Chikungunya fever!

Dr. Sylvester Ikhisemojie
| credits: File copy

October 12, 2014 by Dr. Sylvester Ikhisemojie 

 

The world is in fear as a result of the Ebola virus disease that has evaded all preventive measures and landed almost simultaneously in the United States and Spain. The Liberian traveller to the US who developed the disease several days after arriving in the state of Texas has now died. This has happened despite having access to some of the finest healthcare facilities on the planet. The patient in Spain is relatively more stable but her dog, Escallibur, was euthanized after an unsuccessful campaign by her now quarantined husband to stop it. The reason for that move by the state was clear: it is known that pets like dogs and perhaps cats are prone to developing the disease without having any symptoms. It is not clear if they can transmit the disease to humans. That gap in current knowledge should worry people. We are not allowed in the present circumstances to assume things because that could be dangerous. Preventive actions taken must be with an abundance of caution. Bats, monkeys, gorillas, antelopes and porcupines are known now to be able to transmit the disease. Perhaps, grass-cutters, dogs and cats may also be able to do so. More frightfully, dogs may be able to do this without showing any signs of this terrifying disease. Pet lovers, owners and those who eat dogs need also to be particularly aware. What all these demonstrate is that we are not out of the woods yet and so we must not lower our guard. This is particularly so at a time when there is an outbreak of the Marburg fever in Uganda and an out of control Ebola epidemic in Liberia and Sierra Leone and to a lesser extent, in Guinea and The Congo.

Enter now the bizarre mix of other viral infections suddenly announcing their presence around the world. Of most recent prominence is the Chikungunya virus which bears a striking similarity to Dengue Fever. It is transmitted from one person to another by the bite from a mosquito known as Aedes Egypti which is found in most parts of the tropics. It has been found in parts of Africa, Asia, Europe and the Americas. It is also seen in the Pacific and Indian oceans. In recent weeks, it has made a troublesome appearance in the Central American nations of Venezuela, Colombia and Nicaragua. Hundreds of people have been sickened and this is an area of the world that has never previously seen an outbreak. The original outbreak of this sickness was in Tanzania in 1952 and it means “to bend painfully” or to become “contorted”. It is not transmitted from one person to another directly but through that mosquito vector. There have been reports of more than a few cases in different parts of Nigeria. This infection is established when a mosquito infected with the virus bites somebody who has the infection and goes to bite another who does not have it thereby transferring its infected saliva into such an individual much like it happens when people contract malaria. Most of the bites occur during daylight hours but the Aedis egypti is also known to bite people indoors. There seems to be a peak in these bites in the early morning hours and in the early part of the evening.

The common symptoms begin some two to five days after an infection with a feverish phase and may last for up to 12 days. Majority of those infected will develop symptoms among which are fever, a reddish rash that can involve the trunk and the limbs as well as the non-specific symptoms itemised below. It is known that monkeys, cattle, birds and rodents are natural reservoirs of this disease. The symptoms may include the following: a high grade fever of sudden onset, conjunctivitis, headaches which are throbbing in character and can be quite persistent, nausea and vomiting, severe joint and muscle aches which are very debilitating, photophobia, loss of taste as you might also see in malaria. Swelling of the legs may also occur and it is not related to any kidney, heart or liver disease. However, certain heart complications have been reported nevertheless.

The symptoms are usually mild amongst young people and pregnant women. In elderly people aged more than 65 years, however, nearly a third of sufferers could die. Whether this is due solely to advanced age or the more common illnesses associated with age is unclear. What is known without a doubt is that the elderly people fare a lot worse from this disease. Death from Chikungunya fever is certainly rare but the debilitation it causes with lingering joint pains and relative incapacitation can last for several months or even years. The fever can greatly improve together with other symptoms within sevenp- to 10 days.

Since 2004, Chikungunya fever has reached epidemic proportions around the world. It is most likely to be misdiagnosed also in the regions of the world where Dengue fever is common. There is no known cure for this disease and there is no known preventive vaccine available. Treatment consists of efforts to replenish body fluids with intravenous fluids if they are vomiting or not eating, the administration of antibiotics to deter bacteria which may want to take advantage of the downgraded immune system and the use of analgesics and anti-pyretics to control the fever. Cold baths can also be used in this regard to help in controlling the fever. These are efforts in essence to help the body combat the infection. Rest and sequestration from other people is vital if there is going to be any chance of recovery. There is also no vaccine for this disease.

This disease is diagnosed in the laboratory with a blood test which can identify the virus or the existence of antibiotics developed against the infection. These are the usual ways by which a definitive diagnosis is made and treatment begun. Treatment is supportive in nature and is by no means tailored to attain cure. It is important at the point of diagnosis, to separate a sufferer of this infection from other family members or other patients in a health facility because they can be a risk to others around them if they are bitten by the Aedes mosquito.

The preventive efforts must be geared towards the reduction of the mosquito population, the elimination of their breeding environment among old broken pots for example, old tyres, the elimination of pools of stagnant water around the home. Those who live in densely populated residential neighbourhoods are particularly at risk because of the ability of the mosquito to navigate in such areas. People who live in the rural areas are also not free even if their population density is less. They should be appropriately dressed for the outdoors whenever they are venturing outside. They should wear the traditional wrapper which covers the woman well or as is increasingly common, wear trousers much as the men are likely to do and the men should also wear hats which help in providing extra protection outdoors. This attitude to prevention will avail much. People should also not fail to use mosquito netting on their doors and windows as well as sleeping in insecticide-treated nets. Most importantly, it must be noted here that like the other viral haemorrhagic fevers, this particular one has no vaccine available and has no cure. Prevention of this infection is therefore a key factor to control its spread and its possible complications.

Ask the doctor

Dear doctor, I am a 38-year-old man and I caught my lady using Cytotec. She lost her period for the month of September and I told her that I am ready for the baby. Cytotec is for what? 

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Cytotec is a prostaglandin drug that is used to control vaginal bleeding after childbirth, to induce labour in women who are scheduled to deliver their babies on certain dates and as a combination drug to prevent the development of stomach ulcers in certain people on powerful pain killers. However, the school girls also know about its usefulness to procure abortions. I suppose that is the purpose for which your lady used it.

Dear doctor, I am having a swollen heart. What type of food should I be eating? It was shown on X-ray. I don’t want to die now.

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A swollen heart as you have put it is a very serious issue indeed. This is not a matter for food. It has to do with your age and what disease you suffer from that may have predisposed you to this complication, for it is a complication. You must see your doctor for further examination and a possible referral to a cardiologist for yet more tests and treatment. Do so without any further delay.

Dear doctor, I am a 28-year-old virgin. During my period in September, a painful tiny growth developed on my vulva (labia minora to be specific) but this growth regressed on its own four days after my period without any treatment. Sir, what is this strange occurrence and how can it be prevented in the future?

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There is no way for me to be certain about what that could have been. It ranges in possibility from a Bartholin’s cyst (unlikely because this is usually a growth on the labia majora) to a simple boil which can occur commonly. The fact that it regressed on its own shows that it may not really be a problem other than its nuisance value. However, you should see your doctor for this.

Dear doctor, I am suffering from Staphylococcus and I have taken several injections but it has yet to heal. My body gets hot with noises in my tummy. My penis also gets weak after one round of sex. Please what is the best medicine for it? 

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You need to understand that Staphylococcus is not a usual cause of disease. Therefore, you may be taking drugs for the wrong reasons. The bacteria were found in what kind of specimen? Urine, blood, swab or semen? If so, it is most likely to be from some contamination rather than an infection because infection from this organism is often very severe. As a result of all the above reasons, there is no best medicine for this organism.

Dear doctor, I am a 68-year-old man. Whenever I go to bed between 9 and 10pm, I do not sleep more than four hours except I take sleeping pills. What is the solution to this? I am worried.                    

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You did not say whether you also sleep during the day. If that happens, it would explain why you sleep for such a short period during the night. Generally, most people of your age would probably sleep for brief periods at a time and do so several times in a 24-hour-cycle. If that is true with you, there is no need to take sleeping tablets which could damage you if you use them for a long time.

Dear doctor, is there orthodox medicine for “jedi-jedi” in a baby less than a year? Please kindly tell me because my baby has “jedi-jedi”.

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I have some difficulty understanding what you mean by “jedi-jedi” as I do believe you may be faced with something a bit more serious than what is obvious now. There is orthodox medicine for nearly every ailment described in the world. I believe you should take your baby to see a paediatrician for detailed examination and the correct prescription to treat your baby.

Dear doctor, I always have easy sperm release while having sex with a girl. What can I do about it?      

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I believe your problem is due to a combination of factors. Of all the possibilities, anxiety and fatigue from your daily labours may be the key culprits. You should work judiciously to reduce these challenges in order to get better results from your liaisons. As long as you can penetrate the vagina, you do not require drug treatment at this point.

Dear doctor, my friend says that whenever she removes her panties it will be covered within a few minutes by some small ants. Is this normal and what drugs can she use to deal with it?  

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The presence of ants in the pants indicates there is either an infection resulting in a vaginal discharge or the urine is sweet, perhaps due to diabetes. So what she needs to do is simple: see a doctor for the relevant tests to be conducted so that treatment can be administered.

Dear doctor, I urinate frequently so I went for fasting blood sugar. The result was 113 but I learnt it shouldn’t be more than 110. Does it mean I am diabetic?                                    

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That result does not mean that you are diabetic but it may be a warning that you are close to it. It could mean that your glucose tolerance is impaired or you are becoming resistant to insulin, the blood-borne substance that controls your blood sugar. You need, therefore, to have the test repeated while you avoid in the meantime a diet that is rich in carbohydrates and sugar. A repeat of the fasting blood sugar with a two hours post prandial glucose measurement will help make a clear diagnosis.