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Chikungunya fever

originating from Swahili: chikungunya – the bent
German: Chikungunya-Fieber

1 Definition

The Chikungunya fever is a viral infection that is transmitted by the vectors (mosquito).

2 Pathogen

The pathogen of the Chikungunya fever is the Chikungunya virus. It is an alpha virus of the family of toga viruses. The viruses are transmitted through mosquito bites, especially from the stegomyia aegypti (yellow fever mosquito) and the stegomyia albopictus (tiger mosquito). The virus can be found in the saliva of carrying mosquitos. Previously it had been assumed that transmission happened through bites from the genus of aedes mosquitos.

3 Epidemiology

The chikunguya fever is especially endemic in regions of India, southeast Asia (i.e. Thailand, Indonesia) and Africa (south of the Sahara). In 2005 there was a local epidemic on the French island of La Réunion. For the first time this brought attention to the disease in Europe.

The increased spread of the tiger mosquito in southern Europe may lead to an increased manifestation of the disease there. In Germany there were 50 cases reported in 2006.

4 Symptoms

Following an incubation period of 4 to 7 days after the mosquito bite the first symptoms become apparent. The patient has fever attacks (up to 40° C), chills and aching limbs. The similarity to a malaria infection can lead to a mixing up of the two infections. In addition to the mentioned symptoms there is also an erythema. The strong joint pain leads to the patient walking bent over, thus giving rise to the name of the disease. The joint pain normally regresses after a couple of days but can persist for months in severe cases. In those cases, often the misdiagnosis of rheumatoid arthritis is made.

In most cases the infection heals completely, leaving now defects. For patients with a weakened immune system (Children, seniors, HIV-patients, etc.) the disease can lead to death caused by the viral hyperthermia.

5 Diagnostics

5.1 Physical examination

Compression of one or both wrists is painful.

5.2 Laboratory parameters

5.3 Serology

Serologic detection methods that can be used are: ELISA, IF and haemagglutination-inhibition test. Direct detection of the presence of viral RNA in the blood can be achieved by PCR or virus culture.

6 Differential diagnoses

7 Treatment

Currently, because there is no efficient drug against the infection available, treatment is limited to improving the symptoms. The fever can be reduced through acetaminophen. Acetylsalicylic acid is contraindicated because of the risk of bleeding.

The U.S. military has developed a vaccine (TSI-GSD-218) which is currently in clinical evaluation and not available yet.

8 Notifiable disease

As stated in the infection protection law in Germany, a direct or indirect detection of the pathogen has to be reported, including the name of the patient.

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