Chikungunya And Zika

Question 1

How was chikungunya spread?

Answer 1

Likely from monkeys
Now human reservoir
Uses vector aedes aegypti

Question 2

What happened with Indian Ocean strain?

Answer 2

Mutated to aedes ageypti and aedes albopticus

Question 3

Where is most chikungunya?

Answer 3

South America, India and Indonesia

Question 4

Clinical presentation of Chikengunya?

Answer 4

Fever, can be Biphasic
Polyarthralgia especially hands, wrists, knees and ankles. Symmetric, most with >10 joints
Macular/papular Rash which blanched

Question 5

How does CHKV compare with dengue?

Answer 5

Higher grade fever, much more arthralgia and arthritis in CHKV
Myalgia and haemorrage much more common in Dengue
CHKV has more lymphopenia, but less neutropenia and less thrombocytopenia

Question 6

How do you test for CHKV?

Answer 6

Viral culture and PCR early
Antibodies later

Question 7

Tx of CHKV?

Answer 7

Symptomatic tx mainly
NSAIDs
May need steroids od DMARDs for arthritis

Question 8

What are general clinical findings of arthritogenic viruses?

Answer 8

Common causes of fever, Rash and arthralgias

Question 9

What kind of virus is zika?

Answer 9

Flavi virus
Isolated from rhesus monkeys

Question 10

How does Zika spread?

Answer 10

Spread via some of the aedes species

Question 11

How is zika transmitted?

Answer 11

Mainly mosquito (aedes)
Can be sexual and transplacental and perinatal infections
Blood transfusions

Question 12

What is the global burden of Zika?

Answer 12

Largest burden in Americas
Ongoing transmission in Asia-Pacific regions

Question 13

What are the symptoms of Zika?

Answer 13

Mainly Rash!
Fever/arthralgias/conjunctivitis

Question 14

What is Zika rash?

Answer 14

Maculopapular
Indurated Rash with lymphadenopathy

Question 15

How does Zika compare to CHKV and dengue?

Answer 15

Zika particularly common to get conjunctivitis
Fever least severe in zika
Rash ++
Des not cause thrombocytopenia

Question 16

What are pregnancy cx of Zika virus?

Answer 16

First Timester infection is worst
LBW, preterm birth and infant death
Microcephaly is long term sequelae on children
Chorioretinits, club foot, optic neuritis

Question 17

What are neurological cx in adults of Zika virus?

Answer 17

GBS, often cranial nerves are involved

Question 18

can Zika be transmitted sexually?

Answer 18

Usually symptomatic males
Virus perists in semen for 6 months

Question 19

Dx of Zika?

Answer 19

Urine PCR assay
IgM >14th day up until 12 weeks
The IgM can cross react with dengue and other flavi viruses

Question 20

When do you test for Zika in pregnant woman?

Answer 20

Always when they have symptoms
NAT to asymptomatic women in endemic areas
IgM not usually done

Question 21

When do you test for IgM in zika?

Answer 21

If PCR comes back negative