Dual infection by chikungunya virus and other imported infectious agent in a traveller returning from India

Chikungunya Virus Disease: An Emerging Challenge for the Rheumatologist

Chikungunya is caused by an alphavirus that is transmitted to humans via the Aedes species mosquito. Chikungunya is endemic to tropical Africa and South and Southeast Asia, but over the past decade, the geographic distribution of the virus has been expanding rapidly. The disease is characterized by fever and severe polyarthritis, and although symptoms typically resolve within 7 to 10 days, some patients experience persistent arthritis and arthralgias for months to years.In December 2013, the first local transmission of chikungunya virus in the Americas was identified in the Caribbean Island of Saint Martin. Since then, the number of afflicted individuals has spread throughout the Caribbean and Central America, as well as into South America. The United States reported 2788 chikungunya virus disease cases among travelers returning from affected areas in 2014. In addition, 11 locally acquired cases were reported in Florida. Further spread and establishment of the disease in the Americas are likely considering the high levels of viremia in infected individuals, widespread distribution of effective vectors, lack of immunity among people living in the Americas, and the popularity of international travel.Considering the prominent rheumatic manifestations of chikungunya, rheumatologists are likely to encounter patients with the disease in their practice. We recommend that rheumatologists consider chikungunya in their differential diagnosis when evaluating patients presenting with fever and joint pain following travel to a chikungunya endemic area. Early diagnosis would ensure timely management and reduction of polypharmacy and its associated complications. In this article, we briefly describe the epidemiology of chikungunya, the clinical features, laboratory testing, prevention, and treatment of disease.

Chikungunya virus-vector interactions

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that causes chikungunya fever, a severe, debilitating disease that often produces chronic arthralgia. Since 2004, CHIKV has emerged in Africa, Indian Ocean islands, Asia, Europe, and the Americas, causing millions of human infections. Central to understanding CHIKV emergence is knowledge of the natural ecology of transmission and vector infection dynamics. This review presents current understanding of CHIKV infection dynamics in mosquito vectors and its relationship to human disease emergence. The following topics are reviewed: CHIKV infection and vector life history traits including transmission cycles, genetic origins, distribution, emergence and spread, dispersal, vector competence, vector immunity and microbial interactions, and co-infection by CHIKV and other arboviruses. The genetics of vector susceptibility and host range changes, population heterogeneity and selection for the fittest viral genomes, dual host cycling and its impact on CHIKV adaptation, viral bottlenecks and intrahost diversity, and adaptive constraints on CHIKV evolution are also discussed. The potential for CHIKV re-emergence and expansion into new areas and prospects for prevention via vector control are also briefly reviewed.

Reemergence of Chikungunya virus in Indian Subcontinent

Chikungunya virus (CHIKV), a reemerging arboviral disease of public health concern is characterized by a triad of fever, rash and arthralgia. It was responsible for a number of epidemics in Asia and Africa. The severity of the current epidemic can be judged by the fact that an estimated 1.38 million people in India and one-third of the La Reunion population (by April 2006) were affected by CHIKV. Aedes aegypti and Aedes albopictus are the major mosquitoes transmitting CHIKV in Asia. Various neurological complications and CHIKV associated deaths were encountered during the current outbreak (2005-2010). The aggressive nature of the recent CHIKV epidemic was attributed to the mutations in the viral genome in addition to their adaptation and spread to vectors like Aedes albopictus. Proper diet, adequate rest and symptomatic treatment using non-salicylate analgesics and Non-steroidal anti inflammatory drugs (NSAIDS) helped the patients in recovering from CHIKV infections. In the absence of an effective vaccine, rapid implementation of mosquito control measures and establishment of a system for continuous surveillance of the disease seems to be the only possible solution to prevent any such outbreak in the near future.