Abstract: As we all know that with increasing number of cases of dengue, chikungunya and malaria it has become one of the most problematic issue in Delhi and few other states of India.
A lot many people became victim by epidemic of Chikungunya, dengue and malaria. There was an acute shortage of beds due to the large number of cases coming in with dengue and chikungunya .It has been proved in many surveys that homoeopathic medicines are very effective in treating all such cases of viral fevers and thereby restoring the health of patient. Recent well documented studies have shown how homeopathic medicines are helpful in preventing and treating Dengue in Brazil, Pakistan and India.
The medicine which is being used in epidemics in Homeopathy is called “GENUS EPIDEMICUS”.
Transmission
Chikungunya virus is primarily transmitted to humans through the bites of infected mosquitoes mostly Aedes aegypti and Aedes albopictus. Human beings are the primary host of chikungunya virus during epidemic periods. Blood-borne transmission is possible; cases have been recognized amongst laboratory personnel handling infected blood and a health care worker drawing blood from an infected patient. Rare in utero transmission has been documented mostly during the second trimester. Intra-partum transmission occurs mostly when the mother was viremic around the time of delivery.
Studies have not found chikungunya virus in breast milk and there have been no recoded data till date of infants acquiring chikungunya virus infection through breastfeeding. Because the benefits of breastfeeding likely outweigh the risk of chikungunya virus infection in breastfeeding infants, mothers should be encouraged to breastfeed even if they are infected with chikungunya virus or living in an area with ongoing virus spread and transmission.
The risk of a person transmitting the virus to a biting mosquito or through blood is maximum when the patient is viremic during the period of the first week of illness.
Clinical Signs & Symptoms
The majority of people infected with chikungunya virus turn out to be symptomatic. The incubation period is typically 3–7 days (range, 1–12 days). This means the disease manifests 1 to 12 days after mosquito bitethe symptoms of chikungunya include the following.
· Sudden onset of fever (> 40 C / 104 oF)
· Pain in Head, acute headache with nausea.
· Severe pain in joints (or arthralgia)
· Muscular pain
· Swelling of Joints, limbs, face anywhere on the body
· Rash anywhere on the body
· Stiffness in joints (wrists, ankles, inter-phalangeal joints)
· Loss of taste
· Mouth ulcers
· Sometimes there may be infection of the conjunctiva of the eye and some photophobia
· Chills
· Nausea and vomiting
· Bleeding or hemorrhage (may occur rarely).
Study suggests that most patients recover fully from chikungunya. They get improved after a few days, however sometimes joint pain can continue for a longer period after the other symptoms have wiped out. Over 12% of patients tend to develop chronic joint pains because this virus multiplies in muscles.
Diagnosis
Laboratory diagnosis is generally accomplished by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin (Ig) M and neutralizing antibodies.
Rapid Chikungunya Viral culture may sense virus in the first 3 days of illness;
Chikungunya infections can be confirmed by the detection of the virus, viral RNA, or specific +antibodies in patient samples.
The type of testing performed is characteristically dictated by the timing and volume of samples available. Blood test is the only dependable way to recognize chikungunya since the symptoms are similar to much more deadly dengue fever. Common research laboratory tests for chikungunya include for instance RT-PCR and serological tests.
RT-PCR
Viral RNA can be easily identified by reverse transcriptase-polymerase chain reaction (RT-PCR) in serum specimens obtained from patients during the acute phase of infection. Chikungunya infections cause high levels of viremia (up to 1x10E6.8 plaque-forming units per mL), which characteristically last for 4–6 days after the onset of illness. RT-PCR can therefore easily been done within the first 7 days on an acute-phase specimen to confirm chikungunya virus infection. RT–PCR products from clinical samples may also be used for genotyping of the virus, allowing comparisons with virus samples from various geographical sources. PCR results can be obtainable within one to two days.
ELISA
Enzyme-linked immunosorbent assays (ELISA) detect both anti-CHIKV immunoglobulin (Ig) M and IgG antibodies from either one acute- or convalescent-phase samples. Serological diagnosis needs a larger amount of blood than the other methods. ELISA results require 2–3 days and the test is quite precise with very little cross reactivity with related alphaviruses. Testing of samples from imported cases found that chikungunya-specific IgM antibodies develop speedily within a few days after illness onset and persist for several months.
Immunofluorescence assays
Immunofluorescence assays are sensitive and specific but lack the ability to count antibodies, are subjective, and require special apparatus and training. However, these tests are commercially available and are an possibility for laboratories that routinely use this method for detection of other infectious agents.
PRNT
Plaque reduction neutralization tests (PRNT) are very useful because they are quite specific for alphaviruses and are the gold standard for validation of serologic test results. The foremost drawback to PRNT is that it requires the use of live virus. The test must be carried out in Biosafety level 3 laboratories (BSL-3) that needs special laboratory containment equipment’
Homeopathic Guidelines and clinically varified medicines to combat various effects of Chickungunya.
Gelsemium plant
Dulcamara Plant
Chikunguya
Homeopathic Preventive and treatment, Modus operandi
Dulcamara
After carefully studying symptoms of various patients and bearing in mind the Humidity of various states of India like Delhi NCR, Bombay, UP, few south Indian and north Indian states where relative humidity is more than 60 % and its considered as best for breeding of mosquitoes and also modalities of our few remedies corresponds to these weathers like Dulcamara, Arania-diadema, RhusTox, Bryonia-Alba, Arsenic-album, Natrum-sulph, Eupatorium perf, Rhododenderon, Gelsemium etc.
GENUS EPIDEMICUS
Research groups in our Centre have found patient’s symptoms and modalities correspond to Dulcamara as Genus Epdemicus.
Symptoms are brought on or aggravated by exposure to cold dam, rainy weather, or SUDDEN CHANGES in HOT WEATHER, at the close of summer season and onset of winters.
Humidity level is high (in Delhi 64 % August-September-October).
Why DULCAMARA? Its Suitability…
It is full of rheumatism, pain and aches, sore and bruised all over, the joints are inflamed; red, swollen induced by changing from high to low temperature or from cold wet weather
Characteristic [ 1 ]
Adapted to persons of phlegmatic, scrofulous constitutions, fidgety and restlessness, irritable, subject to catarrhal, rheumatic or skin affections, brought on or aggravated by cold, damp, rainy weather, or sudden changes in hot weather (Bryonia).
The skin is delicate, sensitive to cold, predisposed to eruptions, especially urticaria, every time patient takes cold, or is long exposed to the cold.
Anasarca, after ague, rheumatism, scarlatina, measles.
Dropsy after suppressed sweat or skin diseases, from cold air or damp dwellings, working in milk dairy (Aranea, Arsenicum, Nat.s.).
Diarrhea from taking cold, in damp places or damp weather.
Catarrhal ischuria in grown up children, with milky urine, from wading with bare feet in cold water.
Rash before the menses (Conium – during profuse menses, Belladonna, Graphites).
Urticaria over whole body, no fever, itching, burns after scratching, aggravated in warmth, ameliorated in cold.
Warts, fleshy, large, smooth, on face or back of hands and fingers.
Cannot find the right word for anything. Mental confusion.
Relations – Complementary: to Barytacarb., Kali sulph.
Fever type and Guiding Symptoms [2]
Aggravation: Evening, during rest, cold, damp weather, suppressed menses, eruptions, sweat.
Amelioration: From moving about (Ferrum), warm, dry air.
Type. – Double quartan, tertian, double tertian, double quartan. Continued, typhoid.
Time: Irregular hours.
Cause:
Fevers happening during cold, damp, rainy weather, worse when weather speedily becomes colder(Patients usually are exposed to sudden air-conditioned cars and rooms), caused by exposure, living in damp rooms, sleeping in a damp bed.
Chill: With violent thirst. Commencing in or spreading from the back, not relieved by warmth (relieved by hot applications, Caps. ),shaking, with a feeling of coldness, or actual coldness over the whole body, so that he could not get warm near the hot stove, with shuddering from time to time.
Chilliness of the back, without thirst, in the open air, but especially in a draught (Cantharis).
Chilliness mostly toward evening, over the back, nape of the neck, occiput, with a feeling as if the hair stood on end (Baryta).
With nausea and frequent or involuntary urine.
Heat: General, dry, burning heat all over. Dry heat over whole body, heat and burning in the back. Burning in the skin of the entire back as if he were sitting by a hot stove, with sweat in the face and moderate heat.
Sweat: Offensive sweat, night and morning, over the whole body, during the day more over back, in axillae, and palms of hands. Badly smelling sweat, with profuse discharge of transparent urine. Often wanting.
Tongue: Dry, swollen, as if paralyzed with cold. Bitter taste. Ptyalism, the gums are loose and spongy, saliva tenacious, soap – like. Excessive desire for cold drinks.
Analysis. – Comparable to Aranea, the fevers to which Dulcamara is adapted are rare. They are caused by rheumatic exposure, living in damp rooms, sleeping in a damp bed, during cold, rainy, changeable weather, but the fever of Aranea comes on with great orderliness and regularity, while that of Dulcamara has no reference to time no particular time modality. Compare Crocus and Staphysagria.
Typhoid fever, when patient distinctly remembers having taken cold, tongue clean, stools yellow, liquid, with rumbling, cutting, digging or griping pain in umbilical region or whole abdomen.
Homeopathic Medicines for Arthralgia and post viral pains [3]
1. Eupatorium pereforatum-To relieve severe BONE pain affecting back, head, chest, limbs, especially the wrists, BUT pain make patient restless
2. Bryonia- as pains are aggravated by any motion and are better by absolute rest. SO the pains keep patients quiet.
3.Dulcamara- considered as GENUS EPIDEMICUS
as symptoms are brought on or aggravated by exposure to cold damp, rainy weather or SUDDEN CHANGES in HOT WEATHER at the close of summer season & coming in of winters
Humidity level is high (in Delhi 64 % August-September-October ) during this August & September month –perfectly suiting the condition of DULCAMARA, It is full of rheumatism ,pain & aches ,sores & bruised all over ,the joints are inflamed ,red, swollen induced by changing from high to low temperature or from cold wet weather.
4. Stannum metallicum- To relieve post fever weakness &pain, We have many patients responds well to this remedy in post chikungunya pains,
The STANNUM patient is generally very sad and despondent, feels like crying all the time. (NAT. M., PULS, SEPIA.)
In Sequale repertory its remedy for pains after fever.
Pains-GRADUALLY RISE TO A GREAT DEGREE OF
INTENSITY AND THEN AS GRADUALLY DECREASE.
This pain is of course neuralgic, may be situated anywhere in the tract of a nerve, but has been often verified in prosopalgia, Muscle or Joint pain, gastralgia and abdominal colic.
These pains are ameliorated by pressure, like COLOCYNTH and BRYONIA; so if COLOCYNTH miss the mark, which is generally first thought of in abdominal pains relieved by pressure, STANNUM may relieve, and especially if the attacks have been of long standing or the patient seems to have a chronic tendency thereto.
5. Podophylum – it is found very effective on post viral pains in below knee up to ankles with swelling in feet.
[Boericke ] [Fever]Exanthemata, eruptive fever: Intermittent fever (ague, malarial):Concomitants: Pains, in knees, ankles, wrists, hypogastrium:
6. Sabadilla- Helpful in relieve post fever heel pains& pain in ankles.
Extremities – (Sabadilla)
Weariness and heaviness in all the limbs.
Stinging, Pricking sensation in thighs.
Tension and strain in the calves.
Heaviness of the feet.
Generalities – (Sabadilla)
Lassitude.
Intense but transient bruised pain in various parts of the body.
Intense pain in all the bones, especially in joints, as if the interior of bones were cut and scraped with a sharp knife.
Great sensitiveness to cold air.
Symptoms appear first on right, then on left side.
Most symptoms better when lying down
Case Study
A female 19 years old, after developing chikungunya symptoms had severe pain in the legs and felt extremely weak and wanted to lie down all the time, a few doses of Sabadilla cured her completely. Her pains and weakness were completely cured.
Remedies for Rashes, Allergic rashes, urticarial ,itching eruptions and sore mouth after Fever [ 2, 3]
1. ApisMelifica
Better,Uncovering, In open air, and cold bathing.
WORSE, heat in any form; TOUCH; pressure; late in afternoon; after sleeping; in closed and heated rooms. Right side.
SKIN Stinging, Carbuncles, with burning, stinging pain ( Ars.; Anthrac) Sudden puffing up of whole body. Erysipelas, with sensitiveness and swelling, rosy hu
Case study:
A female age 27 married for last 5 years, had an attack of chikungunya. After 3rd day developed severe itching and maculopapular rash all over skin with difficulty in walking due to pain in right knee and leg up to ankle and had sore mouth with thirstlessness. She felt excessive heat and itching with burning stinging pain,
First day Apis LM 2- 3 doses were given stat, next day morning she came with 70 % relief. Rashes and one peculiar relief was that she was completely free from joint pains.
Other remedies for rashes
UrticaUrens
RhusTox
Nux Vomica
Clematis
Aphthae , swollen gums, gingivitis after fever [2,3 ]
Baptisia. [Bapt]
Produces a low adynamic conditions, in which the blood oozes from the gums, which are dark red and offensive; great foetor, salivation.
Gums ulcerated,the tongue is cracked and the mouth is extremely offensive. It is also useful in mercurial stomatitis. Mercurial stomatitis in nursing women, or with exhausting diseases, phthisis, Bright’s etc. The more offensive the breath, the more indicated; the mucous membrane is in a most unhealthy condition. Hydrastis. One of the best remedies for aphthous stomatitis in the poorly nourished; the membrane is studded with showing teeth imprints. There is also an excessive secretion of thick tenacious mucus; stomatitis materna. Kreasote is relatively homoeopathic to some cases of stomatitis according to Hughes.
Nitric acid. [Nit-ac]
Acrid saliva, pricking, splinter-like pains, aphthae and whitish gums, raw places in the mouth, corners of the mouth excoriated, the gums are weak unhealthy, bleed easily and have a foul odor. Its mouth symptoms are closely allied to those of Mercurius. Mercurial stomatitis. Muriatic acid. This remedy has deep bluish ulcers in the mouth having dark edges; the mucous membrane is shed. The salivary glands are swollen and tender.
Arsenicum. [Ars]
Gangrenaoris ;Burning and heat in mouth or black sloughing ulcers. The aphthae become livid or bluish and the gums livid and bleeding. It resemblesmainly to severe forms of sloughing ulcers and aphthous sore mouth when happening in exhausting diseases. Salicylic acid. Common canker sores. Lycopodium. Common canker sores near the fraenum. Lachesis, Nitric acid, Phytolacca and Natrumhypochlorosum all have canker sores. Helleborus. Canker with yellowish raised edges. Sulphuric acid. Aphthous sore mouth , with soreness; mouth and tongue covered with blisters, breath offensive and gums are white. Kali phosphoricum 3X ,Borax,is,In canker sore mouth.Merc, Argentum nitricum.Nervous , dyspeptic flatulent persons where there is considerable ulceration. Foetor and ptyalism are also present with spongy feeling in gums.
Diet and Management
Day (1-3)
· Take 3 mosumbi (Lime)juice,
· Three glasses of coconut water daily,
· Vegetable soup,
· Fruit juices (POMEGRANATE),
· Take khichdi (Rice meal),
· Dalhiya (Pourage),
· Sooji kheer,
Electrolytes or Namak chinni drink like shikhanji (Lemon water)….
COCONUT WATER is of prime importance as it have ( anti fungal, anti bacterial, anti viral component in it).Patient should take only liquid diet during illness.
AVOID any solid food ,spicy and deep fried foods ,drinking caffeinated beverages ,smoking and consuming alcohol as these can further weaken the body defence
MONITOR BODY TEMPERATURE HOURLY, if temperature exceed 102.2F then administer cold compress( take 4 small towels dip them into ice water ,squeeze it & place it on head and on each calf muscle every 3 minutes till the temperature comes to normal.
……..so there is no need to panic during this epidemic, just follow the above guidelines.
References
1. Allen H.C., Keynotes and Characteristics with Comparisons of Some of the Leading Remedies of the Materia Medica with Bowel Nosodes; B. Jain Publishers (P) Ltd.: New Delhi.
2. Allen H.C, The Therapeutics of Intermittent Fever; B. Jain Publishers (P) Ltd.: New Delhi.
3. Boericke W., New Manual of Homeopathic Materia Medica and Repertory with Relationship of Remedies; B. Jain Publishers (P) Ltd.: New Delhi.
