Outbreak of Chikungunya in Dehradun, Uttarakhand in 2022: Clinical Profile and Management Approach in Early Phase of the Disease

Abstract

Background: Chikungunya fever is a mosquito borne disease caused by Chikungunya virus. The acute phase is similar to dengue, which is transmitted by the same vector while some patients may develop severe polyarthralgia or a chronic inflammatory arthritis. Dehradun, the capital city of the north Indian state of Uttarakhand, witnessed a major outbreak of this disease in the post monsoon months of 2022. Methods: The present study retrospectively analyzed records of confirmed or suspected cases of Chikungunya, presenting to a rheumatology clinic with predominant articular complaints. The data included demographic details, previous diagnosis or co-morbidities, joint involvement, inflammatory markers, diagnostic tests and treatment prescribed. Results: Records of 255 patients were available. 77.6% were females, mean age was 49.9 years, and mean follow up was 5.41 weeks. Seventy-seven patients (30.1%) had pre-existing autoimmune rheumatic diseases and were already on disease modifying agents. Fifty-six patients had positive IgM and 5 had positive PCR. Almost all patients received non-steroidal anti-inflammatory drugs (NSAIDs) and steroid. Methotrexate (87.5%) and Hydroxychloroquine (73.7%) were the two disease modifying agents used. Only 10 patients (3.9%) reported adverse effects. Conclusion: The present study provides valuable insights into the clinical profile of Chikungunya patients in acute and subacute phase presenting with predominantly articular symptoms. The importance of early diagnosis, standardization of diagnostic tests and future directions for treatment planning is discussed.

Keywords: Chikungunya, mosquito-borne diseases, viral arthritis, disease modifying anti-rheumatic drugs