DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20163300

Vitamin D deficiency may exacerbate or prolong arthritis in Chikungunya fever

Rao V. N. Bhavana, Raman V. S. Bhavana, Narmada Vatti Vatti, Prabhakar Rao V. Dirisana

Abstract


Background: Chikungunya is a self-limiting acute febrile illness with acute arthritis. It is carried by Aedes aegypti and Aedes albopictus. The disease mainly affected Africa and Asia, though sporadic cases occurred in the other regions of the world. Background: During an outbreak of this illness in India in 2015 we observed that a portion of the patients were suffering from prolonged arthritis. While investigating for the cause of prolonged arthritis we found that most of them were deficient in Vitamin D. Hence we carried up this study of Vitamin D deficiency in Chikungunya patients.

Methods: All the probable cases of Chikungunya that attended our hospital between 20th July 2015 to 30th January 2016 were registered for study. Their symptoms and clinical signs were analyzed. All were investigated for hematological abnormalities and excluded for dengue fever by serological testing. Those who were hospitalized with severe arthritis were tested for vitamin D deficiency on the day of admission and those who had arthritis beyond a month on 30th day. Those who had a vitamin D deficiency were treated with supplementation and followed up for another three months.

Results: Symptoms were analyzed and charted. Tenderness of the skin of the legs just above the ankle was found in 38% of patients which was not documented in the earlier study. 86% of patients had elevated C-reactive protein average being 21 mg/l. 90% 0f patients admitted to the hospital had Vitamin D deficiency and 62% of patients who had arthritis beyond one month had Vitamin D levels less than 20 ng/ml. Correction of vitamin D deficiency alleviated their pain early.

Conclusions: Testing for Vitamin D deficiency in all the patients of Chikungunya admitted to the hospital and those suffering from joint pains beyond one month and treating with Vitamin D supplementation, may be prudent to alleviate the suffering of Chikungunya.


Keywords


Chickungunya fever, Vitamin D deficiency, Prolonged arthritis, C-reactive protein, Ankle oedema, Facial pigmentation

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References


Ballal BB, Hulawale S, Bhat A, Ballal R, Matey H, Bodhankar M. Deficiency of 25-OH Cholecalciferol, an explored factor aggregating chronic arthritis in chikungunya and search of its therapeutic potential. Asian J Multidisciplinary Studies. 2013;1(1):1-5.

Guidelines on clinical management of chikungunya fever. http://www.wpro.who.int/ mvp/ topics/ ntd/ Clinical_Mgnt_Chikungunya_WHO_SEARO.pdf

Simon F, Parola P, Grandadam M, Fourcade S, Oliver M, Brouqui P, et al. Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. Medicine (Baltimore). 2007;86(3):123-37.

Taubitz W1, Cramer JP, Kapaun A, Pfeffer M, Drosten C, Dobler G, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007;45(1):e1-4.

Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP, et al. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis. 2007;44(11):1401-7.

Schilte C, Staikowsky F, Couderc T, Madec Y, Carpentier F, Kassab S, et al. Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis. 2013;7(3):e2137.

Mahendradas P, Ranganna SK, Shetty R. Ocular manifestations associated with chikungunya. Ophthalmology. 2008;115(2):287-91.

Singh SS, Manimunda SP, Sugunan AP, Sahina, Vijayachari P. Four cases of acute flaccid paralysis associated with chikungunya virus infection. Epidemiol Infect. 2008;136(9):1277-80.

Torres JR, Cordova LG, Saravia V, Arvelaez J, Castro JS. Nasal Skin Necrosis: An Unexpected New Finding in Severe Chikungunya Fever. Clin Infect Dis. 2016;62(1):78-81.

Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani KV. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis. 2008;14(3):412-5.

Solanke VN, Mody MB, Karmarkar MG, Mehta PR. Seroprevalence and Role of C- Reactive Protein (CRP) Estimation in Chikungunya Positive Cases in Mumbai. Am J Med Medical Sci. 2014;4(1):8-13.