Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil

The erasure of infection-associated chronic conditions: Critical interpretive synthesis of literature on healthcare for long COVID and related conditions in Brazil

Evidence is emerging that long COVID is at least as prevalent in the Global South as the Global North, but literature on long COVID healthcare in the Global South is in its infancy. Brazil is seeing significant levels of debility due to long COVID but a limited national evidence-base. long COVID shares symptomatology and appropriate care with a wider category of infection-associated chronic conditions (IACCs). This article reviews literature published between 2000 and 2023 addressing healthcare for long COVID and IACCs in Brazil, in the interest of exploring challenges and opportunities for the SUS (Brazil's universal health system) to offer appropriate long COVID healthcare. We find that long COVID and IACCs collectively are subject to erasure from Brazilian healthcare knowledge, through lack of expertise, a resource-limited health system prioritising urgent care, and the concentration of poor health in marginalised populations with limited decision-making power. A nascent intellectual will to address long COVID, and a tradition of social participation in healthcare governance present potential opportunities. We call for ignition of a global step-change in tackling healthcare for long COVID and IACCs. Global equity in long COVID healthcare requires the development and sharing of expertise regarding its universal and context-specific features.

Unmasking the chik sign: A case report on nasal hyperpigmentation as a diagnostic clue for chikungunya fever

Macular hyperpigmentation of the nasal region, often referred to as the 'chik sign', constitutes a distinctive physical manifestation associated with chikungunya fever. Chikungunya, a mosquito-borne viral illness, presents with acute febrile symptoms, intense arthralgia and cutaneous eruptions. The chik sign serves as a valuable clinical marker for discerning chikungunya from other febrile illnesses with analogous presentations, such as dengue fever and malaria. This differentiation is particularly crucial in endemic regions. Recognition of the chik sign underscores the significance of clinical acumen in diagnosing chikungunya. In conjunction with confirmatory laboratory testing, identification of this sign can augment diagnostic accuracy and guide appropriate therapeutic strategies. Herein, we present the case of a 44-year-old woman with chikungunya virus infection who exhibited acute febrile symptoms, severe polyarthralgia and hyperpigmentation of the nasal region. In conclusion, the chik sign is a crucial clinical marker for identifying chikungunya fever. Its identification can improve diagnostic precision and enable timely care, particularly in places with limited access to laboratory testing. Healthcare professionals should thus be vigilant for this skin pigmentation in patients who exhibit joint pain and feverish symptoms that are indicative of chikungunya virus infection. To further understand the clinical spectrum of chikungunya, more research into the presentation of this pigmentation would be helpful.

High-resolution spatiotemporal analysis of chikungunya epidemics between 2019 and 2020 in Salvador, Brazil: a municipality-level transmission dynamics study

Background

Chikungunya virus (CHIKV) continues to cause explosive epidemics in Brazil. We investigated its transmission dynamics in Salvador, Brazil, to understand the factors driving its reemergence and spread.

Methods

In this epidemiological study, we analyzed by census tracts the chikungunya cases reported in Salvador during the 2019-2020 epidemics. We used SaTScan software to identify spatiotemporal clusters and assessed how census tract characteristics (socioeconomic, environmental, and prior chikungunya occurrence) influenced chikungunya incidence through a Bayesian spatial model using Integrated Laplace Approximation (INLA).

Findings

Citywide, 19,129 cases (mean age: 40.2, range: 0-112; male: 41.8%, female: 58.0%, non-binary: 0.2%) were reported between 2016 and 2020, with a significant increase in 2019 and 2020 (4549 and 13,071 cases, respectively). We found nine spatiotemporal clusters in 2019 and seven in 2020, with 17.2% (387 of 2252) overlap of census tracts between the two years. The chikungunya incidence by census tract was negatively correlated with income and vegetation but positively correlated with land surface temperature. The census tract level incidence in 2020 exhibited a non-linear correlation with the 2019 incidence; up to a certain level, the 2020 risk increased as the 2019 incidence increased, but when the 2019 incidence was extreme, the 2020 risk was reduced.

Interpretation

These findings suggest that CHIKV transmission is localized, even during what appeared to be a citywide epidemic, creating high-risk pockets within the city. Socioeconomic factors, environmental conditions, and prior chikungunya incidence, probably reflecting herd immunity, all influence case incidence.

Funding

Secretary of Health of Salvador, Federal University of Bahia, Oswaldo Cruz Foundation, National Council for Scientific and Technological Development, Foundation for Research Support of the Bahia State, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES), Clinical and Applied Research Network in Chikungunya, Global Virus Network, Burroughs Wellcome Fund, Wellcome Trust, and the United States National Institutes of Health.

Coinfection with chikungunya and Zika results in mild disease and distinct inflammatory response

Chikungunya (CHIKV) and Zika (ZIKV) viruses, both mosquito-borne, often circulate simultaneously, raising concerns about the effects of coinfection. This study evaluated cytokines, chemokines, and growth factors in 12 patients with concurrent CHIKV and ZIKV infections confirmed by RT-qPCR. Clinical data and 45 immune mediators were analyzed. Coinfected and monoinfected patients exhibited similar symptoms, although ZIKV-infected individuals experienced fewer instances of fever. No patients had persistent symptoms or required hospitalization. Chemokines CCL5, CXCL1, and CXCL10 were elevated across all groups. CHIKV-infected patients showed higher levels of CCL2, CCL4, EGF, CXCL12, and IFN-α compared to controls, while IL-1RA, IL-8, and IFN-γ were elevated in both CHIKV and coinfected groups. SCF was elevated only in the ZIKV group. Overall, CHIKV and ZIKV coinfection presented mild clinical symptoms similar to monoinfections and demonstrated a moderate inflammatory response.

IL-17 as a putative hallmark of intense arthralgia and age-related serum immune mediator networks during acute chikungunya fever

INTRODUCTION

The present study aimed at evaluating the systemic profile and network connectivity of immune mediators during acute chikungunya fever (CHIKF) according to days of symptoms onset and ageing.

METHODS

A total of 161 volunteers (76 CHIKF patients and 85 non-infected healthy controls) were enrolled.

RESULTS AND DISCUSSION

Data demonstrated that a massive and polyfunctional storm of serum immune mediators was observed in CHIKF. Distinct patterns of mediators were observed according to days of symptoms onset. Most chemokines and proinflammatory cytokines were increased early at D0-1, with some increased throughout the kinetics timeline, while others presented a waning profile towards D4-12. Rhythmic signatures further underscored these findings. Increased levels IL-17 appeared as a hallmark of intense arthralgia, while CCL5&IL-5 and TNF-α&IL-10 duets are age-tunning features in CHIKF. Differential connectivity of networks was observed with ageing, with a progressive increase in the overall connectivity from < 8 yo towards 51-89 yo. Of note, subsets of immune mediators (IL-17, IL-2 and IL-5) displayed hotspots of hyperconnectivity in elderly as compared to younger patients.

CONCLUSION

Together, the overall scenario reveals unique patterns of soluble immune mediators during acute CHIKF infection with an oscillating symphony according to days of symptoms and ageing, which brings insight to future tailor-made therapeutic interventions.

Safety and immunogenicity of a live-attenuated chikungunya virus vaccine in endemic areas of Brazil: interim results of a double-blind, randomised, placebo-controlled phase 3 trial in adolescents

BACKGROUND

Chikungunya outbreaks have been reported in Brazil since 2014. Adolescents are a sensitive population who would benefit from a prophylactic vaccine. This study assessed the immunogenicity and safety of the vaccine VLA1553 in adolescents in Brazil. With an overall trial duration of 12 months, we now report data on safety and immunogenicity over a period of 28 days after vaccination.

METHODS

In this double-blind, randomised, placebo-controlled phase 3 trial, adolescents aged 12 to <18 years were recruited. The trial was performed at ten trial sites across Brazil. Eligible participants were generally healthy. The main exclusion criteria comprised immune-mediated or chronic arthritis or arthralgia, a known or suspected defect of the immune system, or any live vaccine received within the 4 weeks before trial vaccination. Randomisation was stratified by baseline serostatus in a 2:1 ratio to receive VLA1553 (at a dose of 1 × 104 TCID50 per 0·5 mL [ie, 50% tissue culture infectious dose]) or placebo. VLA1553 or placebo was administered intramuscularly as a single-dose immunisation on day 1. The primary endpoint was the proportion of baseline seronegative participants with chikungunya virus neutralising antibody levels of 150 or more in μPRNT50 (a micro plaque reduction neutralisation test), which was considered a surrogate of protection. The safety analysis included all participants receiving a trial vaccination. Immunogenicity analyses were performed in a subset. The trial is registered with ClinicalTrials.gov, NCT04650399.

FINDINGS

Between Feb 14, 2022, and March 14, 2023, 754 participants received a trial vaccination (502 received VLA1553 and 252 received placebo) with a per-protocol population of 351 participants for immunogenicity analyses (303 in the VLA1553 group and 48 in the placebo group). In participants who were seronegative at baseline, VLA1553 induced seroprotective chikungunya virus neutralising antibody levels in 247 of 250 (98·8%, 95% CI 96·5-99·8) participants 28 days after vaccination. In seropositive participants, the baseline seroprotection rate of 96·2% increased to 100% after vaccination with VLA1553. Most (365 [93%] of 393) adverse events were of mild or moderate intensity, VLA1553 was generally well tolerated. When compared with placebo, participants exposed to VLA1553 had a significantly higher frequency of related adverse events (351 [69·9%] of 502 vs 121 [48·0%] of 252; p<0·0001), mostly headache, myalgia, fatigue, and fever. Among four reported serious adverse events (three in the VLA1553 group and one in the placebo group), one was classified as possibly related to VLA1553: a high-grade fever. Among 20 adverse events of special interest (ie, symptoms suggesting chikungunya-like disease), 16 were classified as related to trial vaccination (15 in the VLA1553 group and one in the placebo group), with severe symptoms reported in four participants (fever, headache, or arthralgia). 17 adverse events of special interest resolved within 1 week. Among 85 participants with arthralgia (68 in the VLA1553 group and 17 in the placebo group), eight adolescents had short-lived (range 1-5 days), mostly mild recurring episodes (seven in the VLA1553 group and one in the placebo group). The median duration of arthralgia was 1 day (range 1-5 days). The frequency of injection site adverse events for VLA1553 was higher than in the placebo group (161 [32%] vs 62 [25%]), but rarely severe (two [<1%] in the VLA1553 group and one [<1%] in the placebo group). After administration of VLA1553, there was a significantly lower frequency of solicited adverse events in participants who were seropositive at baseline compared with those who were seronegative (53% vs 74%; p<0·0001) including headache, fatigue, fever, and arthralgia.

INTERPRETATION

VLA1553 was generally safe and induced seroprotective titres in almost all vaccinated adolescents with favourable safety data in adolescents who were seropositive at baseline. The data support the use of VLA1553 for the prevention of disease caused by the chikungunya virus among adolescents and in endemic areas.

FUNDING

Coalition for Epidemic Preparedness Innovation and EU Horizon 2020.

TRANSLATION

For the Portuguese translation of the abstract see Supplementary Materials section.

Chikungunya chronic arthralgia: impact on general and mental health and absenteeism from work

BACKGROUND

This study investigated the self-rated general health, mental health, and work absenteeism among patients with laboratory-confirmed chikungunya.

METHODS

Telephone interviews were conducted with 63 patients ≥22 months after infection.

RESULTS

Patients who reported (N=42) or did not report (N=21) chronic arthralgia, defined by duration ≥90 days, had different frequencies for low scores for general health (68.3% vs. 30.0%, respectively; prevalence ratio, 95% confidence interval: 2.3, 1.1-4.6), symptoms of depression (31.7% vs. 15.0%; 2.1, 0.7-6.6), symptoms of anxiety (43.9% vs. 35.0%; 1.3, 0.6-2.5), and work absenteeism (76.5% and 40.0%; 1.9, 0.9-4.2).

CONCLUSIONS

Chikungunya chronic arthralgia impacts long-term health and work.

Chikungunya virus E2 B domain nanoparticle immunogen elicits homotypic neutralizing antibody in mice

Alphaviruses are enveloped, positive-sense single-stranded RNA viruses that cause severe human and animal illness. Arthritogenic alphaviruses, such as Chikungunya virus (CHIKV) and Mayaro virus (MAYV), are globally distributed, transmitted by mosquitoes, and can cause rheumatic disease characterized by fever, rash, myalgia, and peripheral polyarthralgia that can persist for years post-infection. These infections can also result in more severe clinical manifestations such as hemorrhage, encephalopathy, and mortality. Several potent monoclonal antibodies (mAbs) with broad neutralizing activity have been shown to bind to the E2 B domain (E2-B) of the alphavirus glycoprotein, suggesting that E2-B epitopes are a site of susceptibility for multiple arthritogenic alphaviruses. However, it is unknown whether E2-B alone can elicit a broadly neutralizing humoral response. Here, we generate and characterize nanoparticle-based immunogens containing CHIKV and MAYV E2-B. Immunization with the CHIKV E2-B nanoparticle elicited sera that were cross-reactive toward CHIKV and MAYV E2-B, but had only homotypic neutralizing activity (serum titer of 1:512) against CHIKV vaccine strain 181/25. Furthermore, immunization with MAYV E2-B nanoparticles elicited non-neutralizing antibody, but sera were cross-reactive for both CHIKV and MAYV E2-B. Our findings suggest that the immunodominant epitopes within CHIKV and MAYV E2-B are bound by cross-reactive, but not cross-neutralizing antibody. Therefore, development of broad E2-B based vaccines that induce broadly neutralizing antibody responses will require engineering to alter the immunodominant landscape.

Strategic vaccination responses to Chikungunya outbreaks in Rome: Insights from a dynamic transmission model

BACKGROUND

Chikungunya virus (CHIKV) outbreaks, driven by the expanding habitat of the Aedes albopictus mosquito and global climate change, pose a significant threat to public health. Our study evaluates the effectiveness of emergency vaccination using a dynamic disease transmission model for a potential large-scale outbreak in Rome, Italy.

METHODS

The model incorporates a susceptible-exposed-infected-recovered (SEIR) framework for human and mosquito populations, taking into account temperature-dependent mosquito lifecycle dynamics, human-mosquito interactions, and various vaccination scenarios.

FINDINGS

Results indicate that emergency vaccination could significantly mitigate the impact of a CHIKV outbreak. Without vaccination, an outbreak is estimated to infect up to 6.21% of Rome's population, equating to approximately 170,762 individuals. Implementing rapid vaccination after detecting the virus in ten individuals and achieving 40% coverage could reduce infection rates by 82%, preventing 139,805 cases. Scenario and sensitivity analyses confirm that even with lower vaccination coverage rates, significant benefits are observed: at 10% coverage, the number of infections drops to 115,231, and at 20% coverage, it further reduces to 76,031. These scenarios indicate prevention of approximately 33% and 55% of infections, respectively.

CONCLUSIONS

The findings highlight the critical role of timely vaccination interventions in outbreak settings, demonstrating that even modest coverage levels can markedly decrease the spread of CHIKV. This study underscores the importance of preparedness, early detection and adaptive response capabilities to manage emerging infectious diseases in urban centres, advocating for strategic vaccine stockpiling and rapid deployment mechanisms to enhance public health outcomes.

Factors Associated with Chronic Chikungunya in Vitória, Espírito Santo State, Brazil, Between 2016 and 2020

Chikungunya patients may develop chronic joint pain that can persist for months to years. This study aimed to determine the factors associated with Chikungunya chronicity. This case-control study involved data from patients with laboratory-confirmed Chikungunya reported from March 2016 to December 2020 in Vitória, Espírito Santo state, Brazil. The data were accessed from compulsory notification databases (SINAN and eSUS VS) and electronic medical reports (Rede Bem-Estar). For each patient who developed chronic symptoms, we included a control patient who did not develop chronic symptoms by random sampling. A total of 183 chronic and 183 non-chronic patients were included in the study. Most of them were female (73.2%), with a median age of 49.5 years (interquartile range = 37-61), and presented fever (89.6%), myalgia (89.6%), arthralgia (89.3%), and headache (82.0%). Chronic patients were older (median = 53; interquartile range = 41-61) than non-chronic cases (median = 46; interquartile age = 31-61) (OR = 0.979, 95% CI = 0.968-0.991) and more frequently presented nausea (58.5% vs. 40.4%; OR = 2.109, 95% CI = 1.374-3.238), and leukopenia (20.2% vs. 10.9%; OR = 2.060, 95% CI = 1.122-3.779). Therefore, these characteristics should be monitored for the better clinical management of cases prone to chronicity.

Sedentary behavior, increasing age, and overweight/obesity increase the presence and intensity of the chronic joint pain in individuals affected by Chikungunya fever

BACKGROUND

Chikungunya fever (CF) is a viral disease, transmitted by alphavirus through Aedes aegypti, and albopictus mosquitoes, affecting several people, mainly in tropical countries, when its transmitter is not under control, and the main symptom of the chronic phase of CF is joint pain.

OBJECTIVES

The primary objective of this study was to observe the prevalence, most affected joints, and intensity of chronic joint pain in individuals affected by CF, and also identify the factors associated with chronic joint pain in these individuals.

METHODS

Cross-sectional study that evaluated one hundred and thirty volunteers, of both sexes, aged between 20-65 years, with a clinical and/or laboratory diagnosis of CF. The presence of joint pain was investigated using the Brazilian version of the Nordic Questionnaire of Musculoskeletal Symptoms and the intensity of pain using the Visual Analogue Scale.

RESULTS

Of the 130 volunteers evaluated, n = 112 (86%) reported currently experiencing chronic joint pain, persistent, for approximately 38.6 ± 1.73 months, with the greatest predominance in the morning (58%). The joints most affected by pain were: the ankles (65.5%), interphalangeal joints of the hands (59.2%), and knees (59.2%). The joints that presented the greatest intensity of pain were: the ankles (5.13 ± 0.34), interphalangeal joints of the hands (4.63 ± 0.34), and knees (4.33 ± 0.33). Sedentary behavior (p = 0.037), increasing age (p = 0.000), and overweight/obesity (p = 0.002) were factors associated with chronic joint pain.

CONCLUSION

A high prevalence of chronic, persistent joint pain was observed, with a greater prevalence in the morning. The joints most affected by chronic pain and with the greatest pain intensity were the ankles, and interphalangeal joints of the hands and knees. Sedentary behavior, increasing age, and overweight/obesity were the factors associated with chronic joint pain in individuals affected by CF in this study. Key Points • Individuals affected by CF had a high prevalence of chronic joint pain, persistent and more prevalent in the mornings • The ankles and interphalangeal joints of the hands and knees were the joints with the highest prevalence of pain • The ankles and interphalangeal joints of the hands and knees were the joints with the greatest pain intensity • Sedentary behavior, increasing age, and overweight/obesity were factors associated with chronic joint pain in individuals affected by CF.

Predictors of chronic joint pain after Chikungunya virus infection in the INOVACHIK prospective cohort study

BACKGROUND

Chikungunya can cause persistent chronic joint pain. Knowledge of the risk factors for disease progression is important for preventing and controlling complications. This study aimed to identify factors associated with chronic joint pain.

METHODS

This prospective cohort study was conducted at a reference center in Rio de Janeiro. Men and women (aged ≥ 18 years) in the acute phase of Chikungunya were included. Clinical data and samples were collected over three months. Risk factors were evaluated using multivariate and logistic regression analyses.

RESULTS

A total of 107 patients were followed up. The incidence rate of joint tenderness was 61.7 %. Female sex (adjusted odds ratio [AOR] 3.24, 95 % confidence interval [CI]:1.07-9.77), diarrhea (AOR 5.08, 95 % CI:1.55-16.67), severe joint pain (AOR 4.26, 95 % CI:1.06-17.06), and CHIKV real-time reverse transcription polymerase chain reaction positivity up to 5 days after the onset of symptoms in urine or saliva (AOR 4.56, 95 % CI:1.41-14.77) were identified as predictors of persistent chronic pain.

CONCLUSIONS

In a predominantly female population, musculoskeletal symptoms are not the sole determinant of chronic pain, and careful evaluation of CHIKV detection in alternative body fluids (such as saliva and urine) during the early phase of the disease is warranted.

Low-Cost Microfluidic Systems for Detection of Neglected Tropical Diseases

Neglected tropical diseases (NTDs) affect tropical and subtropical countries and are caused by viruses, bacteria, protozoa, and helminths. These kinds of diseases spread quickly due to the tropical climate and limited access to clean water, sanitation, and health care, which make exposed people more vulnerable. NTDs are reported to be difficult and inefficient to diagnose. As mentioned, most NTDs occur in countries that are socially vulnerable, and the lack of resources and access to modern laboratories and equipment intensify the difficulty of diagnosis and treatment, leading to an increase in the mortality rate. Portable and low-cost microfluidic systems have been widely applied for clinical diagnosis, offering a promising alternative that can meet the needs for fast, affordable, and reliable diagnostic tests in developing countries. This review provides a critical overview of microfluidic devices that have been reported in the literature for the detection of the most common NTDs over the past 5 years.

Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort

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.

A Novel Sphingosine Kinase Inhibitor Suppresses Chikungunya Virus Infection

Chikungunya virus (CHIKV) is a re-emerging arbovirus in the alphavirus genus. Upon infection, it can cause severe joint pain that can last years in some patients, significantly affecting their quality of life. Currently, there are no vaccines or anti-viral therapies available against CHIKV. Its spread to the Americas from the eastern continents has substantially increased the count of the infected by millions. Thus, there is an urgent need to identify therapeutic targets for CHIKV treatment. A potential point of intervention is the sphingosine-1-phosphate (S1P) pathway. Conversion of sphingosine to S1P is catalyzed by Sphingosine kinases (SKs), which we previously showed to be crucial pro-viral host factor during CHIKV infection. In this study, we screened inhibitors of SKs and identified a novel potent inhibitor of CHIKV infection—SLL3071511. We showed that the pre-treatment of cells with SLL3071511 in vitro effectively inhibited CHIKV infection with an EC50 value of 2.91 µM under both prophylactic and therapeutic modes, significantly decreasing the viral gene expression and release of viral particles. Our studies suggest that targeting SKs is a viable approach for controlling CHIKV replication.

Acute-Phase Levels of CXCL8 as Risk Factor for Chronic Arthralgia Following Chikungunya Virus Infection

The immunopathogenesis of chikungunya virus (CHIKV) infection and the role of acute-phase immune response on joint pain persistence is not fully understood. We investigated the profile of serum chemokine and cytokine in CHIKV-infected patients with acute disease, compared the levels of these biomarkers to those of patients with other acute febrile diseases (OAFD) and healthy controls (HC), and evaluated their role as predictors of chronic arthralgia development. Chemokines and cytokines were measured by flow Cytometric Bead Array. Patients with CHIKV infection were further categorized according to duration of arthralgia (≤ 3 months vs >3 months), presence of anti-CHIKV IgM at acute-phase sample, and number of days of symptoms at sample collection (1 vs 2-3 vs ≥4). Patients with acute CHIKV infection had significantly higher levels of CXCL8, CCL2, CXCL9, CCL5, CXCL10, IL-1β, IL-6, IL-12, and IL-10 as compared to HC. CCL2, CCL5, and CXCL10 levels were also significantly higher in patients with CHIKV infection compared to patients with OAFD. Patients whose arthralgia lasted > 3 months had increased CXCL8 levels compared to patients whose arthralgia did not (p<0.05). Multivariable analyses further indicated that high levels of CXCL8 and female sex were associated with arthralgia lasting >3 months. Patients with chikungunya and OAFD had similar cytokine kinetics for IL-1β, IL-12, TNF, IFN-γ, IL-2, and IL-4, although the levels were lower for CHIKV patients. This study suggests that chemokines may have an important role in the immunopathogenesis of chronic chikungunya-related arthralgia.