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This article was co-written by Laura Marusinec, MD. Marusinec is a licensed pediatrician at Children’s Hospital of Wisconsin, and she is a member of the Clinical Practice Council. She received her PhD from the University of Wisconsin School of Medicine in 1995 and completed her residency at the University of Wisconsin School of Medicine with a major in Pediatrics in 1998. She is a member of the American Medical Writers Association and the American Medical Writers Association. Children’s Emergency Care Association.
There are 17 references cited in this article that you can view at the bottom of the page.
This article has been viewed 2,657 times.
Chikungunya fever is a viral infection that is transmitted to humans through infected mosquitoes. Mosquitoes infected with this virus can also carry other diseases such as dengue fever and yellow fever. Chikungunya fever is endemic worldwide, including the Caribbean, tropical regions of Asia, Africa, South America and North America. There is currently no cure or vaccine for this disease, and treatment focuses on relieving symptoms. [1] X Source of Research It is important to identify the signs and symptoms of the disease, treat symptoms, and prevent complications.
Steps
Identify Signs and Symptoms
- Fever : Usually fever is between 39 and 40.5 °C and lasts from three days to a week. [4] X Research Sources Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 54–63.[5] X Source of Study Patients may present with a biphasic fever pattern (the fever disappears within a few days, followed by a few days of low-grade fever returning (38–39 °C). During this time, the virus reproduces. boiling in the patient’s blood, spreading to other parts of the body.
- Arthritis (joint pain) : People often experience pain in the small joints in the hands, wrists, and ankles, and larger joints like the knees and shoulders, but no pain in the hips. [6] X Research Sources Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 54–63. Up to 70% of people with pain spread from one joint to another (when the previous joints begin to subside, the other joints begin to hurt). [7] X Research Resources Information for Healthcare providers. Chikungunya fever. Pan American Health Organization. Jan 2014. Patients usually have the most pain in the morning, but it will be less painful with light exercise. The joints may also be swollen or tender to the touch and the patient may develop tenosynovitis. [8] X Research Sources Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 54–63. Joint pain may go away within 1-3 weeks, and the severe pain should get better after the first week. However, in some cases, joint pain can continue for up to a year.
- Rash : Approximately 40% to 50% of patients present with a rash. The most common type of rash is the maculopapular. These are red rashes with raised patches on top that appear 3-5 days after the fever and subside within 3-4 days. The rash usually begins on the hands, then the face and trunk. [9] X Research Source Bandyopadhyay D, Ghosh S. MUCOCUTANEOUS MANIFESTATIONS OF CHIKUNGUNYA FEVER. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 64–67. Take off your shirt and look in the mirror, noting red, swollen areas that are large and itchy. Remember to look at your back, nape, and raise your hand to check the area under your armpits.
- Raynaud’s phenomenon is a condition in which blood flow to the hands and feet is reduced in response to cold temperatures or stress in the body. Observe the fingertips for cold and bruising.
- If you have underlying joint conditions such as rheumatism, you are more likely to progress to the chronic stage of chikungunya. [12] X Research Sources Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 54–63.
- Although rare, there have been reports of rheumatic diseases occurring after chikungunya disease. The average time to disease onset is about 10 months. [13] X Research Source Bouquillard E, Combe B. A report of 21 cases of rheumatoid arthritis fplowing Chikungunya fever. A mean fplow-up of two years. Joint, Bone, & Spine Journal. 76 (2009) 654–657.
- Myalgia (pain in the muscles/back)
- Headache
- Sore throat
- Stomach-ache
- Constipation
- Swollen lymph nodes in the neck
- Leptospirosis : Notice pain in the calf (muscle inside the lower leg below the knee) when walking. You should also look in the mirror to see if the whites of your eyes are bright red (subconjunctival hemorrhage). This phenomenon is caused by the bleeding of tiny blood vessels. Recall if you have ever been around livestock or near water sources for livestock, as infected animals can transmit the disease through water and soil.
- Dengue fever : Note if you have ever been exposed to, or bitten by, mosquitoes in tropical climates such as Africa, South America, Central America, the Caribbean, India and southern North America. Dengue fever is more prevalent in these regions. Look in the mirror for bruising on your skin, bleeding or redness in the whites of your eyes, bleeding gums, and repeated nosebleeds. Hemorrhagic fever is the biggest difference between dengue and chikungunya.
- Malaria : Note if you have been exposed to, or bitten by, mosquitoes in areas considered to be a source of the disease, such as South America, Africa, India, the Middle East and Southeast Asia. Notice cold and shivering, followed by fever and sweating. This phenomenon can last from 6 to 10 hours. These episodes may recur.
- Meningitis : Watch out for outbreaks in densely populated areas. If you live in an area where there is an outbreak, you can get the disease. Take your temperature and note if your neck is stiff or painful/discomfort with movement. This may be accompanied by severe headaches and a feeling of fatigue/confusion. You may also get a rash as small red, brown, or purple nodules that can grow into blisters. The rash is usually on the trunk, legs, in the palms of the hands and soles of the feet.
- Rheumatic fever : Rheumatic fever often occurs after a streptococcal infection such as strep throat. This disease is not transmitted by mosquito bites, usually occurs in children aged 5 to 15 years. Check to see if the child has pain in multiple joints with pain that moves (one joint hurts, another hurts), and has a fever that resembles chikungunya. The most obvious difference, however, is the presence of jerky or involuntary movements (chorea); small, painless lumps under the skin, and a rash. The rash may be flat or slightly raised with jagged edges (erythema ring), circular in shape with a dark pink outer border and lighter inner color. [15] X Research Source Guidelines on clinical management of chikungunya fever. World Health Organization. October 2008.
Treating Symptoms of Chikungunya Fever
- Fever for more than five days or above 39°C
- Dizziness (may be due to nerve problems or dehydration)
- Cold fingers or toes (raynaud’s phenomenon)
- Bleeding from the mouth or under the skin (this could be dengue fever)
- Rash
- Pain, redness, stiffness or swelling of the joint
- Low urine output (possibly due to dehydration leading to kidney damage)
- Virus culture test to look for virus growth. This method is usually used within the first 3 days of illness, when the virus is rapidly growing. [19] X Trusted Source World Health Organization Go to Source[20] X Trusted Source Centers for Disease Contrp and Prevention Go to Source
- RT-PCR (reverse transcription-polymerase chain reaction) methods use genes encoding virus-specific proteins to multiply chikungunya-specific genes. If it is chikungunya, the test will show a higher than normal level of the chikungunya gene on the computerized graph. [21] X Trusted Source World Health Organization Go to Source[22] X Trusted Source Centers for Disease Contrp and Prevention Go to Source
- Apply cold compresses to reduce pain and inflammation. You can use bags of frozen vegetables or meat, or ice packs. Wrap a towel around the outside of the freezer bag and place it on the painful area. Avoid applying frozen packs or ice directly to the skin as this can cause tissue damage.
- If you have previous liver or kidney problems, consult your doctor before taking paracetamol/acetaminophen. Consult your pediatrician or pharmacist about dosage for children.
- Do not take aspirin or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, etc. Chikungunya fever is similar to other mosquito-borne diseases such as dengue fever, which can cause hemorrhagic fever. Aspirin and NSAIDS can thin the blood and increase bleeding. Physicians should rule out dengue fever first, and then may recommend NSAIDS for joint pain relief if confirmed non-dengue fever.
- If you have severe joint pain that doesn’t improve after taking an NSAIDS, your doctor may prescribe hydroxychloroquine 200 mg orally once a day or chloroquine phosphate 300 mg once a day for up to 4 weeks.
- Sit on a recliner. Extend one leg parallel to the floor for 10 seconds before lowering it, soles of your feet close to the floor. Do it with the other leg. Repeat this movement several times a day, doing 2 or 3 times, repeating each leg 10 times.
- Try standing on tiptoes, feet together, heels moving up and down.
- Lie on your side. Raise one leg up for about 1 second, then lower it and place it on the other leg. Do this 10 times. Then turn to the other side and repeat. Do 10 times each leg and several times a day.
- You can also do your own light exercises. Pay attention not to exercise vigorously or use weights.
- Be careful when taking antihistamines, as they can cause drowsiness. Do not drive or operate machinery after taking the medicine.
- Soaking in a warm bath with colloidal oatmeal can help soothe the skin.
- Persistent dark spots on the skin can be treated with hydroquinone products. These products can help fade dark spots. [25] X Research Source Bandyopadhyay D, Ghosh S. MUCOCUTANEOUS MANIFESTATIONS OF CHIKUNGUNYA FEVER. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 64–67.
- There are many lotions and creams to treat skin irritations, so it’s probably a good idea to consult your doctor to find out which one to use.
- Eupatorium perfpiatum 200C: This is the leading homeopathic remedy in the treatment of chikungunya fever, is a plant extract that you should take when symptoms appear. It can reduce symptoms and joint pain. Take 6 drops for a month while having symptoms.
- Chamomile: This is a flower extract used to treat the symptoms of chikungunya by improving the effectiveness of the immune system. Take 40 drops per day, divided into three doses.
Beware of Complications and Prevent Chikungunya Fever
- The chikungunya virus can invade the heart muscle and cause inflammation of the heart muscle (myocarditis), which causes the heart to beat irregularly.
- If nerve damage starts in your legs or arms, you may have Guillain Barre syndrome. Note the decrease in sensation, response, and movement on both sides of the body. Also be aware of stinging, burning, numbing, or pins-and-needles sensations on both sides of the body. This phenomenon can progress to the upper body and potentially cause breathing difficulties from the nerves that supply the muscles of the respiratory system. [29] X Research Source Lebrun G. et al. Guillain-Barré Syndrome after Chikungunya Infection. Journal of Emerging Infectious Diseases. 2009 Mar; 15(3): 495–496.
- If you have trouble breathing or any of the above symptoms, call 911 immediately. [30] X Research Source Lebrun G. et al. Guillain-Barré Syndrome after Chikungunya Infection. Journal of Emerging Infectious Diseases. 2009 Mar; 15(3): 495–496.
- If you have difficulty seeing objects straight ahead (center of vision) or the colors of objects appear duller than usual, you may have optic neuritis. [31] X Research Sources Mohan A. et al. EPIDEMIOLOGY, CLINICAL MANIFESTATIONS, AND DIAGNOSIS OF CHIKUNGUNYA FEVER: LESSONS LEARNED FROM THE RE-EMERGING EPIDEMIC. Indian Journal of Dermatpogy. 2010 Jan-Mar; 55(1): 54–63.
- If left untreated, hepatitis can lead to liver failure.
- Your doctor will do more tests and precise measurements to check your kidney function and may give you intravenous fluids if you are dehydrated.
- Walk or be outside when it’s dark. Although mosquitoes can bite at any time, the peak of mosquito activity that transmits chikungunya is during the day.
- Wear long pants and a long-sleeved shirt for maximum protection from mosquito bites. Try wearing light-colored clothing to make it easier to spot mosquitoes and other bugs on clothing.
- Sleep under a mosquito net to avoid mosquitoes.
- Use a mosquito repellent with a DEET content of more than 20%. You can also use other active ingredients such as eucalyptus oil, picaridin and IR3535. In general, the higher the concentration of active ingredients, the longer the effect.
Advice
- Hydroxychloroquine and Chloroquine phosphate are anti-rheumatic drugs but can also be effective in severe joint pain with chikungunya fever. X-rays can identify damage or changes in the cartilage of the joint. [34] X Research Source Guidelines on clinical management of chikungunya fever. World Health Organization. October 2008.
Warning
- Avoid aspirin because it can cause stomach or intestinal bleeding and Reye’s syndrome in children under 18 years of age. Reye’s syndrome is a serious illness in children aged 4 to 12 years, when severe liver and brain symptoms develop and can be fatal.
This article was co-written by Laura Marusinec, MD. Marusinec is a licensed pediatrician at Children’s Hospital of Wisconsin, and she is a member of the Clinical Practice Council. She received her PhD from the University of Wisconsin School of Medicine in 1995 and completed her residency at the University of Wisconsin School of Medicine with a major in Pediatrics in 1998. She is a member of the American Medical Writers Association and the American Medical Writers Association. Children’s Emergency Care Association.
There are 17 references cited in this article that you can view at the bottom of the page.
This article has been viewed 2,657 times.
Chikungunya fever is a viral infection that is transmitted to humans through infected mosquitoes. Mosquitoes infected with this virus can also carry other diseases such as dengue fever and yellow fever. Chikungunya fever is endemic worldwide, including the Caribbean, tropical regions of Asia, Africa, South America and North America. There is currently no cure or vaccine for this disease, and treatment focuses on relieving symptoms. [1] X Source of Research It is important to identify the signs and symptoms of the disease, treat symptoms, and prevent complications.
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