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Insane Medicine – Travelers to the Caribbean or South America – beware of Chikugunya virus!

  • Insane Medicine - Chikungunya virus is spread by mosquitos
    Chikungunya virus is spread by mosquitos

    Insane Medicine - Specifically, the Aedes mosquito spreads this virus.
    Insane Medicine – Specifically, the Aedes mosquito spreads this virus.
  • Chikungunya is making headlines again as a million cases have occurred this year. We covered Chikungunya virus in a prior article http://www.insanemedicine.com/?p=69 in insanemedicine.com.
  • As a refresher, Chikungunya virus is an arbovirus endemic to Wet Africa that produces fever and arthritis in multiple locations. It is spread by the Aedes mosquito to humans, with primates as reservoirs. Aedes aegypti is one vector, that is present in the U.S. Southeast and lives in urban areas, frequenting small puddles of water. Aedes albopictus (Asian Tiger mosquito) is the other vector, and it spreads yellow fever, west nile, japanese encephalitis virus, and eastern equine encephalitis virus as well. It is found in the southeastern and mid-atlantic states areas.
  • A person who gets Chikungunya fever from the bite of one of these mosquitos develops fevers of three to five days duration and about two to five days after this, the patient develops polyarthralgias (arthritis pains) in the hands, wrists, and ankles most commonly. This arthritis can cause sever pain that lasts days to months. Rash also occurs about three days after onset of illness and is small and flat in nature.  In severe cases, death can result. Respiratory failure, encephalitis (brain infection), hepatitis, renal failure,  myocarditis (heart inflammation) have been associated with severe infection.
Insane Medicine - Nothing is too small for a mosquito
Insane Medicine – Nothing is too small for a mosquito.

The following is a link to updated information on the Chikungunya virus (Pan American conference) http://www.paho.org/hq/index.php?option=com_topics&view=article&id=343&Itemid=40931&lang=en

https://www.flickr.com/photos/pahowho/sets/72157645069134907/  < Pictures of infected victims.

Insane Medicine - Chikungunya fever skin rash
Insane Medicine – Chikungunya fever skin rash
  • What is so special about this tropical infection in the United  States? First, There is no immunity to this disease in the Americas, so it can spread rapidly.  Secondly, 1.03 million people have contracted the disease, with 155 dying, especially in Martinique and Guadeloupe. There have been 11 cases in Florida.
  • The economic impact of this disease are  significant with many having chronic arthritis, unable to walk due to the pain. 20-30 % have chronic rheumatological symptoms. This results in disability and missed work.
  • There is no specific treatment or cure. There is no vaccine available as of 2014.
Insane Medicine  distribution of Chikungunya virus
Insane Medicine distribution of Chikungunya virus
Map of Caribbean where the Chikungunya is located
Map of Caribbean where the Chikungunya is located.
  • The best treatment for this disease is prevention, through the use of insect repellent and extermination of mosquitoes by removing their  breeding grounds (areas of standing water) and through the use of insecticide.
  • There have been 11 cases of Chikunguya virus in the U.S., and 1900 cases  or so that have been imported to the U.S. through traveling.  This number will probably rise over the next year.
  • If you are traveling to South America or the Caribbean, be certain to carry insect repellent.
  • More information can be found at the CDC website : http://www.cdc.gov/chikungunya/
  • CDC reportable diseases website: http://wwwn.cdc.gov/nndss/
I survived
I survived

chikungunya drinkschikungunya drinks
chikungunya drinks



Enterovirus D68

Enterovirus Virions
Enterovirus under high magnification.

What is this Enterovirus D68 (EV-D68)?

  • It was first found in California in 1962, but has never really been associated with mass outbreaks of infection
  • Enteroviruses are related to polioviruses. There are many flavors of Enteroviruses, which generally cause rash, mouth sores, conjunctivitis, and sometimes more severe infections.
  • Since doctors generally don’t test for viruses in their patients, it is hard to tell how common the EV-D68 infection is. Some people may be very sick while other show no symptoms. There are a broad range of presentations.
  • This EV-D68 infection is acting like a common cold with a twist. It mostly causes runny nose, fever, muscle aches, and cough. However, occasionally it has led to severe respiratory failure.
  • As of September 15, states which have had the illness present included Colorado, Illinois, Iowa, Kansas, Kentucky, and Missouri. It may be coming to a town near you soon.
  • The National Enterovirus Surveillance System through the CDC tracks such viral infections, but the disease is not reportable, so it will be difficult to assess it’s true impact and presence.
  • Since EV-D68 is acting like a common cold, the usual precautions should be taken among family members and coworkers with any respiratory illness: Don’t share utensils, avoid close contact, and wash your hands frequently. Stay away from sick people, especially if they have cancer, emphysema, or a transplant. Pregnant women and small infants should stay away from people with respiratory illnesses.
  • In all, this infection will pass through the communities in the East and Mid-West as schools have started and people are in close contact.  This will not result in any large scale catastrophes, but occasionally some patients, primarily in the 6 month to 16 year old range, will demonstrate more severe symptoms.
  • There is no vaccine available and no specific treatment other than measures to deal with associated conditions, such as wheezing or worsening asthma and fever. Antibiotics do not help. Good hygiene is important to prevent spread of the virus.

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