Chikungunya Symptoms - Long-Term Effect

Fighting with Mosquitoes is still a dare for many people. Mosquito-borne diseases are usually those spread by the bite from the mouth of an infected mosquito. Common diseases that are transmitted to people of all age groups by mosquitoes are Zika virus, West Nile virus, dengue, malaria, and the threatening chikungunya.

Recognizing chikungunya symptoms is crucial for early intervention and treatment. Although many people might not feel sick following a bite from an infected mosquito, a few people experience a mild, brief illness, severe, or long-term symptoms of chikungunya. In some cases, painful conditions of mosquito-borne diseases can cause death.

Chikungunya fever's first outbreak was documented in Tanzania in 1952. Since then, it has been identified in over 60 countries worldwide. It is most prevalent in Africa, Asia, and the Indian subcontinent. India recorded the first outbreak of Chikungunya in the Cultural Capital of India, Calcutta, in 1963, followed by epidemics in Tamil Nadu, Andhra Pradesh, and Maharashtra till 1973.

What to know about Chikungunya?

Chikungunya is a disease caused by the Chikungunya (CHIKV) virus, which spreads from one person to another through mosquitoes. When a mosquito bites a person whom Chikungunya infects, it carries the infected blood in its system for several weeks, replicating it in the process and making it highly concentrated. Eventually, the virus makes its way to the mosquito’s saliva, so when it feeds on another healthy host, it infects them. The virus grows inside the newly infected person, making them sick within two to three days of the initial contact with the virus. This cycle continues, and thus the infection spreads.

Two varieties of mosquitoes spread chikungunya: the Aedes aegypti mosquito and the Aedes albopictus mosquito. They mainly feed during the day and lay eggs in stagnant water.

Symptoms of Chikungunya

Usually, Chikungunya symptoms are seen within three to seven days of the mosquito bite. But in a few cases, it is even seen by the second day or ten days later.

When the symptoms are mild, people might mistake it for a different illness and leave it untreated, aggravating the disease.
Fever and joint pains are the two most common symptoms of Chikungunya. Joint and body pain develop immediately, but fever begins suddenly. While the fever subsides eventually, joint pain might prolong in a few cases.

Other symptoms of chikungunya include,

● Headache
● Rash
● Swelling in joint
● Fatigue
● Muscle pain
● Nausea

Children may have different presentations of chikungunya symptoms, while adults tend to have more consistent symptoms. Children with chikungunya may experience a combination of symptoms. The most common ones include:

Children may experience gastrointestinal issues such as stomach pain, vomiting, and diarrhoea.
They can develop a high fever of over 104o F.
Once the fever disappears, they may develop an itchy chikungunya rash on their hands and legs.
Joint pain or arthralgia can also occur in some children.
Burst blood vessels can cause purpura or red patches on the skin.
Bleeding from the nose and gums may be observed.
Children may experience headaches.
Children experience a shorter chikungunya recovery time due to their developing joints, resulting in less prolonged arthritic pain.
The virus primarily affects larger joints, such as the hip and knee, in children, making the pain more bearable. Conversely, adults are prone to the attack of smaller, more painful joints like the wrists.
For infants, IgG antibodies in the mother's placenta protect against life-threatening diseases during the initial six months after birth. However, this protection gradually diminishes after that.

Long-Term Effects of Chikungunya

The most common long-term effect of Chikungunya is chronic joint pain. Arthritis caused by Chikungunya also persists for years after being affected by the disease. The most commonly affected joints are the smaller joints like wrists, fingers and ankles.

Older adults and newborn babies are more at risk of getting long-term complications due to Chikungunya. People who have existing health conditions are also at risk of getting more severe long-term effects like diabetes, heart disease and high blood pressure. Death due to Chikungunya is infrequent.

Prevention and control of chikungunya

The most effective way to prevent infection is by avoiding mosquito bites. Individuals suspected of having CHIKV infection should take precautions to prevent further transmission to mosquitoes, which can then infect others.

Controlling the mosquito vectors is the primary method to reduce the spread of CHIKV. This requires the active involvement of communities in eliminating mosquito breeding sites by regularly emptying and cleaning containers that hold water, properly disposing of waste, and supporting local mosquito control programs.

During outbreaks, insecticides may be used to kill adult mosquitoes in flight, applied to surfaces where mosquitoes land, and used to treat water in containers to eliminate immature larvae. Health authorities may also implement emergency measures to control the mosquito population.

It is recommended to wear clothing that minimises skin exposure to mosquitoes that bite during the day to protect against chikungunya during outbreaks. Window and door screens should be used to prevent mosquitoes from entering homes.

Repellents containing DEET, IR3535, or icaridin can be applied to exposed skin or clothing, following the instructions on the product label. Insecticide-treated mosquito nets should be used by individuals who sleep during the daytime, such as young children, sick patients, or older people.

Individuals travelling to areas with active CHIKV transmission should take basic precautions, including using insect repellents, wearing long sleeves and pants, and ensuring that rooms are equipped with screens to prevent mosquitoes from entering.

Six best practices for protecting children from chikungunya

It is essential to educate children about the significance of preventing mosquito bites. Motivating them to remain indoors when mosquitoes are most active, typically at dawn and dusk, is advisable. Emphasise the importance of using mosquito repellents, wearing protective clothing, and avoiding areas with a high concentration of mosquitoes, such as stagnant water bodies.

Implementing these preventive measures can effectively minimise the risk of chikungunya transmission to children. It is important to remember that community-wide mosquito control and education efforts are essential in creating a safe environment for the health of our children. Let us remain vigilant and prioritise their protection against mosquito bites.

Mosquito coils and vaporisers

Ensure that you utilise mosquito coils or vaporisers in the morning as well. Our practice involves keeping the vaporiser running overnight and turning it off in the mornings. This serves as a way to extend a warm welcome to the Aedes aegypti mosquito. Therefore, it is essential to remember to keep the mosquito coil or vaporiser on in the mornings, too, ensuring your protection and that of your loved ones.

Clean your surroundings

Maintaining cleanliness in and around your house is essential to create an unfavourable environment for mosquitoes. Here are some key points to remember:

Ensure that you remove any objects that can collect water. Stagnant water serves as a breeding ground for these pesky insects. Dispose of empty containers and tyres, and store necessary containers properly.
Avoid overwatering your plants if you have a garden, as excess water can accumulate and stagnate.
Add kerosene to open drains to deprive the mosquito larvae of oxygen.
If you have a pond nearby, consider introducing fish species that feed on mosquito larvae.
Remember, clean or dirty, water can become a breeding ground for mosquitoes.

Mosquito repellent

Ensure that you apply personal mosquito repellent every time you venture outside. Are you using mosquito repellent for your child when they go outdoors? You may remember to do so when they go out to play, but what about when they go to school? Many of us need to remember. Make sure to apply a personal mosquito repellent to your children before sending them to school to protect them from the Aedes mosquito, which is active during the daytime. It is important to use mosquito repellents that contain DEET, picaridin, or IR3535 and follow the instructions for age-appropriate use. Choose formulations that are child-friendly and reapply as directed. Remember not to apply repellent to infants under two months old and consult a healthcare professional for guidance.

Mosquito-proof your home

Ensure your home is protected from mosquitoes by installing meshes or screens on your windows and doors. This will keep the pesky insects out and allow fresh air and natural light to enter. Be sure to inspect the meshes and screens regularly to ensure there are no tears or holes.

Additionally, take precautions to protect your child from mosquito bites by ensuring they sleep securely under a mosquito net. For added convenience, you can also use anti-mosquito patches on baby cots, eliminating the need to set up mosquito nets.

Protective clothing

Ensure your child is dressed in long-sleeved t-shirts and tops, and choose leggings or trousers instead of shorts. Aedes aegypti mosquitoes tend to target the ankles, so it is essential to keep them covered. Avoid bright prints and colours, as mosquitoes are attracted to them. Opt for light-coloured clothing, as it may help deter mosquitoes. Additionally, consider clothing that is treated with insect repellent for added protection.

Eliminate potential breeding grounds.

It is crucial to eliminate potential breeding grounds for mosquitoes indoors. While we often associate mosquito breeding with stagnant water, it is essential to note that even a tiny amount of water, regardless of its cleanliness, can serve as a breeding site for mosquitoes.

To prevent the accumulation of water inside your house, take the following measures:

Avoid overwatering indoor plants to prevent water from collecting in the plates under the pots.
Regularly clean the water trays of coolers and air conditioners.
Ensure that water cans are adequately covered.
Fix any leaky pipes and faucets to prevent water from pooling.
Additionally, if you have pets at home, maintain cleanliness by regularly cleaning their feeding bowls and removing leftover food. Keep their sleeping area clean as well.

Diagnostics of chikungunya

During the initial week of illness, blood samples can be used to directly detect the presence of the Chikungunya virus through tests like reverse transcriptase-polymerase chain reaction (RT-PCR).

After the first week of infection, alternative tests can be employed to determine a person's immune response to the Chikungunya virus. These tests are designed to detect antibodies against the virus.

Typically, antibody levels become detectable within the first week of illness and can continue to be detected for approximately 2 months.

When to see a doctor?

When you learn that you have a fever above 104°F and consistent joint pain, then it may be a sign of Chikungunya. In general, people with a strong immune system who are affected by Chikungunya may recover from the CHIKV virus within 3 to 10 days. But doctor consultation is mandatory even if it shows a minuscule level of Chikungunya symptoms.

Chikungunya Complications

Some of the important consequences of Chikungunya include:

● Uveitis - An Eye inflammation that affects the middle layer of eyewall tissues.
● Retinitis - Retina Inflammation
● Myocarditis - It is an inflammation caused by the heart’s muscles. This majorly reduces the heart’s ability to pump.
● Hepatitis - Liver inflammation
● Nephritis - Kidney inflammation
● Haemorrhage - Bleeding
● Meningoencephalitis - Inflammation of the brain and surroundings caused by inflammation.
● Guillain-Barré syndrome - A type of syndrome where the body’s strong immune system attacks its own nervous system.
● Myelitis - Spinal cord inflammation
● Cranial nerve palsies - Loss of function in cranial nerves

Chikungunya Effect on Skin: What You Need to Know?

Chikungunya (CHK) is a mosquito-borne viral disease characterised by high fever, predominant musculoskeletal symptoms, and skin rash.

A maculopapular rash is commonly seen in the first 2–3 days of the illness and exists within 7–10 days.
The chikungunya rash can be patchy or diffuse on the face, limbs and trunk.
The rash on the skin forms slowly within 3–4 days of the onset of fever and tends to decrease its severity in about a week without any outcome.
Skin hyperpigmentation is the following symptom. It might occur in the form of centrofacial pigmentation primarily involving the nose.

As per research, isolated nail pigmentation without any skin lesions in two cases of serologically confirmed Chikungunya, feverish episodes and a maculopapular rash often coincide with periods of viremia.

The most frequently reported manifestation, occurring in approximately 30 to 55 percent of cases, is a widespread rash resembling measles and consists of flat red spots with normal skin patches.
Typically, this chikungunya rash spares the face. Different skin lesions may be observed in infants younger than 12 months, including acrocyanosis (bluish discolouration of the extremities) and symmetrical superficial blisters.

Chikungunya infection can be attributed to dengue and rickettsial fever, also known to cause sudden-onset febrile illnesses accompanied by severe arthritis and skin rash. Rickettsial infection typically presents as a distinct red rash with small raised spots, initially appearing on the lower leg and ankle and then spreading inward to cover the entire body, including the palms and soles.

How to treat skin after getting chikungunya?

Most skin lesions usually clear up within two weeks, but reversible post-inflammatory hypopigmentation may occur.

To treat the skin rash, it is generally recommended to use saline compresses and moisturisers.
Persistent non-healing ulcers in the genital and skin-fold areas and skin erosion resulting from burst blister-like lesions can be addressed with topical or systemic antibiotics.
With the regular diagnosis of chikungunya infection, it is necessary for dermatologists to stick with the presentation of mucocutaneous infection to suspect chikungunya infection early before laboratory investigations are available.

Chikungunya Treatment

Death due to Chikungunya is rare, but the disease can cause severe symptoms. Chikungunya recovery time in most cases are maximum within 10 days but may face joint problems for months and years.

There is no particular antiviral drug available for chikungunya treatment. Treatment can be beneficial in lowering the intensity of Chikungunya symptoms.

In general, Over-the-Counter (OTC) medications like Ibuprofen, Naproxen and Acetaminophen are used to lower the symptoms of Chikungunya.

Other treatments for Chikungunya include antipyretics and analgesics to mitigate pain and fever, as well as drinking fluids and getting enough rest.

Until ruling out Dengue, Chikungunya suspected people are not advised to intake medications like aspirin and non-steroidal anti-inflammatory drugs.

After confirming Chikungunya, patients are allowed to use non-steroidal drugs and corticosteroids.

What are the treatment options for chikungunya in children?

There is no specific chikungunya treatment. However, doctors focus on managing the chikungunya symptoms in children. This includes using fever medications, ensuring proper hydration, and relieving pain. Children must rest entirely during the febrile period when they have a fever.

It is essential to avoid giving children NSAIDs or Aspirin as they can thin the blood and increase the risk of bleeding due to platelet loss.

Parents should remember that the primary treatment for high-grade fever is always paracetamol.

Since chikungunya shares similarities with dengue, hydration is essential in both cases. If a child experiences convulsions, febrile seizures, bleeding, difficulty in consuming liquids, or if the fever persists despite medication, it is advisable to take the child to a medical centre and consult a doctor.

Scientists have developed a new vaccine for chikungunya, but its effectiveness is questionable as it worsens joint pain in patients.

Conclusion

Avoiding mosquito bites is the only efficient way of preventing Chikungunya from the body. There was a deplorable time when Chikungunya spread like fire, and most of the low-immunity people lost their lives. It took an unparalleled effort to mitigate the spread of the Chikungunya virus. We cannot recover from this daunted virus just by killing the mosquitoes in masses. Building a robust immune system is the best way of protecting yourself not only from Chikungunya but also from all diseases. So don’t wait till the chikungunya symptoms are identified, start prevention from now.