Monday, 5 September 2016

Beware of Chikungunya Encephalitis: IMA

Beware of Chikungunya Encephalitis: IMA

Severe encephalitis related to chikungunya infection has been reported in Delhi tweeted Padma Shri Awardee Dr K K Aggarwal National President Elect IMA.

Chikungunya virus (CHIKV) disease can cause CHIKV-associated encephalitis. One can detect CHIKV RNA or anti-CHIKV immunoglobulin M in cerebrospinal fluid, warns IMA.

IMA was the first to report chikungunya cases in West Kidwai Nagar in NBCC construction area and is now first to report spurt of cases of encephalitis in Delhi linked to chikungunya, said Dr Aggarwal.

In a U-shaped distribution, children younger than 1 year and adults age 65 or older have the highest incidence of CHIKV-associated encephalitis.

The overall case fatality rate for CHIKV-associated encephalitis as per literature is 16.6%, and the 3-year rate of neurologic sequelae range from 30% to 45%. The risk for death or neurologic sequelae is significantly higher in adults than in children (53% vs. 18%).
CHIKV is an alphavirus transmitted by Aedes species mosquitoes. Symptomatic CHIKV infections typically result in a self-limited systemic febrile illness associated with rash and arthralgia. However, cases of severe disease, including meningoencephalitis and death, have also been reported.

CHIKV may present similarly to numerous other infectious causes of systemic febrile illness in the tropics, including malaria, dengue, and other arthropod-borne infections.

Central India Institute of Medical Sciences, Nagpur in May 2006, during a large Chikungunya virus infection (CHIKV) described various neurological syndromes: Encephalitis, myelopathy, peripheral neuropathy, myeloneuropathy, and myopathy.

Of the 300 patients with CHIKV infection seen during the study period, June-December 2006, 49 (16.3%) [M : F: 42:7] had neurological complications.

The neurological complications included Encephalitis (27, 55%), myelopathy (7, 14%), peripheral neuropathy (7, 14%), myeloneuropathy (7, 14%), and myopathy (1, 2%).

Reverse Transcriptase polymerase chain reaction (RT-PCR) and real-time PCR was positive in the CSF in 16% and 18%, respectively.

It suggest neurotropic nature of the virus. The outcome of the neurological complications is likely to be good.

Literature reports a cumulative incidence rate of 8.6 per 100,000 people.

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