Chikungunya fever

(Dvd)

The Chikungunya fever is one of the Chikungunya virus (CHIKV) triggered, with fever and joint complaints accompanying tropical infectious disease, which is transmitted by mosquitoes. The disease is particularly in eastern and southern Africa, the Indian subcontinent, Southeast Asia and for the past few years on the islands in the Indian Ocean common. Chikungunya is the curved walkers and is originally Makonde. The Germans, the disease is also "Gebeugter man". The exact diagnosis can only be made by blood tests. There is laboratory reporting obligation pursuant Infection Protection Act (IfSG). A clinical medical reporting requirement exists only if the clinical picture of a hemorrhagic fever is met. This is at the Chikungunya fever, as opposed to some other tropical viral disease, is rarely the case. Among the most affected is the benign disease and samoomejujoči, permanent damage and deaths are rare. A specific treatment option or vaccination is not currently exist. In order to prevent the proliferation and spread of certain types of combat mosquitoes, travellers in risk areas can only be done by avoiding Mückenstichen protect.

Excitation
The bolezni Chikungunya virus is a behülltes (+) single-stranded RNA virus [ss (+) RNA] and belongs to the genus alpha virus from the family of Togaviridae. Moreover, the virus belongs to the group of Arboviren is impeded by the bite of Gliederfüßern. The discovery of the pathogen, to the year 1953 dated. The Virion has a diameter of about 60 nm and is thus one of the smaller viruses. It is sensitive to heat (over 58 ° C), drying, soap and disinfectants.

According to the diverse geographical spread of the virus (see also occurrences), the virus today in five different variants divided, which is genetically different: a West African, Central, East and South Africa, the Indian Ocean and Asian.

The possible transfer cycles (man-man = urban cycle, or animal-human sylvatischer = cycle), as well as similar to the clinical picture of disease partly to the dengue fever and yellow fever. The Chikungunya virus is closely related to the O'nyong-nyong fever O'nyong'nyong causative virus related. As reservoir hosts are still monkeys and rodents have been found.

History and dissemination
The Chikungunya fever is the first time in 1952 in Tanzania and Uganda have been described. 1953 was causing virus discovered in the two countries and in cell cultures isolated. Later, the disease both in West Africa and also in India, Southeast Asia and the Philippines erupted, the first time in Asia in 1958 in Thailand documented. The population in these regions, however, are largely immune to these pathogens proved. This suggests that the disease in these areas even before the first description was endemic. Meanwhile, the Chikungunya fever predominantly along with the Asian tiger mosquito Aedes albopictus in large parts of southern Africa and Southeast Asia spread. For about ten years are also islands in the Pacific and the Indian Ocean affected. The last area of the outbreak on the islands before the East Africa lacks the local residents and tourists from Europe an immunity. Additionally, in recent years the tendency that the African variations in the direction of Asia spread.

A clustering of cases occurrence of the Chikungunya fever is being particularly from the following countries or territories reported: Gambia, Guinea, India, Indonesia, Cambodia, Cameroon, Madagascar, Malaysia, Mauritius, Myanmar, Philippines, Senegal, Seychelles, Sri Lanka, Tanzania and Thailand,(As of May 2007).

In 1999, there was a Chikungunya epidemic in the Democratic Republic of Congo with about 50,000 affected. In the years 2001 to 2003 was the Indonesian island of Java affected by an epidemic, the disease after 20 years, there is not an epidemic occurred.

From December 2005 rampant on the French island of La Reunion in serious Chikungunya epidemic. This in February 2006 reached its peak, up to the end of 2006, slowly abzuklingen. There were, according to the authorities so that 266,000 persons and about one-third of the population is infected, with 254 deaths in 2006, the Chikungunya fever is suspected as the cause. Of the suspected deaths were mostly older people (over 70 years) affected.

The epidemic on La Reunion has been a favored that the virus so far there was unknown and the population previously had no immunity. The economic impact of the epidemic on the tourism-dependent island could be severe.

Other islands in the Indian Ocean were affected. In Mauritius sick in the year 2005 3,500 people. There were also cases on the island of Mayotte Comoros, Madagascar and the Seychelles.

Noteworthy is the outbreak in India since February 2006 (so far approximately 1.25 million cases). He has now largely abated (as of May 2007), some new but still recorded.

In Europe, the Chikungunya fever so far mainly imported as a tropical disease in returning travelers have been diagnosed (exceptions are an outbreak in Italy in the summer of 2007 and secured a case in France, where the disease from an acute illness tropical return her - presumably through contact with their blood -- In a nurse was transferred). The number of reported cases in 2006 Germany was 53rd However, the Mückenart Aedes albopictus also in southern Europe is already quite widespread, so that theory - at least in the summer - the possibility of epidemics in Europe. Experts estimate the risk to be limited at present, a detailed analysis is based on the current data situation is not yet possible. In the autumn of 2007 was also the first time in Germany eggs of the Asian tiger mosquito proof.

In the summer of 2007, there was a limited outbreak of the regional Chikungunya fever in the Italian province of Ravenna (Emilia-Romagna). In all, until 4 September 197 cases reported, most of them in the villages Castiglione di Cervia and Castiglione di Ravenna. Most subjects had no previous trip to a foreign endemic undertaken. Furthermore, the genetic information (RNA) of the virus in mosquitoes local Asian tiger mosquito Aedes albopictus. It is therefore deemed to be proved that the virus can spread locally in Italy. It is thought that the epidemic their output from a traveler has taken on 21 June by the Indian subcontinent to Italy was entered in the two days later in Castiglione di Cervia symptoms of Chikungunya fever occurred. Previously, a death case in a 83-year-old man with severe pre reported. Measures have been taken to insect extermination taken to curb the outbreak. The onset autumn should have done a Rest to the epidemic, at least to interrupt. It will show whether the virus in mosquitoes overwinter carriers or their eggs in the next year is taken. In order to determine this, is a comprehensive monitoring of the mosquito population.

Transfer
UbertragungDas Chikungunya fever can Experts believe theoretically by the bite of various species of mosquitoes malaria mosquito (Anopheles), Aedes, Culex and Mansonia transferred. So far, as a unique vectors (vectors) the yellow fever mosquito Aedes aegypti and originally from East Asia-born Asian tiger mosquito Aedes albopictus (new name: Stegomyia albopicta) demonstrated. Again, this only about five millimeters large, black-and-white striped and very aggressive mosquito, which stands on the day and sometimes even by the clothes round, has spread worldwide and transmits next to the Chikungunya fever even the dengue fever, yellow fever, West Nile fever and other diseases. This Mückenart now comes mostly in the hot summer months in Southern Europe. During the outbreak in Italy in August 2007, the virus in this Mückenart evidence.

The Chikungunya fever is not usually directly from person to person transfer, but they are proven individual cases have been reported. Furthermore, the transfer of infected pregnant women to their unborn children demonstrated.

Apparently, a mutated strain of the Chikungunya virus just by Ae. Albopictus particularly well, so that a further spread of the disease in areas with Asian tiger mosquito is to be feared.

Disease course and symptoms
After a short incubation period is usually three to seven (maximum range from two to twelve [14]) days develop those affected usually rapidly rising and high fever with severe joint pain touch with high sensitivity, so that they are barely able to keep upright. The joint complaints occur mostly in the two halves of the body. The fever usually lasts only a few (mean of three) days. Other common symptoms are:

* Muscle and limb pain (70-99% of cases [4])
* Lymph node swelling [4]
* Rash (about 50% of cases, mostly makulo-papulös Islands eingestreuten with normal skin, not to moderate itching [4], [9])
* Punctiform bleeding skin (petechiae)
* Milder forms of mucosal bleeding, such as from the nose or on the gums (about 25% of cases [4])
* Headaches
* Exhaustion ( "Fatigue")
* Eye infections (mostly as a visible injection of the conjunctivae)
* Gastrointestinal complaints

Normally sounds the disease after about one or two weeks by itself again and there will be no damage. After the disease leads to lifelong immunity. Even asymptomatic histories, in which the infected no complaints noted are possible.

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