[Chikungunya fever—expanded distribution of a re-emerging tropical infectious disease]

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Medizinische Monatsschrift Für Pharmazeuten 2009, 32 (1): 17-26
Chikungunya fever has been originally distributed in several parts of Africa, South Asia and Southeast Asia. The disease is caused by Chikungunya virus, an enveloped, single-stranded ribonucleic acid virus of the alphavirus genus (family Togaviridae). In Asia, virus transmission to humans occurs predominantly by the bite of the female Aedes aegypti or Aedes albopictus mosquito. In rural Africa, other mosquito species are also implicated in virus transmission. Chikungunya fever is characterized by fever with sudden onset, headache, backache, myalgia, and rash as well as painful and long-lasting arthralgia, affecting primarily the peripheral joints. Joint pain frequently persists for two or more months. Treatment strategies are primarily supportive and symptomatic and comprise the continuous application of certain analgetics, i.e., paracetamol (acetaminophen) and several non-steroidal anti-inflammatory agents. Although there is no generally recommended specific antiviral therapy, the use of chloroquine, ribavirin and interferon-alpha might be useful. In 2005 and 2006, the largest epidemic of Chikungunya fever ever recorded has been occurred in the islands of the southwest Indian Ocean and in India. The epidemic affected at least 1.3 million cases in India alone. The most affected island was the French territory La Réunion, where approximately one third of the total population (266,000 of 770,000) suffered from the disease. Based on the extent of the epidemic and the busy tourism between India/the islands of the Indian Ocean and Europe, numerous cases have been reported in several European countries since 2005. In 2007, one of these travellers served as "index patient" for the first outbreak of Chikungunya fever in a temperate region. Between July and September 2007, more than 200 cases of infection with Chikungunya virus have been notified in a region of north eastern Italy. The first autochthonic outbreak in Europe has been associated with the presence of A. albopictus, which is found with a high population density in Italy. During the last decades, A. albopictus mosquitos have been spread into several temperate regions and are now widely distributed in several areas of South and Central Europe and North America.

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