Laboratory Diagnosis of Chikungunya Fevers

The clinical manifestations of chikungunya fever resemble those of dengue fever. Laboratory diagnosis is critical to establish the cause of diagnosis and initiate specific public health response.

Types of Laboratory tests available and specimens required
Three main laboratory tests are used for diagnosing Chikungunya fevers: virus isolation, serological tests and molecular technique of Polymerase Chain Reaction (PCR).

Virus isolation
Virus isolation is the most definitive tests. Between 2-5 ml of whole blood is collected during the first week of illness in commercial heparinzed tube and transported on ice to the laboratory. The CHIK virus produces cytopathic effects in a variety of cell lines including BHK-21, HeLa and Vero cells. The cytopathic effects must be confirmed by CHIK specific antiserum and the results can take between 1-2 weeks. Virus isolation must only be carried in BSL-3 laboratories to reduce the risk of viral transmission.

RT-PCR
Recently, a reverse transcriptase, RT- PCR technique for diagnosing CHIK virus has been developed using nested primer pairs amplifying specific components of three structural gene regions, Capsid (C ), Envelope E-2 and part of Envelope E1. PCR results can be available from within 1-2 days. Specimens for PCR is same as the virus isolation i.e. heparized whole bloodl

Serological diagnosis
For serological diagnosis between 10-15 ml of whole blood sera are required; an acute phase serum must be collected immediately after clinical onset and a convalescent phase serum10-14 after the disease onset. The blood specimen is transported at 4 degrees and not frozen to the laboratory immediately. If testing cannot be done immediately, the blood specimen is separated into sera that should be stored and shipped frozen.

Serologic diagnosis can be made by demonstration of fourfold increase in antibody in acute and convalescent sera or demonstrating IgM antibodies specific for CHIK virus. A commonly used test is the Immunoglobulin M Antibody (IgM) capture enzyme-linked immunosorbent assay (MAC-ELISA). Results of MAC-ELISA can be available within 2-3 days. Cross-reaction with other flavirus antibodies such as o’nyong-nyong and Semliki Forest occur in the MAC-ELISA; however, the latter viruses are relatively rare in South East Asia but if further confirmation is required it can be done by neutralization tests and Hemagglutination Inhibition Assay (HIA).

Interpretation of results
Sero-diagnosis rests on demonstrating a fourfold increase in CHIK IgG titer between the acute and convalescent phase sera. However, getting paired sera is usually not practical. Alternatively, the demonstration of IgM antibodies specific for Chikungunya virus in acute-phase sera is used in instances where paired sera cannot be collected.

A positive virus culture supplemented with neutralization is taken as definitive proof for the presence of Chikungunya virus.
PCR results for E1 and C genome either singly or together constitute a positive result for Chikungunya virus

The Movement of the Eradication of the Nest of Dengue Fever Mosquitoes

3 M. Plus was the action that was carried out in an orderly fashion to combat pinched and avoided the bite of Dengue Fever mosquitoes by means of:Drained places of the water reception like: the bath/the TOILET, tempayan, the bucket, the flower vase, the place drank birds et cetera a week very much.

Close
Closed the meeting of all the places of the water reception like the bucket, gentong, the drum et cetera

Buried
Buried all the second-hand things available around/outside the house that could Accommodated the rain water

Plus the action combatted pinched and avoided the bite Mosquitoes
Killed pinched Dengue Fever mosquitoes in the place of water that was difficult to be drained or to be difficult water by spreading the Temephos powder abate or Altosid 2 s/d 3 months very much with the dose 1 gram abate to 10 litre water or 2,5 gram Altosid to 100 litre water. Abate could be received was bought in the community health centre or in the pharmacy

The Usefulness the Guava for the Dengue Fever illness

The old guava leaves evidently contained various component sorts that The usefulness to overcome the illness of dengue fever (DBD). The group of the tannin compound and flavonoid that was stated as quersetin in the extract of the guava leaves could hinder the activity of the enzyme reverse trancriptase that meant to hinder the growth of the virus berinti RNA.

Was like this results of the research that was done by the The supervisor Body Medicine and Food (Military Police) co-operated with the School Of Medicine and the Farmasi Universitas Airlangga Faculty (Unair) Surabaya, that since 2003 researched the extract of the guava leaves for medical treatment of DBD. In the beginning stage of the research was begun with the testing of the preclinic. Results of the research was explained by the Head of the Military Police Body Drs Sampurno MBA in Jakarta, on Wednesday

As is known, DBD was the illness that was caused by the dengue fever virus with the death rate and quite high pain.Until this DBD medical treatment still was suportif, that is overcame lost the plasma liquid resulting from the increase permeabilitas capillary blood vessels.

Named in the book of Foods that Heal, Foods that Harm that 90 gram the guava more than enough satisfied the requirement for vitamin C for the daily to the adult. The same book mentioned despite has lost almost 25 percent his vitamins because of the process of the processing, juice of the box of the package guava was still being the source of good vitamin C.

Disease Chikungunya

Around 200 s/d in the last 300 years the virus chikungu him CHIK was the virus to the primate animal in the middle of the forest or savannah in Africa. The fauna of the primate that was considered as continuatio of the virus was the nation baboon (Papio sp), Cercopithecus sp.

The cycle in the forest (sylvatic cycle) among the fauna of the primate was carried out by Aedes mosquitoes sp (Ae africanus, Aeluteocephalus, Ae opok, Ae. furciper, Ae taylori, Ae cordelierri.
Scientific authentication that covered the isolation and the identification of the virus just succeeded in being carried out when the plague in Tanzania happening 1952-1953.

Well the virus and his illness were afterwards given by the name in accordance with the local language (Swahili), was based on the sign to the sufferer.
Then was present chikungu him that was significant (the position of the body) bent or buckled that which contorts or bends up. After several old, nature of the virus chikungu him that originally cycle from the fauna primate-mosquitoes-fauna of the primate, could also bersiklus humankind-mosquitoes-humankind. Not all the viruses could from the animal change his cycle like that. In the area of the settlement (the person who has moved to the city cycle), the virus cycle chikungu him was helped by Ae mosquitoes aegypti.

Several countries in Africa that it was reported was attacked by the virus chikungu him was Zimbabwe, Kongo, Burundi, Angola, Gabon, Guinean Bissau, Kenya, Uganda, Nigeria, Senegal, Central Africa, and Bostwana. After Africa, the virus chikungu him was reported in Bangkok (1958), Cambodia, Vietnam, India and Sri Lanka (1964), the Philippines and Indonesia (1973).
Chikungunya had been reported attacked three American corps of the peace volunteer (the US Peace Corp Volunteers) that was assigned in the Philippines, 1968. Was not known definitely how this virus spread international.

Considering the spreading of the international virus relatively slow, the possibility of this spreading happened together with the move of mosquitoes.

In Africa still had again the virus illness with the sign was similar chikungu him, namely the O virus? Nyong nyong (ONN). The term "o?" Nyong-nyong was taken from the regional language in Acholi, Uganda, meant the weakness of the foundation.

The dengue fever connection with chikungu

The sign of the Chikungunya Fever resembled Dengue Dengue Fever that is the Fever that was high, shivered, the headache, nausea, faded, had a stomach-ache, foundation pain and the muscle as well as red spots to skin especially the body and arms. His difference with dengue fever dengue fever, in chikungu him did not have the great bleeding, renjatan (Schok) and the death.

Really the incubation from the Chikungunya fever two to four days. The manifestation of the illness took place three to 10 days. This virus including? Self Limiting Disease? The alias was lost automatically. However the feeling of pain was still backward in the calculation of the week up until the month.

There was no vaccine and special medicine for Chikungunya?

Be enough to take medicine penurun hot and the feeling remover was sick that could be bought in the stall, that important was enough to rest, drank and food was nutritious?

According to the site of the Standford University, the Chikungunya virus entered the Togaviridae family, the genus alphavirus, and was spread by Aedes Aegypti mosquitoes. This virus continued to cause the epidemic in the tropical Asian territory and Africa since it was identified in 1952 in African Timur. In Indonesian Demam Chikungunya it was reported the first time in Samarinda in 1973.
Afterwards was contagious in the Tunkal Estuary, Jambi, in 1980. In 1983 spread in Martapura, Ternate and Yogyakarta. After the vacuum almost 20 years, early 2001 the extraordinary incident (KLB) the Chikungunya fever happened in Muara Enim, South Sumatra and Aceh.

Followed by Bogor in October. Feverishly Chikungunya was again contagious in Bekasi (West Java), Purworejo and Klaten (Central Java) in 2002. From literature that was read by me, indeed had the wave of the epidemic 20 yearly. Possibly related the change in the climate and the weather, the other explanation, according to the site of the Security of the Canadian Laboratory, antibodies that emerged from this illness made the sufferer immune to the further virus attack. Therefore, needed long time for this illness to spread again.

It was as serious that the dengue fever illness for the world?

According to the Organisation of the Health of the World (WHO), Dengue Fever threatened 2.5 milliar the person, two per five of the world's populations. Asiaweek reported, More Than 100 tropical and subtropical countries reported the plague of dengue fever, and were dozens of million the case that was reported every year, totalling 95% that was infected was children.

When dengue fever was found the first time?

There is none that tau precisely when this kind virus was found. A report about the knees fever in Cairo during 1779 possibly in fact meant dengue fever.

Dengue fever continued developed fast especially since World War II, started from South-East Asia, dengue fever had the impact that was big towards the health of humankind. The WHO publication had reported that, the plague of first dengue fever that was serious was in Asia found in Manila during 1954.

Afterwards was followed by other countries especially Thailand, Vietnam, Malaysia, Indonesia and the neighbouring region. The death from the number of virus sufferers then could reach 10 to 50% from the total sufferer. But while more often was learnt about this illness, his percentage also descended.

Moreover this virus spread in the area not tropical, was proven by 1996, The New York Times reported cases of dengue fever in the United States in Massachussetts, New York, Oregon and Texas. In several cases of people held the trip in the risky area this virus and afterwards brought this virus to their origin country.

The sign that was more specific for DBD

• Fall Sudden
• the Bleeding hust
• the Bleeding in an publich
• manner cold and sweaty cold
• Confuses
• Renjatan

with the weak pulse (dengue fever shock syndrome, or DSS)

Several researchers tried the other approach. Through genetic engineering, they made an effort to prevent the dengue fever virus relying on itself in the mosquitoes saliva.If this went according to plan, mosquitoes that experienced genetic engineering of that kind will continue to ketutunan they endurance of dengue fever. Although having the progress, but being not yet seen so was successful this approach eventually.

The case of the Dengue Fever Illness in South-East Asia

In South-East Asia, this illness the first time it was reported during 1953 in Manila, furthermore spread to various countries.In Indonesia personally, the DBD illness was reported the first time in Surabaya and the Special Capital District of Jakarta.Initially this DBD illness was the urban illness and attacked especially age children under 5 years.However, with the development of this illness time afterwards only was not contagious in the area of urban areas, but also spread to the area of rural areas.The age of the sufferer also tended to shift attacked the mature age.The spread method of the DBD illness was through the Aedes mosquitoes bite aegypti that menggit the sufferer DBD was afterwards spread to the healthy person.

There were several factors that influenced the spreading and the spread of the DBD illness, that is fast urbanisation, the development of the development in the area of rural areas, the shortage of clean water supplies, the ease of the transport that caused the ease of the interregional human traffic, the existence of global warming that could influence bionomik the Aedes vector aegypti.

Eradication efforts of dengue fever consisted of 3 matters.

1. The Increase in the activity surveilans the illness and surveilans the vector,
2. The early diagnosis and early medical treatment,
3. The Increase in eradication efforts of the vector penular the DBD illness.

The Spread of the Mosquitoes Culture Aedes Aegypti

Giving abate was eradication efforts to pinch Aedes mosquitoes aegypti with chemicals.
Larvasida that is used usually temephos, in the form of butiran sand or granul.
The dose that was used was one ppm or 10 gram (one level tablespoon) for each 100 litre water.
Abatisasi by this means was effective for three months.

In principle abatisasi was carried out to the pool of water that was accommodated in a place or the vessel, that was not hit by the Sun rays directly and was not directly in contact with the land.

Place kinds The spread of the culture Aedes mosquitoes aegypti that was recommended to diabatisasi was the place of the water reception for the everyday need.
For example, the drum, the tank of the water reception, tempayan, the bath, the TOILET basin, and the bucket.

Moreover still had the place of the water reception that not for the everyday need, for example the place drank birds, the flower vase, the ants trap, and second-hand things (the tyre, tin, the bottle, plastic, et cetera).

There was also the place of the natural water reception, like the tree hole, the stone hole, pelepah the leaves, the coconut coconut shell, pelepah bananas, and the bamboo discount.

All the places of this water reception were recommended to be closed and cleaned in an orderly fashion or diabatisasi.

Places that were not needed but potential accommodated water better be buried.
As for the natural place of a kind of hole in the tree or in the stone could be closed with cement.
The pot that contained small fish not was the place that must be given abate.
Even, maintained the eater's fish pinched, like the head fish of tin, the fish gupi, was one of the eradication efforts pinched that really was recommended.

Aedes Aegypti Mosquitoes

Aedes Aegypti mosquitoes could be recognised from the physical characteristics that had coloured lines white around foot and the back.
These kind mosquitoes usually bite humankind when the sun rose until the sun sank, so could in the morning, the afternoon or in the afternoon, although in fact could also tonight but according to this mosquitoes research usually bit humankind when this.

These kind mosquitoes usually breed in calm water, like the flower vase, the drum, the bucket, the second-hand tyre, second-hand tin, and other things that could accommodate the rain water, therefore dengue fever tuh usually became an epidemic when the rain season.
To prevent bred him this larva of kind mosquitoes, stockpiled second-hand tins and other potential things accommodated the rain water in the land, afterwards closed buckets or the bath so that mosquitoes could not enter and breeding inside there, and especially for the bath drained this bath sesering possibly.

Disease Dengue Fever

The cause and the spread intermediary.

This illness was caused by a virus that caused the disturbance to capillary blood vessels and in the blood clotting system, so as to result in the bleeding. The vector that played a role in in the spread of this illness being Aedes mosquitoes aegypti

The Disease Manifestation

After the incubation/the incubation for 3 - the person's 15 days that contagious could experience/suffered this illness in one of the 4 forms along with this, that is:

• form abortif, the sufferer did not feel a sign anything.

• Dengue classic, the sufferer experienced the high fever for 4 - 7 days, pains to bones, were followed with the emergence of spots or very spotty the bleeding under skin.

• Dengue Haemorrhagic Fever (dengue fever Dengue Fever/DBD) his sign was the same as classic dengue fever was increased with the bleeding from the nose, the mouth, the anus etc..

• Dengue Syok Sindrom, his sign was the same as DBD was increased with the shock/prethe shock in this form often happened the death.

Because the frequency happened the bleeding and the shock then in this illness his death rate was high enough, because of that each Sufferer who it was suspected suffered the dengeu fever Illness in the level that whatever immediately must be brought to the doctor or the Hospital, considering from time to time could experience the shock/the death.

Medical treatment.

Medical treatment towards this illness especially was aimed to overcome the bleeding, prevented/overcame the shock situation/prethe shock, that is with try to get so that the sufferer often drinks, when must be carried out by giving of the liquid through the infusion.
The fever was made an effort to get was dropped off with the cold compress, or giving antipiretika

The prevention.

The prevention was carried out by avoiding BITE MOSQUITO all along the day (the morning up until the afternoon) because of mosquitoes aedes was active during the day (not tonight).
This matter could be carried out with avoided was in the locations that many of his mosquitoes during the day, especially in the available area of the sufferer DBD him.
When indeed very necessary to be in this place put on THE CLOTHES MORE CLOSED, long trousers and the long-sleeved shirt for example.
Use DILUTION CREAM ANTI MOSQUITO (MOSQUITO REPELLANT) that often was sold in shops, in the body part that was not closed clothes.

Supervise the environment in the house and in the page of the house. Discarded or stockpiled objects was not useful that accommodated water, or kept in such a way as to not accommodate water.

Spread dust abate (that could be bought in the pharmacy) to the bath and the place of the other water cross-section, also to the ditch/the ditch inside and around the house, especially when the ditch his water not/not all that flowed.