Emerging Infectious Diseases: Chandipura Virus symptoms and treatment

Emerging infectious diseases pose a significant threat to global health, and the Chandipura virus (CHPV) is one such pathogen that has garnered attention in recent years. This article delves into the symptoms and treatment of CHPV, providing a comprehensive overview based on current research.

Chandipura virus: An insight

Chandipura virus is named after the town of Chandipura in Maharashtra, India, where it was first isolated in 1965. The virus belongs to the Rhabdoviridae family. It is primarily transmitted through sandflies (Phlebotomus species) and has been responsible for several outbreaks in India, posing a severe public health concern, especially among children.1,2The 2003-2004 Chandipura virus outbreaks in Central India showed higher death rate, ranging from 56-75% in Andhra Pradesh and Gujarat exhibiting encephalitic symptoms.3

Chandipura Virus Symptoms

The clinical presentation of CHPV infection can be rapid and severe. The incubation period ranges from 2 to 10 days, after which the following symptoms may manifest:

1. Fever: High-grade fever is often one of the earliest symptoms.
2. Neurological Symptoms: Patients can develop encephalitic symptoms, including seizures, altered mental status, and coma. These neurological manifestations, such as abnormal reflexes of toes and deep tendons, abnormalities associated with a pupil of the eye, and abnormalities related to the tone of the muscles, are particularly concerning as they can lead to rapid deterioration.
3. Gastrointestinal Symptoms: Vomiting may also be present.
4. Skin Lesions: Rashes with swelling and fluid can also be seen in some cases, which later get hyperpigmented upon healing.4,5

Chandipura Virus Diagnosis

Early diagnosis of CHPV is crucial for effective management. Laboratory confirmation is typically achieved through:

1. RT-PCR: Detection of viral RNA using reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard.
2. Serology: Enzyme-linked immunosorbent assay (ELISA) can detect specific antibodies against CHPV.
3. Virus Isolation: Though less common due to its complexity, virus isolation in cell cultures remains a definitive diagnostic method. Techniques like the immunofluorescent antibody technique were performed to detect the presence of CHPVin brain tissues during the 2003 outbreak.3,6

Chandipura Virus Treatment

Currently, there is no specific antiviral treatment for CHPV. Management is primarily supportive and symptomatic, focusing on the following aspects:

1. Fever and Pain Management: Antipyretics like acetaminophen can be used to manage fever and pain.
2. Hydration: Intravenous fluids may be necessary to prevent dehydration, especially in patients with severe vomiting.
3. Seizure Control: Anticonvulsants are administered to control seizures.
4. Intensive Care: Patients with severe neurological symptoms often need intensive care for close monitoring and management of complications.
5. Antiviral treatment: Antiviral medications for CHPV are still being researched. Although broad-spectrum antiviral ribavirin has demonstrated some efficacy in lab tests, its clinical use for treating CHPV is still debatable.
6. Immunotherapy: Preclinical research on passive immunotherapy, which involves the administration of neutralizing antibodies, has shown encouraging results in managing CHPV infections. A few research studies have established that monoclonal antibodies can target CHPV glycoprotein, which, in turn, can neutralize the virus and stop its transmission.
7. Vaccines: Although no vaccine has been approved yet, various investigations are underway to develop a vaccine against the virus. Several vaccination approaches are being investigated currently, including recombinant viral proteins, inactivated vaccines, and live-attenuated vaccines. Ensuring both efficacy and safety, particularly in young children, is one of the problems in vaccine development.4,5,7

Chandipura Virus Prevention

Preventing CHPV infection hinges on reducing exposure to sandfly bites. This can be achieved through:

1. Insect Repellents: Use of insect repellents on exposed skin.
2. Protective Clothing: Wearing long-sleeved shirts and pants to minimize skin exposure.
3. Insecticide-Treated Nets: Utilizing bed nets treated with insecticides, especially in endemic regions.
4. Environmental Control: Reducing sandfly breeding sites by managing waste and maintaining clean surroundings.7,8

 However, maintaining sanitary conditions has become a challenge in areas with ongoing construction, as the sandflies breed in damp places inside crevices of stone used for construction where insecticide spraying is usually not feasible. Another practice of the people living in the endemic areas is smearing cow dung on the walls and floors of their homes and storing dried sheets of cow dung within their homes as feed, which acts as a breeding and resting ground for sandfly larvae; thus, warranting the need of awareness among dwellers.3

DISEASE PREPAREDNESS IN INDIA

The Ministry of Health and Family Welfare, Govt of India, has taken the following prevention and control measures:

• Deployment of National Joint Outbreak Response Team (NJORT): A specialized team has been sent to help the state government of Gujarat carry out comprehensive epidemiological investigations and public health measures.
• Health and awareness campaigns: There are programs in place to educate the public and medical professionals about the virus, its symptoms, and how to avoid it.
• Research and monitoring: The Gujarat Biotechnology Research Centre (GBRC) is carefully monitoring the issue and is aggressively identifying more viruses that cause encephalitis.
• Vector control measures: Comprehensive fumigation and insecticidal spraying are being done to manage the virus's vectors, i.e., sandflies.
• Advisories and coordination: Joint advisories from the National Centre for Disease Control (NCDC) and the National Centre for Vector Borne Diseases Control (NCVBDC) are being issued to guide neighboring states in reporting cases of encephalitis.7

Conclusion

Chandipura virus remains a critical public health challenge due to its potential for rapid spread and severe neurological impact. While no specific antiviral treatment is available, supportive care can significantly improve patient outcomes. Prevention strategies focusing on reducing sandfly exposure are essential in mitigating the risk of infection. Ongoing research and surveillance are vital to understand better and combat this emerging infectious disease.