Chikungunya
In recent years globalization and frequent travel have affected several diseases in geographic distribution. Chikungunya fever is an emerging mosquito borne disease which, since 2004, has caused sustained outbreaks of unparalleled significance. In 2013, t
- PDF / 421,232 Bytes
- 4 Pages / 504.567 x 720 pts Page_size
- 7 Downloads / 174 Views
Chikungunya Pedro Arriaga and Jorge Hidalgo
Case Presentation A 54 years old female patient was admitted to the emergency department with 5 days of high fever and chills which were associated with severe arthralgia, myalgia, anorexia and malaise. The patient complained of severe pain affecting both hands, elbows, and knee joints with slight swelling on her hands. The joint pain was incapacitating and she was not able to walk without assistance. Two days after the onset of fever she had noticed a maculopapular rash in her torso and both extremities (Fig. 59.1). She also reported the onset of vomiting and weakness at that time. The patient had a history of travelling to the Caribbean Islands 1 week before presentation. At the time of admission to the hospital, the patient looked dehydrated and had a temperature of 39.5 C, a heart rate of 115 beats per minute, and a blood pressure of 90/50 mmHg. On laboratory, her CBC showed a platelet count of 95,000/mm3 and
P. Arriaga (*) Internal Medicine, Karl Heusner Memorial Hospital, Belize City, Belize e-mail: [email protected] J. Hidalgo Adult Intensive Care, Critical Care Division, Karl Heusner Memorial Hospital, Belize City, Belize
a white blood cell count of 3500/mm3 with predominance of lymphocytes. Blood chemistries demonstrate an elevated SGOT (75 U/L) and SGPT (125 U/L). Question What diagnostic approach should be undertaken? Answer The presence of fever and arthralgias is a common clinical presentation in viral infections. In patients from tropical areas or with an appropriate travel history diseases sharing these symptoms include: Malaria, Rickettsiosis, Leptospirosis, Dengue, Chikungunya, and Group A Streptococcal infections. Early diagnosis of these conditions is based on a high index of clinical suspicion due to epidemiologic considerations (travel history, exposure, etc.) and the clinical presentation. In this case, the history of recent traveling to the Caribbean and the abrupt onset fever with arthralgias and maculopapular rash serves to suggest certain diagnostic possibilities: Malaria, Chikungunya, Dengue and/or Leptospirosis. Thrombocytopenia and leucopenia are also suggestive of a viral process. The main laboratory finding in Chikungunya infection is lymphopenia, and is associated with viremia when the lymphocyte count is less than 1000 per cubic millimeter. Elevation of liver function tests are also reported, with SGOT and SGPT values elevated up to 1.5 times de normal level in up to 50 % of cases [1–8].
© Springer International Publishing Switzerland 2017 R.C. Hyzy (ed.), Evidence-Based Critical Care, DOI 10.1007/978-3-319-43341-7_59
513
P. Arriaga and J. Hidalgo
514
Fig. 59.2 Conjunctivitis (Courtesy of Dr. Jorge Hidalgo, from Karl Heusner Memorial Hospital Belize) Table 59.1 Clinical and laboratory features of Chikungunya virus infections compared with Dengue virus infections Fig. 59.1 Maculopapular rash (Courtesy of Dr. Jorge Hidalgo, from Karl Heusner Memorial Hospital Belize)
From the clinical point of view the presence of symmetrical
Data Loading...
