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Chikungunya Fever - Coggle Diagram
Chikungunya Fever
DD demam dan nyeri sendi
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Reactive Arthritis
The classical microbes in the gastrointestinal tract include yersinia, salmonella, shigella, Campylobacter jejuni,and also Clostridium difficile,
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Lyme Arthritis
caused by Borrelia burgdorferi (most prevalent in the USA),B. garinii and, B. afzelii.
Viral Arthritis
Parvovirus
Human parvovirus B19 is a small non-enveloped DNA virus, which only replicates in erythrocyte precursors
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Alphavirus Arthritis
Alphaviruses are spherical small RNA containing viruses, the common feature of transmission by arthropod vectors
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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
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.
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Diagnosis Klinis
Tanda&Gejala
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
Pemfis
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.
Pem. Diagnostik
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Diagnosis serologi seperti ELISA, uji inhibisi aglutinasi, uji fiksasi komplemen serta PCR. dapat dipakai sebagai pemeriksaan untuk penunjang diagnosis.
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.
Tatalaksana
Terapi medikamentosa diberikan untuk tujuan simtomatik dan suportif meliputi tirah baring,
analgetik mungkin diperlukan untuk mengurangi rasa nyeri.
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