![Page 1: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/1.jpg)
Clinical aspects and management of the typical uncomplicated acute
chikungunya
Bernard-Alex Gaüzère
Intensive Carte Unit, Centre Hospitalier Universitaire
La Réunion (France)
Visiting professor, University of Bordeaux (France)
1
![Page 2: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/2.jpg)
Chikungunya: a double disease
• Arbovirosis
– Acute
– Epidemic
– Linked to the spread of the vector
– Media staged-event
• Alphavirosis
– Rheumatism
– Chronic
– « Endemic »
– Under estimated
![Page 3: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/3.jpg)
3
3187
3187
2902
2517
1665
1159
974
797
626
0 500 1000 1500 2000 2500 3000 3500
Arthralgies
Fièvre
Myalgies
Céphalées
Eruption
Nausées-vomissements
Signes respiratoires ou ORL
Diarrhée
Signes hémorragiques
Classical presentation in Réunion & Mayotte:
Main clinical signs
![Page 4: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/4.jpg)
Acute phase (D 0-10) : typical presentation
• Incubation: 2-4 days (1-12 days)
• High fever (90-96%): 2-3 days
• Arthralgia / arthritis (95-100%)
– Generalised, intenses, disabling
• Rash (40-75%)
– Cutaneous maculopapular
– Limited bleeding (5-11%)
• Lymphadenopathy: neck +++, 2 – 3 days
• Headache
• 5 – 12% asymptomatic cases
![Page 5: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/5.jpg)
Skin rash: typical presentation
5 – 12% asymptomatic cases
5
![Page 6: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/6.jpg)
Acute chikungunya: facial oedema
6
![Page 7: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/7.jpg)
Acute chikungunya
7Generalised hyperhemia: 2-3 days
![Page 8: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/8.jpg)
Palmar erythema(B. Lamey and Coll.)
8
![Page 9: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/9.jpg)
Enanthema(B. Lamey and Coll.)
9
Always present in case of skin rash with gingival bleeding
![Page 10: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/10.jpg)
Auricular pseudo-chondritis(coll. F. Simon)
10
![Page 11: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/11.jpg)
Eye involvment (J. Roche)
11
![Page 12: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/12.jpg)
Acute phase: joint involvement
• Arthralgias / arthritis (95-100%)
– Bilateral, symetrical
– > 10 joints groups
– Hands, feets: wrists, ankles++
– Incapaciting +++
• Peri-articular oedema
• Tenosynovitis
– Wrists, ankles
12
![Page 13: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/13.jpg)
Acute phase: joint involvement
13Peri-articular swelling and articular effusion
![Page 14: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/14.jpg)
Acute phase: arthritis
14
![Page 15: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/15.jpg)
Acute phase: arthritis
(E. Javelle)
15
![Page 16: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/16.jpg)
Acute phase: multifocal pains
16
![Page 17: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/17.jpg)
Atypical forms
• Definiton: other than fever and arthralgia
• Digestives (40%)
– Nausea, vomiting, diarrhea, abdominal pain
• Ocular
– Optical nevritis, retinitis
• Cutaneous
– Hyper or hypopigmentation (nose, limbs): acute, subacute
– Mucosae ulcers (moutn, genital)
– Bullous dermatosis
– Post-Chik induced psoriasis
17
![Page 18: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/18.jpg)
Keratodermia(B. Lamey and coll.)
18
![Page 19: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/19.jpg)
Dysidrosis(B. Lamey and coll.)
19
![Page 20: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/20.jpg)
Purpura(B. Lamey and coll.)
20
![Page 21: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/21.jpg)
Deep vesiculous rash(B. Lamey and coll.)
21
Bubles
![Page 22: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/22.jpg)
Aphtoïd ulcerations(B. Lamey and coll.)
22
![Page 23: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/23.jpg)
Psoriasis ± purpura (B. Lamey and coll.)
23Psoriasis simplex
![Page 24: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/24.jpg)
Hyperpigmentation(B. Lamey and coll.)
24
![Page 25: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/25.jpg)
25
Hyperpigmentation(B. Lamey and coll.)
![Page 26: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/26.jpg)
26
Erythema nodosum(B. Lamey and coll.)
![Page 27: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/27.jpg)
27
Biological and clinical markers
InoculationClinical
symptoms
D-2 à D-4 D0 D4-D7 D15
IgM
IgG
Viral RNA
(RT-PCR)
Incubation time (3 to 7 days)
Sudden onsetArthralgias, rash, feverHeadaches, buccal erosions
![Page 28: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/28.jpg)
Management of uncomplicated acute
chikungunya (Day 0-10)
• There is currently no effective antiviral treatment for chik.
• Treatment is therefore purely symptomatic and is based onnon-salicylate analgesics and non-steroidal anti-inflammatorydrugs.
• Synergistic efficacy was reported between interferon-α andribavirin on chikungunya virus in vitro.
• A trial in Réunion and in animal model failed to confirm theefficacy of chloroquine during the acute phases of the chikinfection.
28
![Page 29: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/29.jpg)
Management of uncomplicated acute
chikungunya (Day 0-10)
• No antiviral drug
• Rest & no work
• Symptomatic treatment
– Anti-pyretics, pain killers (up to class 3)
– NSAI not indicated: iatrogenic, dangerous if dengue
– No steroids: rebound effect, no mid term benefit
– Oral (or IV) rehydration, given the clinical features
– Caution: overdosages (Paracetamol) and sides effects: traditional
medicine (Noni juice…)
• Altruistic isolation of suspected cases
– Mosquito nets, mosquito repellents
29
![Page 30: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/30.jpg)
Protection of viremic patients from Aedes
bites
30
![Page 31: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/31.jpg)
Individual protection against mosquitos
31
![Page 32: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/32.jpg)
Management of uncomplicated subacute
chikungunya (Day 10-90)
• Rapid improvement
• Or chronic evolution
• Clinical relapse (82%) and worsening at month 2-3
– Rhumatism
– Vascular troubles
– Chronic fatigue and depression
32
![Page 33: Clinical aspects and management of the ......Classical presentation in Réunion & Mayotte: Main clinical signs. Acute phase (D 0-10) : typical presentation ... efficacy of chloroquine](https://reader033.vdocument.in/reader033/viewer/2022042101/5e7e39952a0450641365ea3f/html5/thumbnails/33.jpg)
Conclusion
• Several lessons can be drawn from the outbreaks of chik inthe Indian Ocean islands.
• Clinical manifestations are highly variable and may be moresevere than previously reported
• Economic development does not protect countries fromvector-borne diseases (eg, West Nile virus in the USA, anddengue fever in Rio or Singapore);
• On the contrary, modern lifestyles may amplify an epidemicthrough travel, population ageing, and production of solidwaste that can shelter Aedes mosquitoes.
• There is no satisfactory treatment for the acute phase.
33