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Chikungunya disease is being seen all over the world. Currently, in India 1.3 million people got affected with Chikungunya. The main symptom of this disease is polyarthralgia or polyarthritis. The ankles and wrists are affected and the wrists are very painful on pressure. Often within the first 5 days, there is a history of conjunctivitis or rash. The problem is that many of these patients do not recover from acute illness and develop chronic complaints.
Unfortunately, during the present epidemic, rheumatologists did not see enough of these patients and therefore not much has been written about this illness, which has no cure.
The fact is that even if an average middle class person or even a doctor develops chronic Chikungunya, his whole career could be jeopardized.
The only other polyarthritis is rheumatoid arthritis, for which we have got very good drugs to bring about a remission. The moment the doctor sees atypical rheumatoid arthritis, specially where the rheumatoid factor or Anti CCP test is negative, blood must be tested for Chikungunya. If it is positive, it will be better not to give any prognosis and continue to give only NSAID group of drugs.
SEROLOGICAL TESTS FOR KALA-AZAR WORK WELL
The direct agglutination test and rK39 dipstick have a similar, good to excellent performance for the diagnosis of visceral leishmaniasis (kala-azar). Chappuis and colleagues carried out a meta-analysis of 43 original studies evaluating the two diagnostic tests and found similar sensitivity estimates of 94.8% for the direct agglutination test and 93.9% for the rK39 dipstick. However, sensitivities were lower influenced by type of controls. The authors conclude that both tests generally work well and should be more widely used, but their lower performance in some situations show that better diagnostic tools need to be developed.
BMJ, 2006; 723.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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