Diagnosis Of Chikungunya Research Articles

Chikungunya: Diagnostic, Treatment and Challenge in Indonesia

Chikungunya based on the literature is classified as one of the many diseases that become a differential diagnosis of acute undifferentiated fever. Finally, patients with this condition are treated with empirical therapy so that often the management does not meet the standards / undertreatment. In an effort to reduce morbidity and improve the quality of care with limited modalities, history taking and physical examination as well as effective risk factor analysis are necessary in the current situation in Indonesia. Therefore, the authors raise this topic to help improve diagnostic acuity and the importance of the role of laboratory modalities in the diagnosis of chikungunya in Indonesia. Google Scholar by using the search keywords "Chikungunya" and "In Indonesia" with a time span of 2013-2023. Through a search that has been carried out using these 2 keywords, we get 10,300 publications. Based on the inclusion and exclusion results, 30 publications were obtained that could be used in compiling our literature review. Indonesia is an archipelago and is one of the countries in the world with a tropical climate, so it is certainly an ideal place for various tropical infectious diseases such as chikungunya. Although Indonesia has suppressed chikungunya incidence, Indonesia still facing some problem on diagnostic and case reporting system. This situation effect the performance of incidence validity and quality of treatment. Chikungunya virus infection in Indonesia still requires diagnostic development efforts to anticipate future outbreaks.

Joint Involvement Can Predict Chikungunya in a Dengue Syndemic Setting in India

Dengue and chikungunya have been endemic in India but have the tendency to cause periodic epidemics, often together, wherein they are termed ‘syndemic’. Such a syndemic was observed in 2016 in India which resulted in a further scarcity of already resource-poor specific diagnostic infrastructure even in many urban conglomerates. A cross-sectional study was thus conducted, on 978 fever patients that consulted the ICMR-NIMR fever clinic, New Delhi, in September 2016, with an objective to identify symptom/s that could predict chikungunya with certainty. The overall aim was to rationally channelize the most clinically suitable patients for the required specific diagnosis of chikungunya. Based on their clinical profile, febrile patients attending NIMR’s clinic, appropriate laboratory tests and their association analyses were performed. Bivariate analysis on 34 clinical parameters revealed that joint pain, joint swelling, rashes, red spots, weakness, itching, loss of taste, red eyes, and bleeding gums were found to be statistically significantly associated predictors of chikungunya as compared to dengue. While, in multivariate analysis, only four symptoms (joint pain in elbows, joint swelling, itching and bleeding gums) were found in statistically significant association with chikungunya. Hence, based on the results, a clinician may preferably channelize febrile patients with one or more of these four symptoms for chikungunya-specific diagnosis and divert the rest for dengue lab diagnosis in a dengue–chikungunya syndemic setting.

Advancing Chikungunya Diagnosis: A Cost-Effective and Rapid Visual employing Loop-mediated isothermal reaction

The diagnosis of Chikungunya (CHIKV), along with the simultaneous monitoring of virus circulation in the population or vectors, is essential for global health. Although effective diagnostic methods for CHIKV, such as RT-qPCR, exist, their utilization is constrained by high costs. With the aim of contributing to the field of diagnostics, we have developed a diagnostic assay using isothermal amplification technology with visually interpretable results. This test can detect the virus within a maximum timeframe of 30 minutes. The detection limit of RT-LAMP CHIKV was found to be 66 copies of RNA molecules (Ct ≅ 31.28), and no cross-reactivity with other arboviruses was observed. During test validation, our assay demonstrated a sensitivity of 80.43%, specificity of 100%, and an overall accuracy of 88.89%. By utilizing more cost-effective reagents and equipment compared to RT-qPCR, this test holds the potential for broader application and enhanced accessibility, particularly in point-of-care settings.

Investigation of Chikungunya virus genotype at tertiary care center in Western Maharashtra, India.

Chikungunya is a reemerging arbovirus infection. Laboratory diagnosis can be done by Classical test involving Rapid Immunochromatography, Enzyme-Linked Immunosorbent assay and Molecular methods. The present study was undertaken to know the genotype of the Chikungunya virus (CHICKV) among patients suspected of CHICKV and investigated by virus culture, partial sequencing, Rapid Immunochromatography, and Enzyme-linked Immunosorbent assay (ELISA). To understand different techniques used in Chikungunya diagnosis viz., virus culture, partial sequencing along with Immunochromatography and ELISA. This is a prospective, laboratory-based study at a tertiary care center. Lateral flow chromatography and ELISA was carried out on serum samples. All 50 samples were cultured and indirect Immunofluorescence was performed on positive samples at Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth Medical College Pune, Maharashtra, India. Virus isolates were subjected to partial sequencing for identification of genotype after confirmation by PCR. Statistical Package of Social Science (SPSS) version 22.0 software was used to calculate the Receiver operating curve (ROC) for different tests. Out of 50 samples, 20 were positive by Immunochromatography, 23 by ELISA, and 3 by culture, PCR confirmed CHIKV isolates and sequencing identified genotypes as East Central South African type. CHIKV culture isolates of East Central South African type lineage were predominantly found in the present study. These are also common genotypes present in Asia including India.

Development and evaluation of recombinant E2 protein based IgM capture enzyme-linked immunosorbent assay (ELISA) and double antigen sandwich ELISA for detection of antibodies to Chikungunya virus

Chikungunya virus (CHIKV) reemerged and caused millions of human infections since 2004. The disease could be established, when the virus has been introduced to areas where the appropriate vectors are endemic. The differential diagnosis of CHIKV infection varies based on place of residence, travel history, and exposures. Serological tests are commonly used to diagnose CHIKV infection, but their availability and assessments of the performance of the diagnostics have been limited. To develop and evaluate antibodies detection methods for chikungunya diagnosis and serological investigation. Recombinant E2 protein based IgM capture enzyme-linked immunosorbent assay (Mac-ELISA) and double antigen sandwich ELISA (Das-ELISA) for detection of antibodies to Chikungunya virus were developed and evaluated. The repeatability was evaluated by testing of three reference sera at single dilutions in triplicated for 5 times. The sensitivity, specificity, accuracy, and agreement of the MAC-ELISA and Das-ELISA were obtained by comparing the detection results of 225 serum samples (45 positive; 180 negative) with a real-time RT-PCR assay and an IFA commercial tests manufactured by Euroimmun. The established ELISA assays were standardized by determining the optimal concentrations of the key reagents. The coefficient values of repeat testing were within 10% and 20% for intraassay and interassay precision, respectively. A sensitivity of 60.0% and 52.5%, a specificity of 96.2% and 96.8%, and an accuracy of 89.8% and 88.9% were obtained for the Mac-ELISA and Das-ELISA, respectively, when compared to a CHIKV qRT-PCR method. And a sensitivity of 100%, a specificity of 97.5% and 99.5%, and an accuracy of 97.8% and 99.6% were yielded respectively when using the IIFT as a reference method, which showed a highly consistence to the commercial IIFT assay with a Kappa value greater than 0.90. The Mac-ELISA and Das-ELISA based on recombinant E2 protein of CHIKV were developed and standardized, which could detect IgM or total antibodies against CHIKV in 2-3 hours with acceptable sensitivities and specificities. These assays can be used for laboratory diagnosis and serological investigation of CHIKV infections to evaluate the risk of CHIKV transmission.

Development of Highly Sensitive Sandwich ELISA for the Early-Phase Diagnosis of Chikungunya Virus Utilizing rE2-E1 Protein.

IntroductionChikungunya is caused by an alpha virus transmitted to humans by an infected mosquito. Infection is generally considered to be self-limiting and non-critical. Chikungunya infection may be diagnosed by severe joint pain with fever, but it is difficult to diagnose because the symptoms of chikungunya are common to many pathogens, including dengue fever. Diagnosis mainly depends on viral culture, reverse transcriptase polymerase chain reaction (RT-PCR), and IgM ELISA. Early and accurate diagnosis of the virus can be achieved by the application of PCR methods, but the high cost and the need for a thermal cycler restrict the use of such methods. On the other hand, antibody-based IgM ELISA is considered to be inexpensive, but antibodies against chikungunya virus (CHIKV) only develop after 4 days of infection, so it has limited application in the earlier diagnosis of viral infection and the management of patients. Because of these challenges, a simple antigen-based sensitive, specific, and rapid detection method is required for the early and accurate clinical diagnosis of chikungunya.MethodsThe amino acid sequence of CHIKV ectodomain E1 and E2 proteins was analyzed using bioinformatics tools to determine the antigenic residues, particularly the B-cell epitopes and their characteristics. Recombinant E2-E1 CHIKV antigen was used for the development of polyclonal antibodies in hamsters and IgG was purified. Serological tests of 96 CHIKV patients were conducted by antigen-capture ELISA using primary antibodies raised against rCHIKV E2-E1 in hamsters and human anti-CHIKV antibodies.ResultsWe observed high specificity and sensitivity, of 100% and 95.8%, respectively, and these values demonstrate the efficiency of the test as a clinical diagnostic tool. There was no cross-reactivity with samples taken from dengue patients.DiscussionOur simple and sensitive sandwich ELISA for the early-phase detection of CHIKV infection may be used to improve the diagnosis of chikungunya.

Investigations on TGA-Capped CdTe Quantum-Dots for Detection and Quantitative Assessment of Chikungunya Infection through Lateral Flow Immunoassay

In this paper, we report improved sensitivity of the lateral flow immunoassay (LFI) for diagnosis of chikungunya using highly luminescent Thioglycolic acid (TGA) capped CdTe quantum dots (QDs). The size of the CdTe QDs was controlled by varying the refluxing time during the chemical route synthesis. The systematically optimized TGA capped CdTe QDs were conjugated with the anti-chikungunya virus (CHIKV) antibodies and were utilized to fabricate the LFIs. These LFIs were tested using different concentrations of the recombinant protein of CHIKV, and the quantified results were compared with those obtained by colloidal gold-based LFIs. It has been shown that the LFIs based on TGA capped CdTe QDs show significantly higher sensitivity to chikungunya detection due to enhanced luminescence of the QDs at C and T lines of the LFI under UV illumination as compared to state of the art colloidal gold-based LFIs under normal light.

Diagnosis of Chikungunya Virus in Febrile Patients From a Malaria Holoendemic Area

IntroductionAccurate diagnosis of chikungunya (CHIK) is essential for effective disease management and surveillance. In a cohort of febrile Congolese patients, available diagnostic methods widely used in CHIK diagnosis were evaluated. In addition, plasma cytokines were quantified in CHIK patients and those coinfected with malaria compared with healthy controls. MethodsBetween June and November 2019, a total of 107 febrile patients with suspected CHIK were subjected to differential diagnosis both for CHIK and malaria. Patients were screened for CHIK virus using molecular diagnosis by real-time PCR, serologic testing by IgM-specific and IgG-specific ELISAs, and lateral flow-based method with rapid diagnostic test (RDT), while malaria diagnosis was confirmed by PCR methods. Pro-inflammatory (IL-12, IL-16, IFN-γ, TNF-α) and anti-inflammatory (IL-4, IL-10, IL-13) cytokines were quantified in patients and healthy controls by ELISA assays. ResultsMolecular diagnoses revealed that 57% (61/107) were positive for CHIK by RT-PCR, while serologic testing revealed 31% (33/107) and 9% (10/107) seropositivity for anti- IgM and IgG, respectively. None of the patients were CHIK RDT-positive. Also, 27% (29/107) were PCR-positive for malaria. Among the malaria-positive patients, 14% (15/107) were co-infected with CHIK and 13% (14/107) were monoinfection. Plasma IL-12 and TNF-α levels were increased in patients with malaria and IL-13 levels were increased in patients with co-infection (p<0.05). ConclusionCo-infection of malaria and CHIK were common in febrile Congolese patients. Real-time PCR was a better tool for detecting actual occurrences of CHIK in a malaria holoendemic area.

Evaluation of an Antibody-Based Test for the Diagnosis of Chikungunya Infection

Background: The diagnosis of chikungunya is confusing due to similar clinical presentations of different viral illnesses.&#x0D; Objective: The purpose of the present study was to evaluate the accuracy of an antibody-based test for the diagnosis of chikungunya infection&#x0D; Methodology: This cross-sectional study was conducted at the Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July to September 2017 when an outbreak of chikungunya occurred in Bangladesh. Chikungunya patients were evaluated by the IgM antibody test by immunochromatographic method (ICT) during both the early phase and the convalescent-phase. The sensitivity and specificity of the IgM antibody test were estimated considering the polymerase chain reaction (PCR) method as the gold standard.&#x0D; Result: The sensitivity and specificity of the IgM antibody test in the acute phase were 2.7 percent and 79.5 percent, respectively. In contrast, in the convalescence phase, sensitivity and specificity were 86.5 percent and 33.3 percent.&#x0D; Conclusion: Antibody-based testing was found not suitable for detecting chikungunya infection during the acute phase of the illness.&#x0D; Journal of Current and Advance Medical Research 2020;7(2): 68-72

Chikungunya Outbreak in the Republic of the Congo, 2019-Epidemiological, Virological and Entomological Findings of a South-North Multidisciplinary Taskforce Investigation.

The Republic of Congo (RoC) declared a chikungunya (CHIK) outbreak on 9 February 2019. We conducted a ONE-Human-Animal HEALTH epidemiological, virological and entomological investigation. Methods: We collected national surveillance and epidemiological data. CHIK diagnosis was based on RT-PCR and CHIKV-specific antibodies. Full CHIKV genome sequences were obtained by Sanger and MinION approaches and Bayesian tree phylogenetic analysis was performed. Mosquito larvae and 215 adult mosquitoes were collected in different villages of Kouilou and Pointe-Noire districts and estimates of Aedes (Ae.) mosquitos’ CHIKV-infectious bites obtained. We found two new CHIKV sequences of the East/Central/South African (ECSA) lineage, clustering with the recent enzootic sub-clade 2, showing the A226V mutation. The RoC 2019 CHIKV strain has two novel mutations, E2-T126M and E2-H351N. Phylogenetic suggests a common origin from 2016 Angola strain, from which it diverged around 1989 (95% HPD 1985–1994). The infectious bite pattern was similar for 2017, 2018 and early 2019. One Ae. albopictus pool was RT-PCR positive. The 2019 RoC CHIKV strain seems to be recently introduced or be endemic in sylvatic cycle. Distinct from the contemporary Indian CHIKV isolates and in contrast to the original Central-African strains (transmitted by Ae. aegypti), it carries the A226V mutation, indicating an independent adaptive mutation in response to vector replacement (Ae. albopictus vs Ae. aegypti).

Gengivite necrosante em paciente infantil: relato de caso

Objetivo: Relatar um caso clínico de gengivite necrosante em uma criança, com diagnóstico clínico de Chikungunya. Detalhamento do caso: Paciente de 8 anos de idade, gênero masculino, que procurou a Clínica Escola de Odontologia da Universidade Federal de Campina Grande relatando “dor na gengiva”. Clinicamente foi observada presença de necrose limitada a margem gengival vestibular e nas pontas das papilas interdentais na região antero superior. Foi identificado sinais característicos da doença, como: dor, dificuldade de higienização e alimentação, necrose gengival, odor fétido e candidíase. Foi realizado um tratamento conservador com raspagem e alisamento corononário, limpeza com peróxido de hidrogênio a 10 volumes e prescrição de bochechos com clorexidina a 0,12% duas vezes ao dia por 15 dias, sem necessidade do uso de antibiótico. Cosiderações finais: A baixa da imunidade por conta do acometimento sistêmico gerado pela Chikungunya foi primordial para o aparecimento da gengivite necrosante. Foi realizado acompanhamento durante quase um mês, onde observou-se o reestabelecimento da saúde periodontal do paciente.

Transmission of Chikungunya Virus in an Urban Slum, Brazil.

After a chikungunya outbreak in Salvador, Brazil, we performed a cross-sectional, community-based study of 1,776 inhabitants to determine chikungunya virus (CHIKV) seroprevalence, identify factors associated with exposure, and estimate the symptomatic infection rate. From November 2016 through February 2017, we collected sociodemographic and clinical data by interview and tested serum samples for CHIKV IgG. CHIKV seroprevalence was 11.8% (95% CI 9.8%–13.7%), and 15.3% of seropositive persons reported an episode of fever and arthralgia. Infections were independently and positively associated with residences served by unpaved streets, a presumptive clinical diagnosis of chikungunya, and recall of an episode of fever with arthralgia in 2015–2016. Our findings indicate that the chikungunya outbreak in Salvador may not have conferred sufficient herd immunity to preclude epidemics in the near future. The unusually low frequency of symptomatic disease points to a need for further longitudinal studies to better investigate these findings.

A propósito de 3 casos con retinopatía posterior a fase aguda de fiebre por chikungunya

A descriptive study is presented on a case series of 3 patients, with IgM an IgG serology diagnosis of Chikungunya in whom other metabolic, autoimmune and infectious diseases were ruled out. They presented with other ocular manifestations with vascular changes and inflammatory characteristics. They were treated at the Retinovascular and Retinal and Vitreous clinics at the “Dr. Rodolfo Robles Valverde Hospital” and “Benemérito Comité Pro-ciegos y Sordos” in Guatemala City during 2019.Guatemala is a country with a high prevalence of vector-borne diseases, including chikungunya. In recent years cases of this disease has increased in recent years, and complications are currently seen more frequently. Within these complications, there have been reports of cases of optic neuritis, iridocyclitis, episcleritis, retinitis, uveitis, and blood dyscrasia that can affect the retina. It is important to consider these as an important differential diagnosis of ocular vascular alterations.

Severe Chikungunya infection in the pediatric intensive care unit: A case series

Often known to be a self-limiting disease presenting with fever-rash-arthralgia, chikungunya may cause severe manifestations mimicking septic shock. This case series highlights the clinical profile, course, and outcome of four severe chikungunya cases who were admitted to our tertiary care pediatric intensive care unit (PICU). All four cases had neurological manifestations and presented to the emergency department with features consistent with warm septic shock, requiring fluids, multiple vasoactive drugs, and mechanical ventilation within 2 h of admission. There was no specific hematological or biochemical abnormality on admission, and all cultures remained sterile. The diagnosis of chikungunya was made using real-time polymerase chain reaction in three cases and enzyme-linked immunosorbent assay IgM in one, with one case also showing dengue IgM positivity. All four cases had fever of more than 2 weeks and required multiorgan support and prolonged PICU stay. All children showed complete recovery with neither neurological sequelae nor other morbidities.

Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection.&#x0D; Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (&gt;18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls.&#x0D; Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p &lt;0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p &lt;0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant.&#x0D; Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI.&#x0D; Birdem Med J 2019; 9(3): 193-196

Rheumatic manifestations of chikungunya: emerging concepts and interventions.

The largest epidemic ever recorded for chikungunya, a disease caused by infection with the chikungunya virus (CHIKV), began in Africa in 2004 and spread to >100 countries on four continents. The epidemic caused >10 million cases of often debilitating rheumatic disease, classically involving rapid onset of fever and polyarthralgia, often with polyarthritis. The clinical diagnosis of chikungunya is often complicated by infections with dengue or Zika virus. For many individuals with chikungunya, the disease is benign and self-limiting; however, some patients have a complex spectrum of atypical and severe manifestations. Many patients also experience a chronic phase of the disease, primarily involving arthralgia (which can be protracted (>1 year)), and a number of sequelae are also recognized. CHIKV-induced arthropathy arises from infection of multiple cell types in the joint and the infiltration of mainly mononuclear cells. Innate responses (primarily involving type I interferon responses and natural killer cells) and cognate responses (primarily involving CD4 T helper 1 cells), alongside activation of macrophages and monocytes, mediate CHIKV-induced arthritic immunopathology. Ideally, improved anti-inflammatory treatments should not compromise antiviral immunity. New concepts in mosquito control are being field tested and a number of CHIKV vaccines are being developed.

Burden of dengue among febrile patients at the time of chikungunya introduction in Piedecuesta, Colombia.

ObjectiveTo estimate the age‐specific incidence of symptomatic dengue and chikungunya in Colombia.MethodA passive facility‐based fever surveillance study was conducted among individuals with undifferentiated fever. Confirmatory diagnostics included serological and molecular tests in paired samples, and surveillance's underreporting was assessed using capture–recapture methods.ResultsOf 839 febrile participants 686 completed the study. There were 33.2% (295/839) dengue infections (51% primary infections), and 35.9% (191/532) of negative dengue cases there were chikungunya cases. On average, dengue cases were younger (median = 18 years) than chikungunya cases (median = 25 years). Thrombocytopaenia and abdominal pain were the main dengue predictors, while presence of rash was the main predictor for chikungunya diagnosis. Underreporting of dengue was 31%; the estimated expansion factors indicate an underreporting rate of dengue cases of threefold for all cases and of almost sixfold for inpatients.ConclusionsThese findings highlight the ongoing coexistence of both arboviruses, a distinct clinical profile of each condition in the study area that could be used by clinicians to generate a differential diagnosis, and the presence of underreporting, mostly among hospitalised cases.

Identification of Dengue and Chikungunya Cases Among Suspected Cases of Yellow Fever in the Democratic Republic of the Congo.

For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done. The aim of this study was to test for other arthropod-borne viruses that can induce the same symptoms in patients enrolled in the yellow fever surveillance in the Democratic Republic of the Congo (DRC). Of 652 patients included in the surveillance of yellow fever in DRC from January 2003 to January 2012, 453 patients that tested negative for yellow fever virus (YFV) immunoglobulin M (IgM) antibodies were selected for the study. Real-time polymerase chain reaction was performed for the detection of dengue, West Nile, Chikungunya, O'nyong-nyong, Rift Valley fever, Zika, and YFV. The average age of patients was 22.1 years. We reported 16 cases (3.5%; confidence interval [CI]: 0.8-5.2) of dengue (serotypes 1 and 2) and 2 cases (0.4%; CI: 0.0-1.0) of Chikungunya. Three patients were co-infected with the two serotypes of dengue virus. Three cases of dengue were found in early July 2010 from the city of Titule (Oriental province) during a laboratory-confirmed outbreak of yellow fever, suggesting simultaneous circulation of dengue and yellow fever viruses. This study showed that dengue and Chikungunya viruses are potential causes of acute febrile jaundice in the DRC and highlights the need to consider dengue and Chikungunya diagnosis in the integrated disease surveillance and response program in the DRC. A prospective study is necessary to establish the epidemiology of these diseases.

Study of cutaneous manifestation of chikungunya and its serological correlation

Aim: To assess the hyperpigmentation after fever and joint pain as a cutaneous marker of chikungunya fever and to assess with serological correlation.Methods: A total of 15 patients comprised of 9 males, 6 females and neonate have aged between 14 days to 60 years presented with the pigmentation after the fever subsided were enrolled in the study. The diagnosis of chikungunya was made by detecting virus specific IgM ELISA in the serum.Results: Serological immunoglobulin M enzyme – linked immunosorbent assay (IgM ELISA) test or chikungunya virus was positive in all the patients. Generalized dark coloured pigmentation was the most common finding after the fever subsided. On examination, out of 15 cases, in most of the cases, hyperpigmentation was observed all over the body with the facial involvement. Few cases showed pigmentation over nose, centre of upper lip, on palm, sole, eyelid, dorsum, centrofacial, reticulate pattern on the face and blotchy pigmentation.Conclusion: The presence of pigmentation after fever and joint pain helps to make a retrospective diagnosis of chikungunya fever and this may be considered as a cutaneous marker of chikungunya fever in recent past.

Psychiatric Morbidity of Chikungunya among Children in Bangladesh

Chikungunya occurred as a major epidemic form in Bangladesh in 2017 after a gap of 6 years. The first outbreak of Chikungunya was identified in Bangladesh in 2008. Another outbreak occurred at Dhaka in 2011. But the current outbreak is huge and effecting almost two third of the population. Methods: This was a retrospective case series study, consisted of 60 children, among which 35 were male and 25 female, ages ranging from 5 to 15 years. Those children were recruited from child health care clinic with a history of two to five days’ high grade fever. All patients recruited were IgM antibody for Chikungunya positive (after 5th day of onset of fever) and on the other hand antibody for Dengue was negative. Two patients were excluded from the study due to Cerebral Palsy and Claustrophobia. Finally 58 patients were assessed. Informed written consent was obtained from all the legal guardians before data collection. Results: All patients presented with a history of two to five days’ high grade fever. The fever was preceded by a maculopapular rash over the trunk and extremities, headache, myalgia and arthralgia. Delirium (non-specified) was most prevalent psychiatric symptoms 45 (77%). Other psychiatric symptoms were Panic Disorder (56%), Phobic Disorder (36%), Neurasthenia or Fatigue syndrome (27%), Hypersomnia (13%) and Claustrophobia (5%). Conclusion: This study suggested that psychiatric morbidity among pediatric Chikungunya patients is very common. Knowledge of the pathogenesis is required to reduce the psychiatric complications and to prevent the morbidity. There is an emergence to invent the prophylactic vaccination, proper and early diagnosis of Chikungunya.