What are the clinical lab tests and their results to determine chikungunya and dengue?

Question

preferably, details in a tabular form

Answer 1

Try this web site:
www.chikv.com
put out by the CDC

Answer 2

Dengue fever: A.) *Clinical laboratory tests: WBC, platelets, and haematocrit *Abumin
*Liver function tests
* Urine check up for microscopic haematuria.
B) Dengue specific tests.
* Virus isolation
* Serology
C) In additon tourniquet test.
Chikungunya Fever : Till now no specific test is done for Chikungunya fever.

Answer 3

Diagnosis of chikungunya infection was confirmed by an immunocapture ELISA derived from a yellow fever test by using a goat anti-human immunoglobulin (Ig) M antibody (Sigma, Saint Louis, MO, USA), an inactivated cell-culture–grown chikungunya virus and a mouse anti-chikungunya hyperimmune ascitic fluid (Institut Pasteur, Lyon, France), and a horseradish peroxidase–labeled antimouse IgG conjugate (Sigma) (9). Other blood tests were performed according to the discretion of the physician in charge of the patient.

Physicians should consider dengue in the differential diagnosis of all patients who have fever and a history of travel to a tropical area within 2 weeks of onset of symptoms. Commercial tests are available for serologic diagnosis, but their results must be interpreted with care. Sensitivity and specificity of kits may vary among manufacturers, laboratories, and over time. IgM positivity indicates a recent dengue infection, but IgG positivity may only indicate infection at an indeterminate time in the past. In addition, either IgM or IgG positivity may result from cross-reactivity with anti-West Nile, yellow fever, Japanese encephalitis, and other flavivirus antibodies, so the possibility of exposure to other flaviviruses must be considered. If testing at CDC is requested, acute- and convalescent-phase serum samples should be obtained and sent through state or territorial health department laboratories to CDC's Dengue Branch, Division of Vector-Borne Infectious Diseases (DVBID), National Center for Infectious Diseases, 1324 Calle Cañada, San Juan, Puerto Rico 00920-3860. Serum samples should be accompanied by clinical and epidemiologic information, including the date of disease onset, the date of collection of the sample, and a detailed recent travel history. For additional information, the Dengue Branch can be contacted at telephone [phone]; fax [phone]; e-mail [e-mail]; or the DVBID website at http://www.cdc.gov/ncidod/dvbid/dengue/index.htm.





http://www.cdc.gov/ncidod/dvbid/Chikungunya/chickvfact.htm

http://www.cdc.gov/ncidod/dvbid/dengue/

Answer 4

Dengue:

Diagnosis
The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia.

There exists a WHO definition of dengue haemorrhagic fever that has been in use since 1975; all four criteria must be fulfilled:

Fever
Haemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
Thrombocytopaenia (<100 platelets per mm³ or estimated as less than 3 platelets per high power field)
Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinaemia)
Dengue shock syndrome is defined as dengue haemorrhagic fever plus:

Weak rapid pulse,
Narrow pulse pressure (less than 20 mm Hg)
or,

Hypotension for age;
Cold, clammy skin and restlessness.
Serology and PCR (polymerase chain reaction) studies are available to confirm the diagnosis of dengue if clinically indicated.
__________________________________________________

Chikungunya (CHIK) virus is enzootic in many countries in Asia and throughout tropical Africa. In Asia the virus is transmitted from primates to humans almost exclusively by Aedes aegypti, while various aedine mosquito species are responsible for human infections in Africa. The clinical picture is characterized by a sudden onset of fever, rash and severe pain in the joints which may persist in a small proportion of cases. Although not listed as a haemorrhagic fever virus, illness caused by CHIK virus can be confused with diseases such as dengue or yellow fever, based on the similarity of the symptoms. Thus, laboratory confirmation of suspected cases is required to launch control measures during an epidemic. CHIK virus diagnosis based on virus isolation is very sensitive, yet requires at least a week in conjunction with virus identification using monovalent sera. We developed a reverse transcription-polymerase chain reaction (RT-PCR) assay which amplifies a 427-bp fragment of the E2 gene. Specificity was confirmed by testing representative strains of all known alphavirus species. To verify further the viral origin of the amplicon and to enhance sensitivity, a nested PCR was performed subsequently. This RT-PCR/nested PCR combination was able to amplify a CHIK virus-specific 172-bp amplicon from a sample containing as few as 10 genome equivalents. This assay was successfully applied to four CHIK virus isolates from Asia and Africa as well as to a vaccine strain developed by USAMRIID. The method can be completed in less than two working days and may serve as a sensitive alternative in CHIK virus diagnosis.

Answer 5

widely used results of Serum iron:- * Iron: 60-one hundred seventy mcg/dL * TIBC: 240-450 mcg/dL * Transferrin saturation: 20-50% observe: mcg/dl = micrograms in preserving with deciliter. decrease-than-uncomplicated ranges could probable propose: * continual gastrointestinal blood loss * continual heavy menstrual bleeding * unfavorable absorption of iron * not sufficient dietary iron * being pregnant Anemia is a concern wherein pink blood cells do not look turning in sufficient oxygen to physique tissues. there are various varieties and reasons of anemia. Iron deficiency anemia is a cut down in the quantity of pink cells in the blood led to by using way of too little iron.

Answer 6

Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from the Aedes aegypti mosquito, though recent research by the Pasteur Institute in Paris claims the virus has suffered a mutation that enables it to be transmitted by Aedes albopictus (Tiger mosquito). This was the cause of the actual plague in the Indian Ocean and a threat to the Mediterranean coast at present, requiring urgent meetings of health officials in France, Italy, and Spain.

The name is derived from the Makonde word meaning "that which bends up" in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson[1] and W.H.R. Lumsden[2] in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique, in 1952. Chikungunya is closely related to O'nyong'nyong virus[3].

Chikungunya is generally not fatal. However, in 2005-2006, 200 deaths have been associated with chikungunya on Réunion island and a widespread outbreak in Southern India (especially in Tamil Nadu, Karnataka, Kerala, and Andhra Pradesh). As of July 2006, Tamil Nadu reportedly had the largest number of cases, specifically centered around the southern districts of Madurai and Tirunelveli. The number of reported cases also registered a great increase in the districts of Salem, Chennai, and Chengalpet. As of September 2006, after the flood and heavy rains in Rajasthan in August 2006, India, thousands of cases have been detected in Rajsamand, Bhilwara, Udaipur, and Chittorgarh districts. As of October 12, 2006 in the southern indian state of Kerala, 125 deaths are attributed to Chikungunya and majority of the casualties were reported in the district of Alapuzha [mainly in Cherthala Taluk]. This latest outbreak in Alappuzha is supposed to have transferred from Parassala, the southrenmost point of Kerala state where a recent outbreak were reported before the episodes of Alappuzha started. Kerala goverment has termed this as an epidemic outbreak.

Symptoms
The Aedes aegypti mosquito
Enlarge
The Aedes aegypti mosquito

The symptoms of Chikungunya include fever which can reach 39°C, (102.2 °F) a petechial or maculopapular rash usually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints which can be debilitating. The symptoms could also include headache, conjunctival infection, and slight photophobia. In the present epidemic in the state of Andhra Pradesh and Tamil Nadu, India, high fever and crippling joint pain are the prevalent complaint. The fever typically lasts for two days and abruptly comes down. However, other symptoms, namely joint pain, intense headache, insomnia, and an extreme degree of prostration lasts for a variable period, usually for about 5 to 7 days.

Dermatological manifestations observed in a recent outbreak of Chikungunya fever in Southern India(Dr.Arun Inamadar et al),Western India (Surat)(Western India reported by Dr. Buddhadev) and Eastern India (Puri)(Dr. Milon Mitra et al) includes the following:

* Maculopapular rash
* Nasal blotchy erythema
* Freckle-like pigmentation over centro-facial area
* Flagellate pigmentation on face and extremities
* Lichenoid eruption and hyperpigmentation in photodistributed areas
* Multiple aphthous-like ulcers over scrotum, crural areas and axilla.
* Lympoedema in acral distribution (bilateral /unilateral)
* Multiple ecchymotic spots (Children)
* Vesiculobullous lesions (infants)
* Subungual hemorrhage
* Photo Urticaria
* Acral Urticaria

Answer 7

Chikungunya in La Réunion (France), Mayotte, Maurice, Seychelles and India.

28 March 2006, 3115 cases of chikungunya have been notified by 31 physicians from a sentinel network on La Réunion, including 196 cases reported during the week 27 February - 5 March 2006. Estimations from a mathematical model evaluate that 204 000 people may have been infected by chikungunya virus since March 2005 on La Réunion, including 13 000 persons during the week 27 February - 5 March 2006. Between 1 January 2006 - 5 March 2006, 25 patients with clinical symptoms consistent with dengue fever were laboratory confirmed. Five were isolated cases and 20 were suspected cases of co-infection chikungunya-dengue.

Since the beginning of January 2006, other countries in the south west Indian Ocean have reported chikungunya cases: Mayotte (9 January - 10 March, 2833 suspected cases), Mauritius (1 January - 5 March c. 6000 suspected cases including 1200 confirmed cases), and the Seychelles (1 January - 26 February, 8818 suspected cases).

Several European countries have reported imported cases in people returning from these islands: France (160 imported cases), Germany, Italy, Norway and Switzerland.

A mixed outbreak of chikungunya, with sporadic cases of dengue has been reported in Andhra Pradesh state, India. Between 1 December 2005 - 17 February 2006, 5671 cases of fever with arthralgia were reported. High density of Aedes aegypti was observed in the area. From 1-15 March, over 2000 cases of chikungunya have been reported from Malegaon town in Nasik district, Maharashtra state, India. In Orissa state, India, 4904 cases of fever associated with myalgia and headache have been reported between 27 February - 5 March 2006. These signs are consistent with an arbovirus outbreak. Results of a biological investigation are awaited.

Dengue in Madagascar and Maldives

Madagascar has reported a dengue outbreak in the port city of Toamasina. The outbreak started mid-January 2006. Sporadic cases of chikungunya have been reported since mid-February.

Maldives has experienced an outbreak of dengue since January 2006, with 602 suspected cases until 5 March 2006 (including 64 cases of dengue haemorrhagic fever and 9 cases of dengue shock syndrome).

Chikungunya and dengue viruses are transmitted to humans by the bites of infected mosquitoes. On La Réunion, Mauritius, the Seychelles and the east coast of Madagascar, Aedes aegypti is absent or scarce in the vicinity of houses. In contrast, Ae. albopictus is abundant and may be the only important vector of these viruses on the islands. In the Maldives Ae. aegypti is the presumed vector. Both species bite mainly during the daytime, particularly in the early hours after dawn and for 2-3 hours before darkness. Aedes albopictus is more active outdoors whereas Ae. aegypti typically feeds and rests more indoors.

Mosquito control is the main outbreak control activity. Close to habitation, these two mosquito species multiply in collections of stagnant water, mostly in artificial containers. To control the mosquitoes, their breeding sites must be removed, destroyed, protected, frequently emptied and cleaned, or treated with insecticides. During epidemics, insecticides are also often applied as space sprays to kill the adult mosquitoes.

Such measures require the mobilization of affected communities to carry out critical, well-identified healthy behaviours. The Communications for Behavioural Impact (COMBI) approach is a powerful strategy to support this mobilization process both in individuals and communities.

Control measures

A WHO team from the Regional Office for Africa and from headquarters was deployed to the south west Indian Ocean in February-March 2006 to assess the control measures under way in the islands and to discuss a sub-regional coordinated strategy for surveillance and control of arboviruses in the area with national authorities. Additional expertise in the COMBI approach has been sent to Madagascar and Mauritius for follow-up. Similarly, Maldives has received support for their social mobilization activities on dengue vector control.

In India, a multidisciplinary national team was deployed from 13 -17 February 2006 to assist local health authorities in improving public health measures including strengthening of arbovirus surveillance, clinical management of cases, vector control and social mobilization.

Although transmission of chikungunya and dengue is continuing in the affected areas, WHO recommends no special restrictions on travel or trade to or from these areas. However, it is recommended that individuals take precautions to protect themselves from mosquito bites, e.g., by wearing clothes that minimize skin exposure and applying insect repellents to exposed skin or clothing in accordance with label instructions.