title: Chikungunya Infection: a Global Public Health Menace.
abstract: Chikungunya virus (CHIKV) has been involved in epidemics in African and Asian subcontinents and, of late, has transcended to affect the Americas. Aedes aegypti and Aedes albopictus are the major vectors for CHIKV infection, which results in dissemination of virus to various vital organs. Entry of virus into these tissues causes infiltration of innate immune cells, monocytes, macrophages, neutrophils, natural killer cells, and adaptive immune cells. Macrophages bearing the replicating virus, in turn, secrete pro-inflammatory cytokines IL-1β, TNF-α, and IL-17. Together, this pro-inflammatory milieu induces osteoclastogenesis, bone loss, and erosion. CHIKV is characterized by fever, headache, myalgia, rash, and symmetric polyarthritis, which is generally self-limiting. In a subset of cases, however, musculoskeletal symptoms may persist for up to 3-5 years. Viral culture and isolation from blood cells of infected patients are the gold standards for diagnosis of CHIKV. In routine practice, however, assays for anti-CHIKV IgM antibodies are used for diagnosis, as elevated levels in blood of infected patients are noted from 10 days following infection for up to 3-6 months. Early diagnosis of CHIKV is possible by nucleic acid detection techniques. Treatment of acute CHIKV is mainly symptomatic, with analgesics, non-steroidal anti-inflammatory agents (NSAIDs), and low-dose steroids. No vaccines or anti-viral medicines have been approved for clinical therapy in CHIKV as yet. Hydroxychloroquine and methotrexate have been used in chronic CHIKV infection with variable success.
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: A J
authors.initials: AJ
authors.lastname: Mathew
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: A
authors.initials: A
authors.lastname: Ganapati
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: J
authors.initials: J
authors.lastname: Kabeerdoss
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: A
authors.initials: A
authors.lastname: Nair
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: N
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: P
authors.initials: P
authors.lastname: Chebbi
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Mandal
authors.affiliation: Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, 632 004, India. debashisdandacmc@hotmail.com.
authors.forename: Debashish
authors.initials: D
authors.lastname: Danda
mesh_terms: D000330:Aedes / Q000254:growth & development / Q000821:virology*; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D065632:Chikungunya Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D014943:Global Health; D006801:Humans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Chikungunya virus; Disease modifying anti-rheumatic drugs; Inflammatory arthritis