blebs, CHIKV was able to infect the neighboring cells. Thus, these apoptotic blebs act
like Trojan horses, being capable of infecting macrophages and, interestingly, this process of
viral replication in macrophages originating from cell blebs did not yield a proinflammatory
response, constituting a mechanism by which CHIKV invades host cells and escapes the host
respons
 CLINICAL FEATURES

Most people infected with chikungunya virus will develop some symptoms
• In symptomatic patients, CHIKV disease onset is typically 4–8 days (range 2–12 days) after the
bite of an infected mosquito. It is characterized by an abrupt onset of fever, frequently
accompanied by severe joint pain.
• The joint pain is often debilitating and usually lasts for a few days but may be prolonged, lasting
for weeks, months or even years.
• Other common signs and symptoms include joint swelling, muscle pain, headache, nausea,
fatigue and rash. Since these symptoms overlap with other infections, including those with
dengue and Zika viruses, cases can be misdiagnosed. In the absence of significant joint pain,
symptoms in infected individuals are usually mild and the infection may go unrecognized
• Most patients recover fully from the infection;
however, occasional cases of eye, heart, and
neurological complications have been reported
with CHIKV infections. Patients at extremes of
the age spectrum are at higher risk for severe
disease.
• Newborns infected during delivery and older
people with underlying medical conditions may
become severely ill and CHIKV infection can
increase the risk of death.
• Once an individual is recovered, available
evidence suggests they are likely to be immune
from future infections
 DIAGNOSIS

• Chikungunya virus may be detected directly in blood samples collected during the first week of
illness using tests such as reverse transcriptase–polymerase chain reaction (RT–PCR).

• Other tests can detect a person’s immune response to chikungunya virus infection. These are
typically used after the first week of infection to test for antibodies to the virus. The antibody
levels are typically detectable by the first week after illness onset and can still be detected for
about 2 months.
 TREATMENT

• The clinical management includes addressing fever and joint pain with anti-pyretics and optimal
analgesics, drinking plenty of fluids and general rest. There is no specific antiviral drug treatment
for CHIKV infections.

• Paracetamol or acetaminophen are recommended for pain relief and reducing fever until dengue
infections are ruled out, as non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk
of bleeding.
 PREVENTION
• Prevention of infection by avoiding mosquito bites is the best protection. Patients suspected of having
CHIKV infection should avoid getting mosquito bites during the first week of illness to prevent further
transmission to mosquitoes, who may in turn infect other people.
• The main method to reduce transmission of CHIKV is through control of the mosquito vectors. This
requires mobilization of communities, who are critical in reducing mosquito breeding sites through
emptying and cleaning containers that contain water on a weekly basis, disposing of waste, and supporting
local mosquito control programmes.
• During outbreaks, insecticides may be sprayed to kill flying adult mosquitoes, applied to surfaces in and
around containers where the mosquitoes land, and used to treat water in containers to kill the immature
larvae. This may also be performed by health authorities as an emergency measure to control the mosquito
population.
• For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting
vectors is advised. Window and door screens should be used to prevent mosquitoes from entering homes.
Repellents can be applied to exposed skin or to clothing in strict accordance with product label
instructions. Repellents should contain DEET, IR3535 or icaridin.
• For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the
day-biting vectors is advised. Window and door screens should be used to prevent mosquitoes
from entering homes. Repellents can be applied to exposed skin or to clothing in strict
accordance with product label instructions. Repellents should contain DEET, IR3535 or icaridin.
• Insecticide-treated mosquito nets should be used against day-biting mosquitoes by persons who
sleep during the daytime, for example young children, sick patients or older people.
• People travelling to areas of active CHIKV transmission should apply basic precautions
including the use of insect repellents, wearing long sleeves and pants and ensuring rooms are
fitted with screens to prevent mosquitoes from entering.
• While there are several vaccines currently in different stages of development (as of Dec 2022)
they are yet to be licensed. There is no commercial vaccine available to protect against
chikungunya virus infection.
 REFRENCES

• https://www.who.int/news-room/fact-sheets/detail/chikungunya
• https://www.cdc.gov/chikungunya/symptoms/index.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9147731/
THANK YOU