Principles of Management

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Mild and moderate cases can be managed at home. Severe cases should be managed at hospital.

A. Home Management

  • Consume plenty of water with electrolytes (approximately 2 litres of home available fluids with salt in 24 hours).
  • Take paracetamol tablets during periods of fever (up to 1000 mg tablets four times daily), in persons with no preexisting liver or kidney disease . Children may be given 50-60 mg per kg body weight per day in divided doses.
  • Adequate rest in a warm environment
  • Cold compresses may help in reducing joint damage. Heat may increase/worsen joint pain and is therefore best to avoid during acute stage.
  • Refrain from exertion. Mild forms of exercise and physiotherapy are recommended in recovering persons.
  • Avoid self medication with aspirin or NSAIDs.
  • Antihistamines can be used for itching.

B. Admission criteria

  1. If the person is hemo-dynamically unstable (frequent syncopal attacks, hypotension with a systolic BP less than 90 mmHg or a pulse pressure less than 30 mmHg),
  2. oliguria (urine output less than 500 ml in 24 hours),
  3. altered sensorium
  4. bleeding manifestations
  5. persons not responding or having persistent joint pain or disabling arthritis even after three days of symptomatic treatment
  6. persons above sixty years
  7. infants (below one year of age)
  8. Pregnancy
  9. High risk Group

C. Hospital management

  • Assess for dehydration and institute proper rehydration therapy.
    (5% DNS, Normal Saline, & baby saline for paediatric cases)
  • Take paracetamol tablets during periods of fever (up to 1000 mg tablets four times daily), in persons with no preexisting liver or kidney disease. Children may be given 50-60 mg per kg body weight per day in divided doses.
  • Antibiotics can be used to treat secondary bacterial infection.
  • Antihistamines can be used for itching.
  • Cold compresses may help in reducing joint damage. Heat may increase/worsen joint pain and is therefore best to avoid during acute stage.
  • Refrain from exertion.
  • Mild forms of exercise and physiotherapy are recommended in recovering persons.
  • Aspirin or NSAIDs should be avoided during first 10 days. NSAIDs can be used in Chikungunya only when Dengue fever is adequately excluded.
  • Cutaneous manifestations with topical or systemic drugs, and neuro-psychiatric problems with specialist care and drugs).
  • Steroid has no role in acute stage.
  • In cases with ophthalmic symptoms complications, consult with ophthalmologists.