Content

• To step
• Part 1 of 3: Recognizing the signs and symptoms
• Part 2 of 3: Treating the symptoms
• Part 3 of 3: Keeping an eye on complications and preventing chikungunya
• Tips
• Warnings

Chikungunya is a virus that can be transmitted to humans by infected mosquitoes. The infected mosquitoes can also carry other diseases, such as dengue and yellow fever. Chikungunya is found in many places in the world, including the Caribbean, the tropical parts of Asia, Africa, South and North America. There is no medicine, no vaccination, and no treatment for it. You can only try to relieve the symptoms. It's important to learn the signs and symptoms of chikungunya, manage the symptoms, and watch for complications.

To step

Part 1 of 3: Recognizing the signs and symptoms

1. Recognize the symptoms in the acute phase. The acute phase of the disease is a short period in which you start to experience symptoms. Symptoms can take anywhere from 2 to 12 days after being bitten by an infected mosquito. Usually there are no symptoms for the first 3 to 7 days. When symptoms begin, you will usually be sick for 10 days before getting better. You may experience the following symptoms during the acute phase:
   • Fever: The temperature is usually between 39ºC and 40.5ºC and usually lasts 3 days to a week. The fever can be biphasic (disappearing for a few days, followed by a few days of slightly lower fever (38-39ºC), during which time the virus accumulates in the bloodstream, spreading to different parts of the body .
   • Joint pain: You usually experience joint pain in the small joints of the hands, wrists, ankles and the larger joints such as the knees and shoulders, but not the hips. More than 70% of people have pain that passes from one joint to another as soon as the first joint feels better. The pain is usually worst in the morning, and it gets better with gentle movement. Your joints may also be swollen or painful to the touch, and you may have inflamed tendons. The joint pain is usually completely gone after 1 to 3 weeks, and the pain is at its worst during the first week.
   • Rash: About 40% to 50% of patients develop a rash. This is usually a spotted rash. There are small bumps covering the rash, which often become visible 3 to 5 days after the fever has started, and disappear after 3 to 4 days. The rash usually starts on the upper arms and legs, followed by the face and trunk. Look in the mirror and take off your shirt to see if you see red bumps in many areas and if they are itchy. Also check your back, the back of your neck, and raise your arms to check your armpits.
2. Know the symptoms of the sub-acute phase. The sub-acute phase of Chikungunya lasts from one to three months after the end of the acute phase. During the sub-acute phase, the main symptom is joint pain. In addition, abnormalities of the blood vessels, such as Raynaud's syndrome, can also occur.
   • Raynaud's syndrome is a condition in which there is reduced blood flow to the hands and feet due to cold or stress. Look at the tips of your fingers and check if they are cold and blue / black in color.
3. Recognize the chronic phase. This phase starts three months after the first symptoms of the disease. It is characterized by persistent joint pain. 33% of patients suffer from joint pain for 4 months, 15% last for 20 months and 12% last for 3 to 5 years. A study has shown that 64% of people still had stiff or painful joints after one year. You may also experience fever attacks, asthenia (abnormal tiredness or weakness), arthritis (inflamed / swollen joints) in multiple joints and inflamed tendons.
   • If you already have an underlying joint disease, such as rheumatoid arthritis, you are more prone to developing chronic chikungunya.
   • Rheumatoid arthritis rarely occurs in the acute phase. On average, this only starts after about 10 months.
4. Watch for other symptoms. Although fever, rash, and joint pain are the most common symptoms, many patients experience other things as well. These could include:
   • muscle strain
   • Headache
   • Sore throat
   • Stomach ache
   • Blockage
   • Swollen lymph nodes in the neck
5. Distinguish chikungunya from similar diseases. Since many of the symptoms associated with chikungunya also occur with similar mosquito-borne diseases, it is important to know the distinction. Diseases similar to chikungunya include:
   • Leptospirosis: Notice if your calf muscles hurt when you walk. Also notice if the white part of your eyes is bright red (bleeding on the conjunctiva). This is caused by the rupture of small blood vessels. Consider whether you've been around farm animals or water, as infected animals can spread this disease through water or soil.
   • Dengue: Consider whether you have been bitten by mosquitoes if you have been in a tropical climate such as Asia, Africa, South America, Central America, the Caribbean, or southern North America. Dengue is common in these places. Look in the mirror for bruises, bleeding or redness of the whites of the eyes, bleeding gums or frequent nosebleeds. The bleeding is the main difference between dengue and chikungunya.
   • Malaria: Consider whether you have been bitten by mosquitoes in places where malaria is prevalent, such as South America, Africa, India, the Middle East and Southeast Asia. Notice if you have chills, fever, and sweats. This can take 6 to 10 hours. After that, these phases can return again and again.
   • Meningitis: Note if there is an outbreak in the area where you are. If so, you could be infected. See if you have a fever and if you have a stiff or sore neck. You can also experience severe headaches and fatigue.
   • Acute rheumatism: This is most common in children between the ages of 5 and 15. Check if your child has pain in several joints, which usually passes from one joint to another (if one joint is better, another joint will hurt) and if he or she has a fever, as with chikungunya. However, the difference is that the child is making uncontrolled or jerky movements, has small, painless lumps under the skin and a rash. The rash may be flat, or slightly thickened, with frayed edges and blotchy or circular with a darker pink border on the outside.

Part 2 of 3: Treating the symptoms

1. Know when to seek medical attention. A doctor can draw blood to test if you have chikungunya or another mosquito-borne disease. See a doctor if you experience the following symptoms:
   • Fever that lasts longer than 5 days
   • Dizziness (possibly due to dehydration or a neurological problem)
   • Cold fingers or toes (Raynaud's syndrome)
   • Bleeding in the mouth or under the skin (possibly Dengue)
   • Little urine (due to dehydration, which can lead to kidney damage)
     • If the joint pains are excruciating and painkillers do not help, the doctor may prescribe hydroxychloroquine 200 mg or chloroquine phosphate 300 mg, which can be taken for up to 4 weeks.
2. Understand what tests the lab can run. The doctor will send blood samples to the lab. Several tests can be done to make the diagnosis. ELISA (Enzyme-Linked Immuno Sorbent Assay) looks for specific antibodies against the virus. These antibodies develop towards the end of the first week of the disease and are at their peak after 3 weeks to 2 months. If the result is negative, the doctor can repeat the blood test to see if it has gone up.
   • A virus culture can also check for growth. This is usually used in the first 3 days of the illness when the virus is growing rapidly.
   • The RT-PCR (reverse transcriptase polymerase chain reaction) method uses virus-specific gene encoding proteins to mimic the specific genes of chikungunya. If you have chikungunya, the lab will see more chikungunya genes than usual in an automated graph.
3. Peace. There is no specific treatment for the virus, and no vaccine to prevent it. You can only fight the symptoms. The World Health Organization recommends that you take plenty of rest. This provides relief and allows your body to recover. Rest in a place that is not too hot or humid as this can make symptoms worse.
   • Apply a cold compress to sore areas to relieve pain and reduce inflammation. You can use a bag of frozen vegetables or an ice pack. Wrap the frozen bag in a towel and place it on the painful area. Never put it directly on the skin as you can damage your skin.
4. Take painkillers. If you have a fever and joint pain, take acetaminophen. Take 2 tablets of 500 mg, up to 4 times a day. Make sure you drink enough water during the day. Since the fever can lead to dehydration and electrolyte deficiency, you should drink at least 2 liters of water with a little salt per day.
   • If you have liver or kidney problems, consult a doctor before taking acetaminophen.
   • Do not take aspirin or other anti-inflammatory painkillers such as ibuprofen, naproxen, etc. Chikungunya is similar to other mosquito-borne diseases such as dengue, which can lead to severe bleeding. Aspirin and anti-inflammatory painkillers can thin the blood and make bleeding worse. Make sure you don't have dengue by seeing a doctor.
5. Move. Exercise moderately, but not too intensively, as this can make muscle or joint pain worse. If possible, make an appointment with a physiotherapist and get treatment as a result. This can strengthen the muscles around the joints, which can reduce pain and stiffness. Try moving in the morning if your joints feel stiff. Do some of these simple exercises:
   • Sit in a chair. Extend one leg in front of you so that it is parallel to the ground and hold for 10 seconds. Lower the leg and put your foot flat on the floor. Do the same with your other leg. Repeat this several times a day, doing two to three sets of ten reps per leg.
   • Stand on your toes with your feet together and lower yourself back onto your entire feet. Repeat this a number of times, up and down.
   • Lie on your side. Raise one leg for ten seconds and put it back on the other leg. Do this ten times. Then turn onto your other side and repeat with the other leg. Do this a few times a day.
   • You can also do gentle aerobic exercises. You are not allowed to make aggressive movements or use weights.
6. Use oil or cream against skin irritation. You may have dry flakes or an itchy rash. That doesn't necessarily need to be treated, but you can relieve the itching and help your skin recover. Put some mineral oil, moisturizer, or calamine lotion on your skin. If you are very itchy, you can take an oral antihistamine such as diphenhydramine, according to the instructions in the package insert. This can cause the inflammatory cells to release less of the proteins that cause the itching.
   • Stubborn skin patches can be treated with hydroquinone-based products. This will lighten the spots.
   • Ask a doctor for advice if you want to buy a cream or lotion to reduce the skin irritation.
7. Try an herbal remedy. It appears that there are a number of herbs and plants that can help relieve the symptoms of chikungunya. You can buy them at most drug stores, but always consult a doctor before starting. Herbal remedies include:
   • Eupatorium perfoliatum 200C: This is the best homeopathic remedy for chikungunya. It is a vegetable-based extract that you can use against the symptoms. It relieves symptoms including joint pain. Take 6 drops a day for a month as long as symptoms persist.
   • Echinacea: This plant extract is used to combat the symptoms of chikungunya by strengthening the immune system. Take 40 drops per day, divided into 3 doses.

Part 3 of 3: Keeping an eye on complications and preventing chikungunya

1. Watch for heart complications. Pay special attention to cardiac arrhythmias, which can be potentially fatal. To check, place the pads of your index and middle fingers on your wrist, just below the thumb. If you feel the heartbeat, it is the radial artery. Count how many beats you feel per minute. 60 to 100 beats per minute is normal. Also pay attention to whether you feel a constant rhythm; Skips or abnormal pauses may indicate a heart rhythm disturbance. Your doctor can do an electrocardiogram (EKG), which involves putting electrodes on your chest to check your heart rhythm.
   • The chikungunya virus can inflame heart tissue, which can cause abnormal heart rhythms.
2. Watch for neurological complications. Look out for fever, tiredness, and confusion which could be signs of encephalitis or meningitis. Disorientation or concentration problems are also a sign of this. If you experience severe headache, neck stiffness or pain, sensitivity to light, fever, double vision, seizures, nausea, and vomiting, you may have meningoencephalitis. This is a combination of meningitis and encephalitis (inflammation of the spinal tissue that attaches to the brain).
   • If you have nerve damage to the legs or arms, you could have Guillain-Barré syndrome. Look for decreased sensation, convulsions and movements on both sides of the body. Also look for sharp, burning, dull, or stabbing pain on both sides of the body. This can pull up further and further and eventually lead to breathing difficulties because the nerves of the respiratory muscles are affected.
   • If you have trouble breathing, call emergency services right away.
3. Watch for eye complications. Explain if you have sore, red, or watery eyes. These could all be signs that your eyes are inflamed from conjunctivitis, episcleritis, or uveitis.
   • If you have trouble seeing objects in front of you and the colors or objects appear dim, you may have neuroretinitis.
4. Check your skin for signs of hepatitis. Look in the mirror for yellow spots on your skin or in the whites of your eyes. These can be signs of hepatitis, inflammation of the liver. The inflammation causes the waste products from your liver to spread over your skin, making it yellow and itchy. Then get medical help immediately.
   • If not treated in time, it can lead to liver failure.
5. Watch for signs of dehydration that could indicate kidney failure. Chikungunya can lead to dehydration because the kidneys don't get enough blood to function normally. This can lead to kidney failure, so watch your urine carefully. If you feel like you are producing a lot less urine and the urine is very dark, get immediate medical attention.
   • A doctor will do some tests to see if the kidney functions are good.
6. Avoid chikungunya when traveling. Consult the GGD to find out where cases of chikungunya have been reported. When traveling to these areas, you can take various measures to prevent the disease. These precautions include:
   • Do not go outside during the day. Although mosquitoes can always sting, the mosquito that spreads chikungunya is especially active in daylight.
   • Wear long sleeves and long legs to protect your body against mosquitoes as much as possible. Try to wear light-colored clothing, as this will help you see mosquitoes.
   • Sleep under a mosquito net to protect you from mosquitoes at night.
   • Use insect spray with at least 20% DEET. Other active ingredients against mosquitoes can include: eucalyptus, Picardin and Ethylbutylacetylaminopropionate (IR3535). The higher the dosage of the active ingredient, the longer the agent will generally work.

Tips

• Hydroxychloroquine and chloroquine phosphate are drugs used for rheumatoid arthritis, but they can also help with chikungunya arthritis. An X-ray may be needed to see if the cartilage in the joints has been damaged.

Warnings

• Do not give aspirin to children under the age of 12, as it can cause stomach bleeding and Reye's syndrome. The latter is a serious disease that can affect the brain and liver, and it can even be fatal.