Chikungunya Fever
Patofisiologi Demam & Nyeri Sendi
DD demam dan nyeri sendi
Diagnosis Klinis
Tatalaksana
Edukasi & Pencegahan Chikungunya (PHBS)
Demam Chikungunya
Inflammatory reaction mediated by CD8+ (acute), CD4+ T lymphocytes, and pro-inflammatory cytokines are thought to be responsible for the acute symptoms, while a persistent reservoir of infected monocytes in the joints may be responsible for chronic joint disease.
RF
Molecular mimicry accounts for the tissue injury that occurs in rheumatic fever. Both the humoral and cellular host defenses of a genetically vulnerable host are involved. In this process, the patient's immune responses (both B- and T-cell mediated) are unable to distinguish between the invading microbe and certain host tissues
Multiple joints are frequently involved, with the onset of arthritis in different joints either separated in time or overlapping, giving rise to the description of a “migratory” or “additive” polyarthritis
Dengue Fever
Fever typically begins on the third day of illness and persists 5-7 days, abating with the cessation of viremia. Fever may reach 41C°.
Leukopenia, lymphopenia near the end of the febrile phase, and thrombocytopenia are common findings in dengue fever and are believed to be caused by direct destructive actions of the virus on bone marrow precursor cells. The resulting active viral replication and cellular destruction in the bone marrow are believed to cause the bone pain.
Septic Arthritis
Reactive Arthritis
Lyme Arthritis
Viral Arthritis
Parvovirus
Rubella
Alphavirus Arthritis
HIV Infection and Arthritis
Nongonococcal Arthritis
Gonococcal Arthritis
The classical microbes in the gastrointestinal tract include yersinia, salmonella, shigella, Campylobacter jejuni,and also Clostridium difficile,
Streptococcal sore throat (caused by Group A beta-haemolytic streptococci)
caused by Borrelia burgdorferi (most prevalent in the USA),B. garinii and, B. afzelii.
Human parvovirus B19 is a small non-enveloped DNA virus, which only replicates in erythrocyte precursors
Rubella virus is a single-stranded RNA containing virus
Alphaviruses are spherical small RNA containing viruses, the common feature of transmission by arthropod vectors
The most severe form is induced by Chikungunya virus
Arthralgia occurs in 5% of patients with HIV infection. The musculoskeletal symptoms can be divided in 3 subgroups: those associated directly with the HI virus infection, those occurring more frequently in HIV positive individuals, at least partially associated with increased risk of infection, and those as a result of HIV treatment.
Crystal-Related Arthritis
Gout, an inflammatory response to monosodium urate monohydrate crystals and pseudogout (chondrocalcinosis), an inflammatory response associated with calcium pyrophosphate crystal deposition are the major forms of crystal-related joint inflammation.
Acute gout develops within hours and is designated by intense pain, swelling and redness of the affected joint and often by fever ascribed to spill-over of pro-inflammatory cytokines from the inflamed joint into the circulation
Sarcoid
a non-caseating granulomatous inflammation affects the joint tissue, most commonly the ankles and the knee joints and less frequently other larger joints
Paraneoplastic Arthritis
Paraneoplastic joint inflammation presents usually as a polyarthritis, often asymmetric arthritis with predilection to joints of the lower limbs. It can be suspected in an elderly patient with acute asymmetric arthritis and markedly elevated ESR and CRP
Etiology
Chikungunya virus (CHIKV) is an arbovirus spread predominantly by Aedes aegypti and Ae. albopictus mosquitoes.
Virus Chikungunya dimasukkan ke dalam genus Alphavirus, yang mempunyai beberapa kompleks antigen. Sangat mirip satu sama lain dengan virus dalam serogroup yang sama (Group A Arbovirus) dan akan bereaksi silang dengan golongan Alphavirus yang heterolog.
Istilah di Swahili berarti kejang urat (that which bends up) yang merupakan suatu tanda dari artralgia. Di Indonesia pernah dilaporkan kejadian luar biasa di Kuala Tungkal di provinsi Jambi, Pontianak.
Tanda&Gejala
Pemfis
Pem. Diagnostik
Demam ringan, sampai demam disertai artralgia dan atau perdarahan. Demam tinggi biasanya berlangsung 1 – 3 hari (Den-like diseases)
Pada manusia virus Chik menyebabkan sakit setelah 48 jam digigit nyamuk. Masa inkubasi virus Chik antara 2-3 hari (1-12 hr)
Pada anak dimulai dengan demam yang terjadi secara akut diikuti dengan nyeri kepala, mialgia dan artralgia, yang melibatkan beberapa sendisendi kecil pada jari-jari tangan, pergelangan tangan dan kaki meningkat dengan aktivitas dan berkurang/menghilang saat istirahat
Saat muncul ruam makulopapular biasanya diikuti dengan limfadenopati. Nyeri kepala, nyeri retro orbital, anoreksia, mual dan muntah, nyeri perut dan gejala umum lain yang muncul pada infeksi virus mungkin terjadi namun tidak dalam bentuk yang berat.
Ruam yang terjadi seringkali sulit dibedakan dengan ruam pada infeksi Dengue. Tetapi pada Chikungunya tidak pernah dilaporkan kejadian hematemesis melena dan syok.
Leukopenia dengan limfositosis relatif dapat terjadi pada hari ke 3-6 sejak demam.
Kenaikan Hct terjadi namun secara statistik tidak bermakna.
Diagnosis serologi seperti ELISA, uji inhibisi aglutinasi, uji fiksasi komplemen serta PCR. dapat dipakai sebagai pemeriksaan untuk penunjang diagnosis.
Terapi medikamentosa diberikan untuk tujuan simtomatik dan suportif meliputi tirah baring,
analgetik mungkin diperlukan untuk mengurangi rasa nyeri.
PSN 3M Plus.
Menguras
Menutup
Memanfaatkan kembali limbah barang bekas
Patogenesis
CHIKV is known to transmit in 2 cycles: urban and sylvatic. Urban transmission is from human to mosquito to human and is the main source of the current Western Hemisphere epidemic. Sylvatic transmission can be found in Africa and is based on animal to mosquito to human
The route of infection used by CHIKV starts after inoculation and infection of human epithelial and endothelial cells, primary fibroblasts, and monocyte-derived macrophages.
Transmitted through the vector Ae. aegypti, but incorporation of Ae. albopictus through a mutation in the E1 envelope protein not only increased the fitness of the virus in this species but improved transmissibility to vertebrates
After an initial immune response and sheltering in the lymph nodes, CHIKV travels through the lymphatic and circulatory system causing significant viremia.
Transportation into target organs (muscles, joints, liver, and brain) has been found to be caused by infected monocyte-derived macrophages. Inflammatory reaction mediated by CD8+ (acute), CD4+ T lymphocytes, and pro-inflammatory cytokines are thought to be responsible for the acute symptoms
a persistent reservoir of infected monocytes in the joints may be responsible for chronic joint disease.