Chikungunya

By Dr. Jim Ferguson

At first glance some of you may be puzzled by this title.  Or perhaps you thought I misspelled the phrase “kawabonga” used by Chief Thunderthud on the Howdy Doody show.  Maybe you thought I was using surfer lingo, “cowabunga,” or quoting Snoopy in the Peanuts cartoon.  Parents like me may remember The Cookie Monster on Sesame Street who used “Kowabunga” to teach my girls about the letter “K.”  Actually, my title has nothing to do with pop culture.  Chikungunya is another virus which threatens America.

As I was completing my internal medicine residency in the late 1970s, I considered sub-specialty training in infectious disease.  But I decided that I liked the variety of medical issues of general internal medicine and decided against special infectious disease training – though I retain a keen interest in this area.

As I began my practice AIDS struck America and infectious disease doctors were the epicenter of this viral epidemic.  Though I cared for many AIDS victims in the 80s and 90s, I stepped back when the retroviral therapies became so complicated that nuanced expertise became necessary to keep up with the voluminous AIDS literature.  Now,  virtually all AIDS patients are cared for by specialists in infectious diseases.

We live in a world that is both wondrous and hostile.  We take for granted a functioning immune system which protects us from microorganisms like bacteria, fungi, and a host of viruses.  There are at least eighty different “cold” viruses, and a supposedly “rare” virus known as enterovirus 68 has now been documented in seventeen American states.  No one knows where this recrudescent infection came from.  Dr. Jane Orient, Executive Director of the Association of American Physicians and Surgeons, has even raised concerns about this more severe “cold” virus and the influx of illegal alien children dispersed across our country.  Suffice it to say that our protective immune system can be overwhelmed if there is no natural immunity to a pathogen or if the immune system has been damaged by, for instance, cancer chemotherapy.

There is a touch of Fall in the air as I write this afternoon, and it reminds me to stay practical and recommend everyone get a flu shot.  At one time “flu shots” were directed toward high risk groups like pregnant women, the elderly, and folks with cancer.  Now, everyone is encouraged to take these prophylactic inoculations which boost the immune system, reduce influenza infections, and lessen its severity.  You may recall the Spanish Flu of 1918-19.  This influenza pandemic killed more people than were killed in WW I.

Unfortunately, there are no vaccines for the viral scourges of Ebola, Dengue Fever, and Chikungunya, pronounced chi-ken-guun-ye.  I’ve previously written about Dengue and Ebola – you should read the Focus every week to keep up!  This week features the latest African viral infection which has arrived on our shores.

I’ll admit that I had not heard of Chikungunya until December 2013 when reports of sickened people on the Caribbean island of Saint-Martin/Sint Maarten began to appear.  Becky and I visited this lovely island in February 2013 when we found a last minute cruise deal to escape Knoxville’s winter chill.  Perhaps the infection wasn’t there when we visited or perhaps we were just lucky.

I knew to take precautions against mosquitoes that transmit viral infections like Dengue Fever which is prevalent in the Caribbean Basin.  Preventive measures are readily available on the internet or at the CDC website.  Learning should never cease, and I have discovered that both Dengue and Chikungunya are transmitted by the Aedes aegypti mosquito.  Surprisingly, I have also learned that the aggressive Aedes albopictus or Tiger mosquitoes, now here in Knoxville, can feed and transmit infection throughout the day, rather than just at night.  Tiger mosquitoes have transmitted Chikungunya in other parts of the world, but fortunately not here, yet.

Both Dengue and Chikungunya produce high fever, headache, severe aches and pains, and sometimes a rash.  The colorful street name for Dengue is “break-back fever” and emphasizes why you want to avoid these viral infections.  There are blood tests that can help doctors diagnose these infections, though there is no specific treatment for either.  Chikungunya can also produce a long lasting or recrudescent arthritic syndrome reminiscent of rheumatoid arthritis.  Obviously, your doctor needs your whole medical history including travel and previous conditions.

I’ve found that doctors do a better job when patients point them in the right direction.  I once saw a lady with a complicated medical history, and after an exhausting interview and thorough exam I told her of my suspicions regarding her case.  She then told me she agreed with my diagnosis which concurred with that of other physicians.  I asked her why she hadn’t told me the whole story and she said, “I wanted to see if you could find the problem.”

Chikungunya was first described in 1952 in Tanzania.  The present Caribbean epidemic now totals 576,535 cases as of August 2014.  Contrast this with 2.4 million cases of Dengue infection in the Americas in 2013.  Efforts are underway to produce effective vaccines and even anti-viral therapies for these viruses like those recently used to treat Americans infected with Ebola.  Unfortunately, vaccines and specific therapies will not be available soon, and the best we can do is anti-mosquito programs.  These are effective and have a good track record combating malaria, a protozoan infection also spread by mosquitoes.

Though I am vigilant regarding mosquitoes and infection, I also deal with the realities of horse troughs and the care of animals on our small farm.  Even bird baths can afford a breeding ground for pests.  Water is necessary for all life.  I once played golf in Arizona and enjoyed seeing roadrunners on the course, but my attention was drawn to signs warning us hackers not to search for wayward shots in the brush.  You see rattlesnakes are drawn to fountains of life along watered fairways.

The cooler temperatures and drier conditions of the fall will curtail mosquito breeding and probably this current epidemic.  However, the Chikungunya virus is now here in the “new” world and we we will just have to deal with it.  You see you can’t reason with a virus or an ISIS.  I hope and pray that dear leader understands this.

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