Chikungunya: an emerging viral infection with varied clinical presentations in Bangladesh: Reports of seven cases

Abstract

BackgroundChikungunya is an emerging and rapidly spreading viral infection in many parts of the world including Bangladesh. It shares many epidemiological and clinical characteristics with dengue. So, a sound knowledge is required for its detection and differentiation from dengue, specially in endemic regions.Case presentationWe present seven confirmed cases of chikungunya having different clinical presentations occurring among middle aged males and females from different socio-economic background in Dhaka city, the capital of Bangladesh. All patients had fever and aches and pains. Less common features were rash, diarrhea, vomiting and altered liver biochemistry. Dengue was excluded in six patients. Paracetamol remained the mainstay of treatment during febrile periods, but over 50% of the patients had prolonged joint symptoms requiring non-steroidal anti-inflammatory drugs.ConclusionsIn spite of being a self-limiting disease, chikungunya may have different presentations and a protracted clinical course. During the febrile episode, exclusion of dengue is equally important. Physicians should be aware of the condition and public health initiatives are necessary to break the disease transmission.

Emerging Viral Diseases

“…Then the recent outbreak started in April-May of this year. 7 Chikungunya epidemics display cyclical and seasonal trends. There is an inter-epidemic period of 4-8 years.…”

Chikungunya infection confirmed in a Moroccan traveller returning from Bangladesh

“…albopictus was the main vector in 2011 outbreak in Dohar, Dhaka. 26 Our patient leaves Dhaka for a visit to Morocco exactly during the last outbreak of Chikungunya. This outbreak was declared by the Institute of Epidemiology, Disease Control and Research of Bangladesh (IEDCR).…”

Dengue-Chikungunya Co-Infection: A Case Report from 2017-Chikungunya Outbreak in Dhaka, Bangladesh

“…Aedes aegypti and Aedes albopictus are the usual vectors for chikungunya, which are also responsible for transmission of dengue, hence well explains concurrence or co-incidences of dengue and chikungunya in endemic regions ( Figure 1). 2 High rates of chikungunya-dengue co-infection have been reported in literature. 5 …”

“…Exclusion of dengue is more important than establishing chikungunya during febrile periods, as patients may require non-steroidal antiinflammatory drugs (NSAIDs) in case of chikungunya, which is not advocated during dengue infection. 2,9 Dengue and chikungunya infections continue to co-exist in our country and there is substantial overlap in clinical presentation between these infections. 2,8,10 So, clinicians should use simple clinical and laboratory criteria to predict these infections for appropriate management.…”

“…1 Among them chikungunya is emerging in Bangladesh whereas dengue is endemic. 2 DENV is the most relevant arbovirus in terms of morbidity, mortality and socioeconomic impact, threatening more than 2.5 billion individuals worldwide. 3 It belongs to the Flaviviridae family, genus Flavivirus and is composed by four closely related serotypes (DENV 1, 2, 3, 4).…”