La Chikunguña, en tiempo de huaycos e inundaciones

Oswaldo Herrera (agendapais.com).

Por Dr. Oswaldo Andrés Herrera Cavero

Catedrático de la U. N. M. de S. Marcos

Microbiología, Parasitología, Fisiología,

Biología Celular

Chikunguña (en makonde, chikungunya), significa ‘enfermedad del hombre retorcido’, conocida además como artritis epidémica chikunguña o fiebre de chikunguña, es una enfermedad producida por el virus de tipo alfavirus del mismo nombre, que se transmite a las personas mediante la picadura de los mosquitos portadores Aedes; tanto el Aedes aegypti como el Aedes albopictus.

Aedes aegypti y Aedes albopictus son los nombres científicos de los mosquitos transmisores de varias enfermedades entre las cuales está la chikungunya. Estos mosquitos o “zancudos”, que realiza gran parte de su ciclo biológico en aguas estancadas (charcos, recipientes con agua de lluvia, llantas, botellas, etc. que contengan agua estancada), se reproducen en aguas estancadas.

Lamentablemente en estos tiempos de lluvias abundantes que causan desbordes de los ríos que vienen de la serranía a la costa o litoral pacífico, se forman grandes cantidades de aguas estancadas, lo cual aprovecha el zancudo, para reproducirse en gran cantidad, invadiendo poblaciones humanas, y trayendo consigo los virus causantes de varias enfermedades.

El virus chikunguña (abrev.: CHIK) se transmite de manera similar al que produce la fiebre del dengue y el sika, y causa una enfermedad con una fase febril aguda que dura de 2 a 5 días, seguida de un período de dolores en las articulaciones de las extremidades; este dolor puede persistir semanas, meses o incluso durante años en un porcentaje que puede rondar el 12 % de los casos.

La mejor forma de prevención es el control general del mosquito; además, evitar las picaduras de mosquitos infectados. Hasta la fecha no hay un tratamiento específico, pero existen medicamentos que se pueden usar para reducir los síntomas. El reposo y la ingesta de líquidos también pueden ser útiles.

El chikunguña puede dar solo una vez. Después se desarrollan anticuerpos que se encargarán de proteger a las personas enfermas y, de acuerdo con evidencias disponibles hasta el momento, la inmunidad sería de por vida.

Los síntomas se parecen a una crisis de paludismo o de dengue aunque la fiebre de chikungunya no tiene nada que ver con estas enfermedades. La enfermedad empieza con una fuerte fiebre, a veces superior a los 40 °C, que dura 3 días. A esta fiebre le sigue un eritema y, durante 5 días, agujetas muy dolorosas en las articulaciones. Estos dolores articulares pueden permanecer o reaparecer hasta varios meses después de la primera crisis.

Debe sospecharse por el cuadro clínico antes mostrado, y el contexto epidemiológico de cada paciente que presente la sintomatología anteriormente descrita así como otros factores desencadenantes del virus, como contacto con infectados, viajes a zonas que hayan declarado la epidemia, viajes a zonas endémicas, el contacto directo con contagiados, hemotransfusiones, entre otros. El diagnóstico certero se debe hacer por hemoaglutinación indirecta o con una prueba ELISA.

El período de incubación del virus de la chikunguña varía entre cuatro y doce días, pero más típico entre tres y siete días. La enfermedad puede ser asintomática, pero por lo general, entre el 72% y el 97% de los infectados, desarrollan síntomas. Los síntomas característicos incluyen un inicio súbito de fiebre alta, dolor en articulaciones y rash. Otros síntomas podrían presentarse, como dolor de cabeza, fatiga, problemas digestivos y conjuntivitis. Información obtenida durante recientes epidemias sugieren que la fiebre de la chikunguña podría resultar en una fase crónica de enfermedad aguda.

Dentro de la fase aguda, dos etapas se han identificado: una etapa viral durante los primeros cinco a siete días, durante los cuales podría presentarse la viremia, seguido de una etapa de convalecencia de aproximadamente diez días de duración, en los cuales los síntomas empeoran y el virus no puede detectarse en la sangre. Usualmente, la enfermedad empieza con una fiebre alta repentina con duración entre tres a siete días, pero podría llegar a durar diez días.

La fiebre se presenta por encima de 39 °C (102 °F) y algunas veces alcanzando 40 °C (104 °F) y podría ser bifásico (Una enfermedad bifásica es una enfermedad que tiene dos fases distintas) —durando un par de días, cortándose, y luego regresando. La fiebre se produce con el inicio de la viremia, el nivel de virus en la sangre se correlaciona con la intensidad de los síntomas en la fase aguda. Cuando la “inmunoglobina m” y los anticuerpos que, como respuesta a la exposición inicial a un antígeno, aparecen en la sangre, la viremia empieza a disminuir.

No obstante, el dolor de cabeza, insomnio y un extremo grado de cansancio continúan, usualmente entre cinco y siete días. Después de la fiebre, se presenta un fuerte dolor de articulaciones o rigidez; usualmente dura semanas o meses pero puede durar incluso años. El dolor de articulaciones puede ser debilitante, resultando a menudo en casi una inmovilidad total de las articulaciones afectadas. El dolor en articulaciones ha sido reportado en ocurrir entre el 87%–98% de los casos, y casi siempre se presenta en más de una articulación, aunque la inflamación articular es poco común. Usualmente las articulaciones afectadas están ubicadas en ambos brazos y piernas, y son afectadas simétricamente. Las articulaciones que han sufrido alguna otra enfermedad, como la artritis, son más propensas a ser afectadas nuevamente.

El dolor se produce con mayor frecuencia en articulaciones periféricas, o que son las más usadas, como podrían ser las muñecas, tobillos, articulaciones en manos y pies, así otras articulaciones mayores como hombros, codos y rodillas. El dolor también puede presentarse en músculos y ligamentos. El Rash ocurre en el 40%-50% de los casos, generalmente como una erupción maculopapular (Una erupción maculopapular es un tipo de erupción cutánea caracterizada por una zona roja plana en la piel que se cubre con pequeñas protuberancias confluentes. Sólo puede aparecer de color rojo en las personas de piel más clara) que ocurre entre dos y cinco días después del inicio de los síntomas.

Pueden presentarse síntomas digestivos, incluyendo dolor abdominal, náuseas, vómito o diarrea. En más de la mitad de los casos los síntomas se limitan a fatiga significativa y dolor. Con poca frecuencia, puede producirse inflamación de los ojos como iridociclitis, o uveítis, y pueden producirse lesiones en la retina. En raras ocasiones, trastornos neurológicos han sido reportados en asociación con el virus de la chikunguña como síndrome de Guillain-Barré, parálisis, meningoencefalitis, parálisis flácida y neuropatía. Al contrario del dengue, la fiebre de la chikunguña, muy raras veces causa complicaciones hemorrágicas. Los síntomas de sangrado deben conducir a la consideración de diagnósticos alternativos o co-infección con el dengue o la coexistencia de hepatopatía congestiva.

Como ya mencioné, hasta la actualidad, no existe tratamiento específico, solamente se trata de amenguar los síntomas con desinflamantes y anestésicos comunes, hasta que termine el ciclo de vida del virus.

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