Sat | Dec 10, 2016

Is it really chik-V?

Published:Monday | September 29, 2014 | 12:00 AM

First, there was the emailed message expressing extreme concern for a relative. The brother of the patient reported that he was having a very high fever, was so weak that he could hardly move, was not eating or drinking, was also having upper abdominal pain and that he even vomited. I suggested that he be taken straight away to an Emergency Room (ER).

There, he was seen, assessed, treated with intravenous fluids, medications, and received a blood test for a complete blood count and for several viruses, including chikungunya or chik-V.

The patient's recovery was difficult and slow. He even developed a very annoying, itchy rash all over his body. What was interesting was that his blood test for several viruses, including the chik-V immunoglobulin M (IgM) antibody, came back as negative. I waited for about a week and sent him for a repeat of his chik-V test. It came back as negative again. He made a full recovery in time.

Initial pains

At first, I didn't pay the pain in my left knee much attention. It made me limp, but, at my age, I limp because of one transient pain or the other now and then. I still paid no attention when the joints at my ankles and wrists began hurting. Then, when my shoulders started to ache, I began to say to myself, "Hmmmm".

It wasn't until about a day and a half into the increasing joint pains that I began feeling very tired all the time. It was difficult to get moving and I even yawned a lot. I attributed the malaise to chronic fatigue and went on as usual. However, the next evening, at around 11 p.m., I was awakened by the most horrific headache that I have ever experienced. I could feel the tell-tale chills of a fever, the joint pains were now in full bloom but the headache made me seriously consider going to the ER.

Doctors make some of the very worst patients. We tend to self-diagnose and treat minor conditions by ourselves. But this headache felt like a nine out of 10 (on the analogue pain scale) and a 10 out of 10 when it peaked (which was very often). Was this an intracranial haemorrhage? Was it meningitis? Somehow, through the fog created by the searing headache, I recalled the prodromal joint pains, malaise and fever. "Aha!" This must be chik-V ... I thought.

Acetaminophen with codeine to the rescue! Two, taken every six hours brought some relief, enough that, although I should have taken some days off for rest, I managed to continue working (after all, doctors don't get sick, right?). I dragged on until I managed to get my blood tests done. Lo and behold, I too was chik-V IgM negative.

I have seen many patients severely smitten by a viral illness that presents with symptoms identical to the mosquito-borne chik-V. In spite of waiting for about five days to have them do their chik-V IgM antibody test, so far none came back as chik-V or dengue positive.

Another virus?

Could it be that most of our chik-V IgM antibody blood tests are in error? Is it possible that either the chik-V illness or another similar flu-like virus is affecting many people?

Several flu-like viruses share common symptoms with the chik-V virus infection. Joint or muscle pains, high fever, tiredness, weakness, headache, loss of appetite, a (viral erythematous) rash, sometimes abdominal pains and even vomiting.

In cases that are not severe, it may be mostly academic to learn whether or not the illness is due to chik-V. If symptoms are not severe, the treatment for flu-like viruses are the same ... supportive therapy with acetominophen, rest, lots of fluids and a light diet are very helpful. But, if you feel very ill, go see your doctor.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.