RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES , KARNATAA , BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of candidate Dr . SRINIVASULU.D

PG in GENERAL MEDICINE

Department of Medicine

KIMS BANGALORE

2 Name of the institution KEMPEGOUDA INSTITUE OF MEDICAL SCIENCES

BANGALORE

3 Course of study and subject M.D IN GENERAL MEDICINE

4 Date of admission to course 04 MAY 2009

5 Title of the topic A CLINICAL STUDY OF CHIKUNGUNYA

FEVER WITH SPECIAL REFERENCE TO

ACUTE COMPLICATIONS.

6 Brief resume of the intended work

6.1 Need for the study

Chikungunya fever is an arthropode born viral fever caused by an RNA virus of togaviridae family .it is transmitted by aedes mosquito.In recent days chikungunya fever is one of the commcn viral infection.

Chikungunya epidemic started in December 2005 . it affected nearly 1.8 million people in india . the diseases is mainly confined to south Indian states like Karnataka ,Andhra Pradesh, Maharashtra, orrissa, tamil nadu . it has caused wide spread morbidity and heavy toll on health related expenditure. Its complications are not well known.Only arthralgia is a well known complication.only few studies are available about chikungunya manifestations and its complication .Due to paucity of literature about detailed clinical profile and atypical manifestations of chikungunya fever . this study is designed to evaluate spectrum of clinical manifestation of diseases and acute complication that arise out of it .

Review of literature :

In India a chikungunya fever outbreak started in December 2005 when the country experienced more than 13 lakhs of chikungunya infected cases.

Chikungunya is a viral fever characterized by triad of fever,arthralgia and joint pain1.

Fever and arthralgia were present in all cases2. Rash was present in 31% confirmed cases

and. Lymphadenopathy was present in 13.8 % confirmed cases and Chronic

polyarthritis was seen in 25.3% confirmed cases2.

Patients may have petechiae,bleeding gums,possitive torniquet test.

Other than arthralgia neurological complications like meningo encephalitis,myelitis,carditis are also noted3.

Acute flaccid paralysis also reported as a complication4.

Myocarditis,hepatitis,G B syndrome are also reported as complications of chikungunya3.

Acute onset visual loss due to optic neuritis may be caused by chikungunya infectio5 .

Skin involvement consists of patchy to diffuse and edematous exanthema and, less frequently itching, peeling, or epidermolysis; all types can be followed by persisting dyschromic patches on dark skin6,7,8.

Epidemiology :

In Indian history first epidemic is recorded in 1964 affecting vellore Calcutta and maharashatra region

Present epidemic started in December 2005 and till now affected nearly 1.8 million people the statewise distribution is

Andhra Pradesh 9 lakh

Karnataka 5 lakh Maharashtra 2 lakh Gujarat 5000 tamil nadu 50000 madhya Pradesh 50000

Chikungunya virus

It is a rna virus

Class- arbo virus

Genus- alpha virus

Family – togaviridae

Transmission :

It is transmitted by the bite of aedes aegypti and aedes albapticus

Clinical features:

Characterized by

Fever , arthralgia ,myalgia ,back ache, headache

maculopapular rash ,somatitis, pruritis , facial erythema , apthous ulcers , petichae,photosensitive hyper pigmentation,exfoliative dermatitis,photophobia,retro orbital pain, vomiting,diarrhora,meningo encephalitis,acute encephalopathy, neuro retinitis,uveitis,dendritic ulcers,

Altered sensorium , conjuctival suffusion

Complications :

Limitation of joint movements

Persistent arthralgia

Tendonitis of tendoachilis tendon

Peripheral neuropathy

Ascending polyneuritis

Flaccid paralysis

Myocarditis

Bleeding manifestations

Lymphaedema ,

Hypotension

Meningo encephalitis

Optic neuritis

Papillitis

Psychosis , Coma , Seizurs, Cranial nerve palsy, Involuntary movements , Paraperesis.

Objective:

To study various clinical manifestations of Chikungunya fever.

To evaluvate acute complications of Chikungunya fever.

7. Materials and methods :

7.1 Source of data :

Cf cases admitted to kims hospital

Cf cases treated in kims on opd basis

7.2 Method of collection of data :

The data for study is collected from subjects fulfilling inclusion criteria and admitted to kims hospital .

Sample size 50 cases

Study designe Prospective clinical study

Sample designe Purposive sampling

Duration of study November 2009 to September 2011

Study place Kims Bangalore.

Inclusion criteria :

Patients with symptoms and signs of chikungunya fever and positive for Igm capture ELISA using monoclonal antibodies .

Exclusion criteria :

Patients negative for above mentioned diagnostic test

Patients with mixed infections

7.3 Does study require any investigations or interventions to be conducted on patients or other humans or animals ? if so please describe briefly:

1 Complete haemogram

2. Chikungunya igm card test

3 Chest X ray, ECG

4.Urine routine

5. CRP

6. Malarial parasite ( qbc ), WIDALtest, Dengue rapid test

FOLLOWING INVESTIGATIONS DONE IF NECESSARY :

7 Liver function tests , Renal function tests

8. Xray of joints

9 Ultrasound abdomen ,

10 2D ECHO

11 Lumbar puncture - csf analysis

12 Serum electrolytes

13 Fundoscopy

15 Enmg

16 EEG

17 CT/ MRI

Methodology :

All adult patients who are going to get admitted in KIMS Hospital and clinically suspected to have chikungunya infection because of their presenting symptoms or clinical signs elicited during examination will be subjected to chikungunya Ig M test for chikungunya infection and those positive will be included in the study.

A detailed clinical history taken followed by a thorough clinical examination of all systems.

Dermatological ,ophthamological,psychiatrist orthopaedic Opinion will be taken whenever required.

7.4 Has ethical clearance been obtained from your institution

Yes

8. List of references :

1.MANSONS TROPICAL DISEASES.21 EDITION Page no: 737-738

2. Suryawanshi SD Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India. Indian J Med Res - 01-APR-2009; 129(4): 438-41.

3. JérômeLemant,MD, VéroniqueBoisson,MD,ArnaudWiner,MD etal Serious acute chikungunya virus infection requiring intensive care during the reunion island outbreak in 2005-2006. Critical Care Medicine - Volume 36, Issue 9 (September 2008)

4. Singh SS Four cases of acute flaccid paralysis associated with chikungunya virus infection. - - Epidemiol Infect - 01-SEP-2008; 136(9): 1277-80.

5. Eileen C.Farnon,MD,James J.Sejvar,MD, J ErinStaples,MD, PhD Severe disease manifestations associated with acute chikungunya virus infectionCritical Care Medicine - Volume 36, Issue 9 (September 2008).

6. Simon F.,Parola P.,Grandadam M.,et al: chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. Medicine (Baltimore)86.123-137.2007

7. Hochedez P.,Jaureguiberry S.,Debruyne M.,et al: chikungunya infection in travelers. Emerg Infect Dis12.1565-1567.2006;

8. Talarmin F.,Staikowsky F.,Schoenlaub P.,et al: [Skin and mucosal manifestations of chikungunya virus infection in adults in Reunion Island]. Med Trop (Mars)67.167-173.2007.

9. Signature of the candidate :

10. Remarks of the guide :

11. Name & Designation of

11.1  Guide : Dr.G.N.NAGESH.

M.D

Associate professor

Department of medicine.

KIMSH, Bangalore.

11.2  Signature

11.3  Head of the department : Dr.M.V.POORNACHANDRA

Professor & Head of department

Of medicine

KIMSH,Bangalore.

11.4  Signature :

12.  12.1 Remarks of Chairmen & Principal :

12.2 Signature :