SESSION TITLE: Infectious Disease Cases - Student/Resident
SESSION TYPE: Student/Resident Case Report Slide
PRESENTED ON: Monday, October 26, 2015 at 11:00 AM - 12:00 PM
INTRODUCTION: Chikungunya is a viral mosquito-borne infection that has rapidly spread from Africa across the globe, most recently in the Caribbean. This case describes a young Puerto Rican woman with primary ciliary dyskinesia (PCD), who presented to a large community hospital with fever, arthralgias, rash, and hypoxic respiratory failure.
CASE PRESENTATION: A 39 year old Puerto Rican female with PCD stepped off the airplane into Virginia, struggling to breathe, and went immediately to a local hospital. Chikungunya had recently become endemic to Puerto Rico, and the patient had been exposed to multiple sick contacts. She was noted to have acute on chronic hypoxic respiratory failure. She had endured fever, arthralgias, headache and shortness of breath in the 5 days prior to travel. On exam, she had a diffuse maculopapular rash over her lower extremities, and a CT scan of her chest showed new bilateral upper lobe pulmonary infiltrates superimposed upon chronic changes. Sputum culture grew P.aeruginosa, a previously known colonizer. She was treated with intravenous antibiotic therapy and gradually improved. IgM and IgG testing confirmed active infection. Acute chikungunya had not only manifested with classic features, but also as an acute exacerbation of chronic disease.
DISCUSSION: The arbovirus Chikungunya was first identified in Tanzania in 1952 and has spread across the globe. Symptom onset is usually 3 days after the bite of an infected Aedes aegypti or Aedes albopictus mosquito. Common symptoms are joint pain and fever, but may include rash, headache, and myalgia. Symptoms are self-limited and last 5-7 days, but the effects can be severe in those with chronic disease, as conveyed in this case report. RT-PCR or IgM can be utilized for diagnostic purposes.There are no approved viral treatments or vaccines to treat the infection, however, there is an experimental weakened measles virus in phase I trials. Efforts to reduce infection are primarily centered around removal of stagnant water and prevention of mosquito bites.
CONCLUSIONS: This case beautifully illustrates the clinical picture of Chikungunya virus, but also the complications arising in those patients with chronic pulmonary disease. The disease has reached the USA mainland, and further cases can be expected to endanger the chronically ill. Maintaining a high index of suspicion for this disease will be necessary to prevent morbidity and mortality in our most vulnerable patients.
Reference #1: Weaver, et al. "Chikungunya virus and prospects for a vaccine." Expert Rev Vaccines. 2012 Sep; 11(9): 1087-1101.
Reference #2: "Chikungunya virus." Centers for Disease Control and Prevention. http://www.cdc.gov/chikungunya/
Reference #3: "Texas Chikungunya Virus Expert Publishes Important Overview of this Emerging Disease." http://bionews-tx.com/news/2015/03/30/texas-chikungunya-virus-expert-publishes-important-overview-of-emerging-disease/
DISCLOSURE: The following authors have nothing to disclose: Sunjay Devarajan, A.W. Brown
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