CHIKUNGUNYA RISING

Ferdinand S. de Guzman, MD, MHA, FPAFP, FPSVI, FPSMS

Chair, Dept. of Family and Community Medicine
San Lazaro Hospital

Historical Background
Chikungunya is Swahili for that
which bends up
Stooped posture of patients
afflicted with the severe joint
pains
First recognized in epidemic form
in East Africa in 1952-53
Epidemics of Chikungunya were
documented in the Philippines in
1954, 1956, and 1968.

Philippine Statistics

2013:
TravelCare International
reports that at least
500 cases of
Chikungunya were
detected in Villareal in
Samar Province at the
start of 2013.
Catbalogan, capital of
Samar, and 3 other
municipalities have also
reported cases. No
fatalities, however.
Samar, Philippines

September 17,
2013: Mariveles in
Bataan declared an
outbreak of
Chikungunya after
100 patients have
been checked for
the virus.

Bataan, Philippines

2012:
appoximately 600
cases were reported

Albay, Philippines

12/29/2012: Albay
(villages of San Juan
and San Vicente in
Santo Domingo
town) reported 19
villagers as possible
Chikungunya fever
cases

9/262012:
Surigao del Sur
(2 villages) reported that
a hundred residents have
shown symptoms of the
viral disease
Chikungunya.

Mindanao, Philippines

 2011:
over a 1,000 cases of Chikungunya reported
in the Philippines

2013:
San Lazaro Hospital admissions for
Chikungunya - 14

Chikungunya in 3 Years:
1200
2011, 1000

1000
2012, 600

800
600

2013, 600
400
200
0
2013

2012

2011

Chikungunya Virus

Viral fever
caused by an
alpha virus
belonging to the
family
Togaviridae

alphavirus

Chikungunya Virus

Spread by
mosquito bites
from Aedes
aegypti
and
Aedes albopictus

 Recent research by the

Pasteur Institute in Paris
claims the virus has
suffered a mutation that
enables it to be
transmitted by Aedes
albopictus

(Tiger mosquito)

Clinical Manifestations
Cause of Emergence and Re-emergence
yet to be understood
Studies conducted during outbreaks show
1) an increased severity of disease
2) and shows that the genetic sequence of the virus
multiplies more early in mosquitoes

What is this disease?

Chinese Fever or Asian Flu
Self limiting
Incubation period: 1-12 days
RARELY FATAL

COMPARISON BETWEEN DENGUE

AND CHIKUNGUNYA

Incubation period
DENGUE
2-7 days

CHIKUNGUNYA DISEASE
1-12 days

History of acute fever

DENGUE

biphasic, saddle-back or
camel-back

CHIKUNGUNYA DISEASE

with chills
(can reach 39C)

Headache
DENGUE

CHIKUNGUNYA DISEASE

with insomnia and extreme

degree of prostration

Muscle and Joint Pains

DENGUE

severe,
CHIKUNGUNYA DISEASE
predominantly
involves SMALL
joints of hands,
wrists, ankles and
feet
LESSER
involvement of
larger joints

Nausea and Vomiting

DENGUE

CHIKUNGUNYA DISEASE

DENGUE

(Hermans rash)

cutaneous
manifestations
in
CHIKUNGUNYA
the form of
maculopapular rash
on face and trunk
buccal and palatal
enanthem can
occur

Rash

DENGUE

CHIKUNGUNYA

Photophobia,
Conjunctival
Redness

Pharyngitis

DENGUE

CHIKUNGUNYA

DENGUE

CHIKUNGUNYA
(not present)

Plasma leakage
(hemoconcentration or
pleural effusion or
ascites)

Hemorrhagic manifestations
DENGUE

CHIKUNGUNYA

Mild hemorrhagia may be

present especially in children

DENGUE

CHIKUNGUNYA

(+) to particular strain

Immunity is long lasting

Immunity

DENGUE

Characteristic

CHIKUNGUNYA DISEASE

2-7 days

Incubation
period

1-12 days

(biphasic,
saddle-back or
camel-back)

History of
acute fever

with chills
(can reach 39C)

Headache

(with insomnia and extreme

degree of prostration)

Muscle and
joint pains

(severe, predominantly involves

SMALL joints of hands, wrists,
ankles and feet)
(LESSER involvement of larger
joints)

Nausea and
vomiting

May or may not be present

Comparison
Between
Dengue
and
Chikungunya
Disease

Comparison Between Dengue

and Chikungunya Disease
DENGUE

CHIKUNGUNYA DISEASE

(Hermans rash)

Rash

(cutaneous manifestations in the form

of maculopapular rash on face and
trunk)
(buccal and palatal enanthem can
occur)

Photophobia,
conjunctival redness

Pharyngitis

Plasma leakage
(hemoconcentration or
pleural effusion or
ascites)

(not present)

Hemorrhagic
manifestations

Mild hemorrhagia may be present

especially in children

(+) to particular
strain

Immunity

Immunity is long lasting

Diagnosis: How is Diagnosis Done?

Detection of antigens or
antibody to the agent in
the blood (serology)
ELISA is available

An IgM capture ELISA is

necessary to distinguish
the disease from dengue
fever

The family physician has 2 options of treatment available:

MANAGEMENT

A. Homeopathy Treatment/Remedies
Enpatorium perfoliatum Q (or perf)
tincture,
3-5 drops/dose will remove the
debilitating joint pains and cut short
the intensity and duration of the
disease

Pyroginum, Cedron, Influenzinum,

Arnica, Belladona

B. Conventional Treatment
No vaccine or specific antiviral
treatment available

Treatment is symptomatic: rest,

fluids, and Ibuprofen, Naproxen,
Acetaminophen or Paracetamol
may relieve symptoms of fever and
aching.

 Avoid aspirin

Infected persons should be

protected from further mosquito
exposure (staying indoors
and/or under a mosquito net
during the first few days of
illness) so they will not
contribute to the transmission
cycle

 Chloroquine
possible treatment as an antiinflammatory agent for the arthritis
a university of Malaya study found
that for arthritis-like symptoms that
are not relieved by ASA and NSAIDS,
Chloroquine phosphate (250mgs/day)
has given promising results.
Unpublished studies in cell culture and
monkeys show no effect of
Chloroquine treatment on reduction of
Chikungunya disease.