Neurological complications in Chikungunya fever.

OBJECTIVE: The present prospective study was undertaken to study the clinical manifestations and mainly neurological complication of an acute febrile illness termed chikungunya which has recently attacked india after 43 years. METHOD: This prospective study has been conducted in hospitalised patients admitted in government and private hospitals of Kota city from August 2006 to October 2006. Patients showing neurological involvement with typical clinical picture of chikungunya infection were studied in detail and followed up for improvement and any permanent damage or death. RESULTS: Apart from typical clinical triad of high grade fever, arthralgia and rash of chikungunya infection we have observed a spectrum of neurological abnormalities in terms of altered mental functions, seizures, focal neurological deficit with abnormal CT scan of head and altered CSF biochemistry. Permanent neurological sequelae and even death has occurred. CONCLUSION: Typical clinical history of chikungunya infection, neurological complications with associated CSF abnormalities, supportive laboratory evidences, positive chikungunya IgM card test, exclusion of other causes and known predilection of arboviruses for CNS infection allows us to conclude the diagnosis of study cases as Chikungunya Encephalitis.

Clinico-epidemiological profile of fever cases admitted during epidemics of Chikungunya fever.

A study of Clinico-epidemiological profile of fever cases admitted during epidemics of Chikungunya fever was carried out in Latur city of Maharashtra State. A total of 238 fever cases were investigated in relation to clinico-epidemilogical characteristics. Maximum fever cases admitted during epidemics of Chikungunya fever were in the age group 16-60 years (74.8%). There was no sex predominance. The commonest symptoms of admitted fever cases were sudden onset of high-grade fever (99.5%), followed by joint pains with tenderness on examination (90.7%), headache (58.4%) and body ache (23.5%). Average duration of illness was 3.01 days (S.D.=0.38). There was no mortality among affected fever cases. Family or neighborhood clustering of cases was observed in 66.8% and 31.5% of the cases respectively. The important environmental factors were presence of open water tank in the house (68%), infrequent cleaning and drying of non drinking water containers (once in 11 days) and abundance of mosquitoes in the house. (45.7%).

Chikungunya in Thailand: a re-emerging disease?

The first reported case of chikungunya virus diagnosed by serology in Thailand was in 1960 and the last one was in 1991. The disease surveillance system does not specifically include chikungunya cases and the signs and symptoms are similar to these of dengue fever/dengue hemorrhagic fever (DF/DHF), rubella, and fever of unknown origin (FUO); thus cases might often be reported under those diagnoses. During the rainy season of 1995 (Jun-Aug), there were at least 2 reported chikungunya outbreaks which might indicate that it is a re-emerging disease in Thailand. However, there is still limited information and knowledge on some aspects of this disease such as clinical manifestations, subclinical cases, duration of illness, complications, transmission, immunity, and reservoirs. Thus, the objectives of this paper are to describe the epidemiology of chikungunya infection based on outbreak investigations carried out in Khon Kaen (July 1991), Nakorn Si Thammarat (July 1995), and Nong Khai Provinces (August 1995). All three outbreaks occurred during the rainy season. The three most common clinical manifestations were fever with severe althralgia with maculopapular rash. Both sexes and all age groups were affected. Serological results were positive for IgM, with four-fold rises in paired sera, and viral isolation in Nakorn Si Thammarat and Nong Khai. Only in Nong Khai was hemagglutinin inhibition conducted and the results were positive. No deaths were reported. The outbreaks occurred in rural villages and all three larval indices (BI, HI, CI) were very high. The possible vectors in these outbreaks were Aedes aegypti and Aedes albopictus. In the Nong Khai outbreak, blood specimens were taken at the 3-5th day after onset and therefore the proportion of positive results was low. IgM antibody of follow-up cases declined within 3 months, villagers from all three areas with outbreaks mentioned that they had no previous experience of this disease. This suggests that chikungunya infection is a re-emerging disease.