Chikungunya is a mosquito borne viral disease caused by RNA virus of Togaviridae family. The most common symptoms are fever and joint pain which usually begin 3–7 days after mosquito bites. Other symptoms may include headache, muscle pain, joint swelling, or rash. Laboratory diagnosis is by ELIZA for virus specific IgM antibody. Levels are highest 3 to 5 weeks after the onset of illness and persist for about 2 months.
Medications:
- Tab. Dolo 650 (Paracetamol 650 mg) 1 tablet thrice a day.
- Tab. HCQS 200 (Hydroxychloroquine 200 mg) – one tablet once a day after breakfast. Increase dose by 200 mg per week till pain subsides. Maximum dose is 6.5 mg/kg/day or 600 mg/day, whichever is lower in 2 equally divided doses. After adequate control, reduce the dose by 200 mg every week.
Consider 7 day course of steroids (avoid in diabetic patients) – Tab. Wysolone 10 (Prednisolone 10 mg) –
- Day 1 – 1 tablet four times a day (8 am, 1 pm, 6 pm, 11 pm).
- Day 2 and 3 – 1 tablet thrice a day (8 am, 3 pm, 11 pm).
- Day 4 and 5 – 1 tablet twice a day (8 am and 8 pm).
- Day 6 and 7 – 1 tablet once a day (8 am).
General advice:
- Advice bed rest for acute phase.
- Ensure adequate fluid resuscitation and prevent dehydration
- Do not give Aspirin or NSAIDs
- Exercises like stretching, joint movement, walking once acute phase resolves
- Cold compresses over painful joints
Investigations:
- Complete Blood Count – Look for raised WBC count, low platelets.
- Chikungunya IgM (ELIZA) – To diagnose Chikungunya. It may be falsely negative in first 2 weeks of symptoms.
Referrals:
Please consider referral to secondary care for severe cases or when patients fail to respond.