Chikungunya- A Diabetogenic Stress.

Abstract

Diabetogenic potential of chikungunya fever was suspected during routine management of cases attending my hospital during the 2009 chikungunya epidemic in Kerala, south India. The suspicion was given due attention because doctors were treating chikungunya with steroids like methyl prednisolone,a known diabetogenic drug and many patients had one ... or more components of metabolic syndrome..I made an attempt to evaluate the interaction between chikungunya and diabetes using the patient and laboratory data that was naturally available to me till cases ceased to report. Chikungunya is an insect-born virus of the genus alpha virus, family togaviridae that is transmitted to human by virus-carrying mosquito aedes aegypti.Recent epidemic in different parts of the world including kerala has been due to aedes albopictus mosquito .The change was due to a mutation in the virus. Symptoms of the disease include a fever upto 40 degree C , petechial or maculo-papular rash of the trunk, face or limbs and sudden onset of symmetrical polyarthralgia or arthritis. There will be nonspecific symptoms like head ache, photophobia etc. The acute phase is treated with paracetamol and NSAID. Chloroquine is also advised by virtue of its anti inflammatory action ,but doctors preferred and used steroid for definite results. Recovery from chikungunya varies with age. Younger patients recover within 5-15 days .Arthralgia may persist for weeks to months irrespective of treatment modality followed. I noticed that recovery from acute phase of chikungunya was slow in diabetics ,and their blood sugar used to go up quite early during the disease. Also I noted that severity and chronicity of the disease In prediabetics and diabetics were reduced when measures to addres s dysglycemia were followed. II. Material and method It was the mansoon of 2009 , and beside chikungunya ,there were other fevers like viral fever, hepatitis,enteric fever and respiratory tract infection .Often more than one type of fever were present in different members of same family making the diagnosis difficult. Chikungunya cases were diagnosed based on the clinical features and virological diagnosis of random cases using government facilities. I examined more than one thousand cases of fever during that period out of which 420 were chikungunya cases. My patients included cases partly treated by other doctors also among which most of the patients were on steroids from day one itself. All routine tests including blood sugar estimation and platelet count were done to pick up serious cases like dengue fever and pneumonia. Along with this, routine screening for diabetes continued as ever, and I included a history of chikungunya also as a criteria for screening for obvious reasons. More over any disease precipitated or aggravated along with or after chikungunya were also carefully watched and their relationship to dysglycemia noted. The effect of steroid therapy initiated by other doctors were noted while trying to taper it as early as possible.