‘Chikungunya can be confused with malaria and dengue’: Mumbai doctors highlight symptoms, treatment

Every monsoon, Mumbai is threatened by the increase of malaria, dengue and chikungunya cases. While leptospirosis is also common, the one aspect that binds the other three is that all of them are mosquito-borne diseases. Often, it is also what makes people confuse them with the other, say Mumbai experts, and that may also cause severe co-manifestations.

Earlier this week, mid-day reported a rise in cases of chikungunya in Mumbai's Juhu area, just after BMC's data revealed there were 25 cases of the mosquito-borne disease. Till July, reports state that Maharashtra's cases of the disease have doubled. While the cases across Mumbai may vary, the rise in cases during monsoon season is expected, and Mumbai doctors say it is important to take the chikungunya seriously. Even though one of the easiest ways to prevent it is by discarding stagnant water to avoid mosquito breeding, says Dr Mala Kaneria, consultant, Infectious Diseases- Jaslok Hospital & Research Centre, Mumbai, there is more.

She explains, "As compared to dengue, Chikungunya cases see a spike cyclically after a few years and the cases are restricted to certain geographical spots. This infection does not spread from person to person and can affect any age group." The disease particularly causes sudden onset of episodic fever which subsides rapidly to start with. "It is important to remember though that co-infection with dengue and chikungunya or chikungunya and zika virus is possible as all three viruses are transmitted by the same vector," she adds.

With the monsoon season underway and cases of mosquito-borne disease looking high, mid-day.com spoke to Kaneria, along with Dr Aniket Mule, consultant internal medicine, Wockhardt Hospitals, Mira Road, and Dr. Umang Agrawal, Infectious Diseases Consultant, P. D. Hinduja Hospital & MRC, to break down Chikungunya through its causes, effects and treatment. They also stress why people should take it seriously, especially because of the possibility of confusing it with other mosquito-borne diseases.

What are the causes of chikungunya?
Mule: Chikungunya virus is transmitted due to Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus and is a common occurrence in people of all age groups. It is known as a mosquito-borne viral disease that can also become life-threatening if left untreated.

Kaneria: Chikungunya is a mosquito-borne arboviral infection, which is transmitted by the mosquito named Aedes aegypti, which is the same vector that also transmits dengue and Zika virus.

How is it different from all other mosquito-related diseases, especially during the monsoon?
Mule: The monsoon season sets the stage for Aedes mosquitoes, which are responsible for transmitting this virus. However, unlike dengue, which spreads quickly due to higher mosquito populations, the spread of chikungunya is higher in areas affected by flooding.

Agarwal: While this disease is also mosquito-transmitted, the key difference between chikungunya and other mosquito-borne illnesses is its higher prevalence of joint pains, which can be severely disabling and persist for extended periods.

What are the symptoms of chikungunya?
Mule: The symptoms of Chikungunya are fever, joint pain, rash, headaches, nausea, fatigue, and joint swelling. However, the intensity of these symptoms varies from one individual to another. It is imperative to seek timely intervention after experiencing the symptoms to ensure successful treatment outcomes.

Agarwal: Initial symptoms of chikungunya resemble other viral illnesses, including fever, body aches, and arthralgias. About a week into the illness, patients typically develop joint pains that may last long and can be extremely debilitating. Due to these similarities, there's a possibility of confusing early chikungunya symptoms with those of malaria or dengue. The chikungunya virus has a particular affinity for joints, resulting in prolonged joint pains in patients.

Is there a possibility of people confusing the symptoms?
Mule: The symptoms of Chikungunya such as high fever, rash, and muscle pain tend to overlap with dengue and malaria. The doctor should do the necessary blood tests to confirm the diagnosis and then initiate the treatment to improve the quality of life of an individual. One has to visit the doctor without neglecting his/her symptoms.

What are the effects of chikungunya?
Mule: Chikungunya is known to take a toll on the brain, heart, lungs, kidneys, skin, and joints. The complications are neurological imbalances, seizures, acute renal disease, myocarditis or inflammation of the heart muscles can be seen in patients. This condition should not be left untreated.

Kaneria: The associated joint pains are much more severe than that seen in dengue and zika virus and may be crippling and long-lasting, sometimes for months and is a hallmark of chikungunya. Also, entire families may be affected.

What is the treatment for chikungunya and when should people go to the doctor?
Mule: The treatment includes medication, rest, and fluids. One has to follow the instructions given by the doctor only. The patient's blood pressure should be monitored from time to time. Some patients may also require hospital admission and intravenous (IV) fluid and electrolyte replacement.

Agarwal: Treatment for chikungunya is largely conservative, focusing on fluid intake and pain management. Paracetamol is generally recommended as a first-line treatment for joint pains. If pain persists, second-line management may include stronger anti-inflammatory drugs like naproxen. In some cases, opioids may be necessary.

Kaneria: Beyond joint pains responding to paracetamol, patients are also administered nonsteroidal anti-inflammatory drugs like Ibuprofen. If the joint pains are crippling and do not resolve soon, the patient should visit a doctor as he/she may need stronger medicines like steroids, especially those patients who have symptoms that last beyond three months.

What is the food that people can eat to help them treat chikungunya?
Mule: One should include coconut water to detoxify the body, green leafy vegetables containing vitamin A to manage joint pain, broccolis loaded with vitamin C, soups, papaya leaf extract for improving the platelet count, fruits rich in vitamin C like oranges, kiwis to boost immunity.

Agarwal: There's no specific dietary association that can protect against or predispose one to chikungunya. A healthy, balanced diet is generally advised.

What are the common misconceptions about chikungunya?
Mule: These are some of the common misconceptions about chikungunya:

Myth: Chikungunya is transmitted from one individual to another
Fact: This statement is false. Chikungunya is transmitted via mosquito bites. A mosquito must first bite an infected person and then transmit the virus by biting another person.

Myth: Only older people tend to get Chikungunya
Fact: All age groups, including children and young adults, are known to be affected by Chikungunya.

Agarwal: Common misconceptions about chikungunya include the belief that it's transmitted by eating chicken, which is false - it's mosquito-borne. Another misconception is that it can be fatal, which is generally not the case. In most instances, it's a self-limiting disease, with the primary concern being long-lasting joint pains.

Kaneria: A common misconception about chikungunya is that it can lead to permanent damage to the joints. This usually does not happen, and a complete recovery happens in most individuals, though there may be a prolonged course in some patients.

Why should people take chikungunya seriously?
Mule: Chikungunya leads to fatal complications such as seizures, acute renal disease, myocarditis, or inflammation of the heart muscles and needs to be managed without any delay.

Agarwal: It's crucial to take chikungunya seriously due to its potential to cause debilitating bone and joint inflammation. Early medical attention is strongly recommended.

How many cases are currently reported in Mumbai? How many patients are you getting at the hospital?
Mule: Currently, there is no surge in the number of Chikungunya cases. Only 1-2 cases in 2-3 months have been reported.

Agarwal: Exact case numbers for Chikungunya in Mumbai are difficult to determine. However, recent reports indicated Maharashtra was facing a surge of around 3,700 dengue cases, with chikungunya cases estimated to be at least double that. The Juhu area has been reporting numerous cases recently. At our Mahim facility, we're seeing approximately 10 chikungunya cases per week in outpatient departments.

Kaneria: Some areas have reported cases, though the situation is not alarming. Besides, all suspected patients are not tested as the PCR test and the serological tests have their challenges. PCR-based tests are positive only in the first week of illness and are costly, whereas serological tests like chikungunya IgM are positive only after the first week of illness and false positives and false negative results are common.