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Serfaty A, Mendonça S, Canella C, Marchiori E. Detection of musculoskeletal inflammatory lesions in patients with chronic chikungunya infection using 3T whole-body magnetic resonance imaging. Rev Soc Bras Med Trop 2024; 57:e004062024. [PMID: 38808799 PMCID: PMC11136507 DOI: 10.1590/0037-8682-0090-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Musculoskeletal inflammatory lesions in chronic Chikungunya virus (CHIKV) infection have not been thoroughly assessed using whole-body magnetic resonance imaging (WBMRI). This study aimed to determine the prevalence of these lesions in such patients. METHODS From September 2018 to February 2019, patients with positive Chikungunya-specific serology (Immunoglobulin M/Immunoglobulin G anti-CHIKV), with a history of polyarthralgia for > 6 months prior to MRI with no pre-existing rheumatic disorders, underwent 3T WBMRI and localized MRI. The evaluation focused on musculoskeletal inflammatory lesions correlated with chronic CHIKV infection. Pain levels were assessed using a visual analogue scale on the same day as WBMRI. RESULTS The study included 86 patients of whom 26 met the inclusion criteria. All patients reported pain and most (92.3%) categorized it as moderate or severe. The most common finding across joints was effusion, particularly in the tibiotalar joint (57.7%) and bursitis, with the retrocalcaneal bursa most affected (48.0%). Tenosynovitis was prevalent in the flexor compartment of the hands (44.2%), while Kager fat pad and soleus edema were also observed. Bone marrow edema-like signals were frequently seen in the sacroiliac joints (19.2%). Most WBMRI findings were classified as mild. CONCLUSIONS This study represents the first utilization of 3T WBMRI to assess musculoskeletal inflammatory disorders in chronic CHIKV infection. The aim was to identify the most affected joints and prevalent lesions, providing valuable insights for future research and clinical management of this condition regarding understanding disease pathophysiology, developing targeted treatment strategies, and using advanced imaging techniques in the assessment of musculoskeletal manifestations.
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Affiliation(s)
- Aline Serfaty
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Medscanlagos Diagnóstico por imagem, Cabo Frio, RJ, Brasil
| | - Silvana Mendonça
- Clínica de Diagnóstico por Imagem CDPI, Rio de Janeiro, RJ, Brasil
| | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Amaral JK, Taylor PC, Schoen RT. Bone erosions and joint damage caused by chikungunya virus: a systematic review. Rev Soc Bras Med Trop 2024; 57:e00404. [PMID: 38597523 PMCID: PMC11000508 DOI: 10.1590/0037-8682-0433-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Chikungunya fever is an emerging global infection transmitted by Aedes mosquitoes that manifests as an acute febrile illness with joint pain and can lead to chronic arthritis. The mechanism underlying chronic joint damage remains unclear; however, chronic chikungunya arthritis shares similarities with rheumatoid arthritis. Disease-modifying antirheumatic drugs have revolutionized rheumatoid arthritis treatment by preventing joint damage. However, the role of these therapies in chronic chikungunya arthritis has not been determined. We conducted a systematic review to evaluate the burden of joint structural damage in chronic chikungunya arthritis to help to define the role of disease-modifying therapy in this disease. METHODS This systematic review included retrospective and prospective studies, trials, and case reports evaluating joint damage caused by chikungunya virus. Various databases were searched without any date or language restrictions. Study selection was conducted independently by two researchers, and data were extracted from the articles selected. RESULTS A total of 108 studies were initially evaluated, with 8 meeting the inclusion criteria. Longitudinal studies have reported persistent joint pain from chikungunya infection and the progression of radiographic joint damage up to 13 years post-infection. Joint imaging revealed synovial inflammation, bone erosion, and cartilage destruction in patients with chronic chikungunya arthritis. CONCLUSIONS Few studies have addressed chikungunya-induced joint damage, limiting our understanding of chronic chikungunya arthritis. Nevertheless, chronic chikungunya arthritis has similarities to rheumatoid arthritis. The success of early disease-modifying antirheumatic drug therapy in rheumatoid arthritis underscores the need for comprehensive research on its role in chikungunya arthritis.
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Affiliation(s)
- José Kennedy Amaral
- Instituto de Medicina Diagnóstica do Cariri, Departamento de Reumatologia, Juazeiro do Norte, CE, Brasil
| | - Peter Charles Taylor
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
| | - Robert Taylor Schoen
- Yale University, School of Medicine, Section of Rheumatology, New Haven, Connecticut, United States of America
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Caetano CCS, Azamor T, Meyer NM, Onwubueke C, Calabrese CM, Calabrese LH, Visperas A, Piuzzi NS, Husni ME, Foo SS, Chen W. Mechanistic insights into bone remodelling dysregulation by human viral pathogens. Nat Microbiol 2024; 9:322-335. [PMID: 38316931 PMCID: PMC11045166 DOI: 10.1038/s41564-023-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/12/2023] [Indexed: 02/07/2024]
Abstract
Bone-related diseases (osteopathologies) associated with human virus infections have increased around the globe. Recent findings have highlighted the intricate interplay between viral infection, the host immune system and the bone remodelling process. Viral infections can disrupt bone homeostasis, contributing to conditions such as arthritis and soft tissue calcifications. Osteopathologies can occur after arbovirus infections such as chikungunya virus, dengue virus and Zika virus, as well as respiratory viruses, such as severe acute respiratory syndrome coronavirus 2 and enteroviruses such as Coxsackievirus B. Here we explore how human viruses dysregulate bone homeostasis, detailing viral factors, molecular mechanisms, host immune response changes and bone remodelling that ultimately result in osteopathologies. We highlight model systems and technologies to advance mechanistic understanding of viral-mediated bone alterations. Finally, we propose potential prophylactic and therapeutic strategies, introduce 'osteovirology' as a research field highlighting the underestimated roles of viruses in bone-related diseases, and discuss research avenues for further investigation.
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Affiliation(s)
- Camila C S Caetano
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamiris Azamor
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikki M Meyer
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chineme Onwubueke
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Cassandra M Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Leonard H Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Anabelle Visperas
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Suan-Sin Foo
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Weiqiang Chen
- Infection Biology Program, Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort. PLoS Negl Trop Dis 2023; 17:e0011037. [PMID: 36608155 PMCID: PMC9851532 DOI: 10.1371/journal.pntd.0011037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/19/2023] [Accepted: 12/18/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. METHODOLOGY/PRINCIPAL FINDINGS We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). CONCLUSION This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health.
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Leidersnaider CL, Sztajnbok FR, Coutinho ESF, Vaz JLP, Porangaba M, Hamdan PC, Martins PH, Constantino CPL, Ancillotti RV, Messeder AM, Monteiro DG, Folly MM, Mogami R. Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:865-873. [PMID: 34170018 DOI: 10.1002/jum.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.
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Affiliation(s)
| | | | | | - João Luiz Pereira Vaz
- Department of Rheumatology, Federal University of the State of Rio de Janeiro, Brazil
| | - Marina Porangaba
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Cesar Hamdan
- Department of Rheumatology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Mayara Malta Folly
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto Mogami
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Hossain S, Choudhury MR, Islam MA, Hassan MM, Yeasmin S, Hossain F, Zaman MM. Post-chikungunya arthritis: a longitudinal study in a tertiary care hospital in Bangladesh. Trop Med Health 2022; 50:21. [PMID: 35260197 PMCID: PMC8903658 DOI: 10.1186/s41182-022-00412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objective To identify the clinical patterns and consequences of post-chikungunya arthritis was the study's objective. Methods This longitudinal study was carried out among 143 Chikungunya virus (CHIKV) infected adult patients at the rheumatology department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the outbreak of CHIKV infection in 2017. The disease was categorized into three phases: acute or febrile (lasting up to 10 days), subacute (11–90 days), and chronic (> 90 days). Patients who progressed towards the chronic phase were followed up to 1-year. Post-CHIKV de novo chronic inflammatory rheumatisms (CIRs) were characterized by persistent mono or oligoarthritis, undifferentiated polyarthritis, or meet the criteria rheumatoid arthritis (RA) or Spondyloarthritis (SpA). In addition, functional status was assessed by the validated Bangla version of the Health Assessment Questionnaire (HAQ). Results Mean age was 43.3 ± 11.5 years, and 51.0% were male. Within 1-year follow-up, 60 (41.9%) patients were suffering from arthralgia/ arthritis. Of them 52 patients did not have any pre-existing arthralgia/arthritis. 35 (65.3%) had undifferentiated arthritis, 10 (19.2%) had SpA, and 7 (13.5%) had RA. Patients with pre-existing rheumatological disorders, 6(4.2%) had SpA, 1(0.7%) had RA and 1(0.7%) had osteoarthritis. Polyarthralgia (n = 33, 55.0%) and polyarthritis (n = 20, 33.3%) were the main presentations. Female gender (OR: 0.45; CI: 0.21–0.96), positive IgG (OR: 0.30; CI: 0.12–0.76), and moderate to severe functional disability (OR: 3.46; CI: 1.62–7.40) were independent predictors of developing chronic post-CHIKV rheumatism. Conclusions At 1-year follow-up, more than one-third of the patients remained symptomatic. Female gender, positive IgG, and moderate to severe functional disability contributed to the development of chronicity.
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Rheumatic manifestations of Chikungunya virus infection: Prevalence, patterns, and enthesitis. PLoS One 2021; 16:e0249867. [PMID: 33886579 PMCID: PMC8062098 DOI: 10.1371/journal.pone.0249867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Chikungunya virus (CHIKV) is an arthropod-borne virus transmitted by mosquitoes of the genus Aedes. CHIKV infection causes various rheumatic symptoms, including enthesitis; however, these effects are rarely investigated. The aim of this study was to describe the rheumatic manifestations in CHIKV infection, estimate the prevalence of enthesitis in CHIKV-infected patients, and determine the factors associated with CHIKV-induced enthesitis. We conducted a prospective, observational study in patients with CHIKV infection confirmed by positive RT-PCR or IgM assay from October 2019 to March 2020. Patients with pre-existing inflammatory rheumatic diseases were excluded. A rheumatologist evaluated the demographic and clinical characteristics of the patients, including the number of inflamed joints, enthesitis sites, tendinitis, and tenosynovitis. The Leeds enthesitis index (LEI) and the Maastricht ankylosing spondylitis enthesis score (MASES) were used to evaluate enthesitis sites. Factors associated with enthesitis were determined using logistic regression analysis. One hundred and sixty-four participants diagnosed with CHIKV infection were enrolled. The mean (SD) age of the patients was 48.2 (14) years. The most common pattern of rheumatic manifestations was polyarthritis with or without enthesitis. Enthesitis was observed in 63 patients (38.4%). The most common site of enthesitis was the left lateral epicondyle as assessed by LEI and the posterior superior iliac spine as assessed by MASES. Multivariate analysis indicated that the number of actively inflamed joints and Thai-HAQ score at the initial evaluation were significantly associated with the presence of enthesitis. The main rheumatic manifestations of CHIKV infection were arthritis/arthralgia, with enthesitis as a prominent extraarticular feature. CHIKV infection can cause enthesitis at peripheral and axial sites. We found that enthesitis was associated with a high number of inflamed joints and reduced physical function. These results indicate that the assessment of enthesitis should be considered when monitoring disease activity and as a treatment response parameter in CHIKV-infected patients.
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Abstract
Alphaviruses, members of the enveloped, positive-sense, single-stranded RNA Togaviridae family, represent a reemerging public health threat as mosquito vectors expand into new geographic territories. The Old World alphaviruses, which include chikungunya virus, Ross River virus, and Sindbis virus, tend to cause a clinical syndrome characterized by fever, rash, and arthritis, whereas the New World alphaviruses, which consist of Venezuelan equine encephalitis virus, eastern equine encephalitis virus, and western equine encephalitis virus, induce encephalomyelitis. Following recovery from the acute phase of infection, many patients are left with debilitating persistent joint and neurological complications that can last for years. Clues from human cases and studies using animal models strongly suggest that much of the disease and pathology induced by alphavirus infection, particularly atypical and chronic manifestations, is mediated by the immune system rather than directly by the virus. This review discusses the current understanding of the immunopathogenesis of the arthritogenic and neurotropic alphaviruses accumulated through both natural infection of humans and experimental infection of animals, particularly mice. As treatment following alphavirus infection is currently limited to supportive care, understanding the contribution of the immune system to the disease process is critical to developing safe and effective therapies.
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Affiliation(s)
- Victoria K Baxter
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark T Heise
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Davenport BJ, Bullock C, McCarthy MK, Hawman DW, Murphy KM, Kedl RM, Diamond MS, Morrison TE. Chikungunya Virus Evades Antiviral CD8 + T Cell Responses To Establish Persistent Infection in Joint-Associated Tissues. J Virol 2020; 94:e02036-19. [PMID: 32102875 PMCID: PMC7163133 DOI: 10.1128/jvi.02036-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/14/2020] [Indexed: 02/06/2023] Open
Abstract
Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes explosive epidemics of a febrile illness characterized by debilitating arthralgia and arthritis that can endure for months to years following infection. In mouse models, CHIKV persists in joint tissues for weeks to months and is associated with chronic synovitis. Using a recombinant CHIKV strain encoding a CD8+ T cell receptor epitope from ovalbumin, as well as a viral peptide-specific major histocompatibility complex class I tetramer, we interrogated CD8+ T cell responses during CHIKV infection. Epitope-specific CD8+ T cells, which were reduced in Batf3-/- and Wdfy4-/- mice with known defects in antigen cross-presentation, accumulated in joint tissue and the spleen. Antigen-specific ex vivo restimulation assays and in vivo killing assays demonstrated that CD8+ T cells produce cytokine and have cytolytic activity. Despite the induction of a virus-specific CD8+ T cell response, the CHIKV burden in joint-associated tissues and the spleen were equivalent in wild-type (WT) and CD8α-/- mice during both the acute and the chronic phases of infection. In comparison, CD8+ T cells were essential for the control of acute and chronic lymphocytic choriomeningitis virus infection in the joint and spleen. Moreover, adoptive transfer of virus-specific effector CD8+ T cells or immunization with a vaccine that induces virus-specific effector CD8+ T cells prior to infection enhanced the clearance of CHIKV infection in the spleen but had a minimal impact on CHIKV infection in the joint. Collectively, these data suggest that CHIKV establishes and maintains a persistent infection in joint-associated tissue in part by evading CD8+ T cell immunity.IMPORTANCE CHIKV is a reemerging mosquito-transmitted virus that in the last decade has spread into Europe, Asia, the Pacific Region, and the Americas. Joint pain, swelling, and stiffness can endure for months to years after CHIKV infection, and epidemics have a severe economic impact. Elucidating the mechanisms by which CHIKV subverts antiviral immunity to establish and maintain a persistent infection may lead to the development of new therapeutic strategies against chronic CHIKV disease. In this study, we found that CHIKV establishes and maintains a persistent infection in joint-associated tissue in part by evading antiviral CD8+ T cell immunity. Thus, immunomodulatory therapies that improve CD8+ T cell immune surveillance and clearance of CHIKV infection could be a strategy for mitigating chronic CHIKV disease.
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Affiliation(s)
- Bennett J Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher Bullock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary K McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David W Hawman
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth M Murphy
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Howard Hughes Medical Institute, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ross M Kedl
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas E Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Abstract
Purpose of Review Emerging infectious diseases have seen a record increase in prevalence, and understanding their management is critical in an increasingly global community. In this paper, we review current literature detailing the role of radiology in the diagnosis and treatment of the Ebola (EVD), Zika (ZVD), Chikungunya (CHIKF), H1N1, Middle East Respiratory (MERS), and Severe Acute Respiratory Syndrome (SARS) viruses. Recent Findings Complex protocols are required to safely use portable imaging in EVD to prevent nosocomial spread of disease. In ZVD, antenatal ultrasound can detect fetal abnormalities early, allowing implementation of care and support to affected families. Imaging is useful in assessing the extent of involvement of chronic CHIKF and monitoring treatment effect. Chest radiography and CT play a more direct role in the diagnosis and monitoring of the viral infections with primarily respiratory manifestations (H1N1, MERS, and SARS). Summary Radiology plays a variable role in emerging infectious diseases, requiring an understanding of disease transmission and safe imaging practices, as well as imaging features that affect clinical management.
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Affiliation(s)
- Meghan Jardon
- 1Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA USA.,3Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, University of California Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095 USA
| | - Shaden F Mohammad
- 2Department of Radiological Sciences, Olive View - UCLA Medical Center, Sylmar, CA USA
| | - Cecilia M Jude
- 2Department of Radiological Sciences, Olive View - UCLA Medical Center, Sylmar, CA USA
| | - Anokh Pahwa
- 2Department of Radiological Sciences, Olive View - UCLA Medical Center, Sylmar, CA USA
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Ultrasound in the Limited-Resource Setting: A Systematic Qualitative Review. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Blettery M, Brunier L, Banydeen R, Derancourt C, de Bandt M. Management of acute-stage chikungunya disease: Contribution of ultrasonographic joint examination. Int J Infect Dis 2019; 84:1-4. [PMID: 30930186 DOI: 10.1016/j.ijid.2019.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Chikungunya (CHIKV) is an arbovirus that causes acute, debilitating polyarthritis. Its diagnosis can be difficult for clinicians not used to managing joint diseases or detecting synovitis. Joint Doppler ultrasonography (DUS) is a simple, non-invasive examination, able to visualize synovitis. Its diagnostic and prognostic value in rheumatoid arthritis is well-established. METHODS Patients with serologically proven acute arbovirosis where included. Clinical examination and joint count were performed (DAS score). Ultrasound examination was performed by another clinician - experienced in joint DUS - who also performed ultrasound joint score. Joints were examined by DUS in B-mode looking for: subcutaneous infiltration, effusion, tenosynovitis, erosion and Doppler signal. RESULTS In our experience, joint DUS is able to detect effusions in 92.8% of painful joints, with 28.3% of the effusions emitting a high-power Doppler signal. No erosion was observed. Subcutaneous inflammatory infiltration of the ankles (aseptic cellulitis) was found in 28.6% of patients. CONCLUSION Joint DUS is able to detect objective signs responsible for joint pain, which can be useful for practitioners not accustomed to this type of pathology. It also makes possible distinction between articular and periarticular manifestations.
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Affiliation(s)
- Marie Blettery
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Lauren Brunier
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Rishika Banydeen
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Christian Derancourt
- Unit of Epidemiology and Biostatistics (USMR), Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France
| | - Michel de Bandt
- Unit of Rheumatology, University Hospital Fort-de-France, Centre Hospitalier de Martinique (CHUM), route de Chateauboeuf, 97200 Fort-de-France, France.
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Mogami R, Sztajnbock F, Koifman ACB, Vieira ADA, Torezan RS, De Abreu MM, Chagas YDFB, Vaz JLP. Ultrasonography and Power Doppler Studies in Chikungunya Disease: Comment on the Article by Chang et al. Arthritis Rheumatol 2018. [DOI: 10.1002/art.40477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Roberto Mogami
- State University of Rio de Janeiro; Rio de Janeiro Brazil
| | | | | | | | | | | | | | - João L. P. Vaz
- Federal University of Rio de Janeiro; Rio de Janeiro Brazil
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McCarthy MK, Davenport BJJ, Morrison TE. Chronic Chikungunya Virus Disease. Curr Top Microbiol Immunol 2018; 435:55-80. [DOI: 10.1007/82_2018_147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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