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Rama K, de Roo AM, Louwsma T, Hofstra HS, S Gurgel do Amaral G, Vondeling GT, Postma MJ, Freriks RD. Clinical outcomes of chikungunya: A systematic literature review and meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012254. [PMID: 38848443 DOI: 10.1371/journal.pntd.0012254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Chikungunya is a viral disease caused by a mosquito-borne alphavirus. The acute phase of the disease includes symptoms such as fever and arthralgia and lasts 7-10 days. However, debilitating symptoms can persist for months or years. Despite the substantial impact of this disease, a comprehensive assessment of its clinical picture is currently lacking. METHODS We conducted a systematic literature review on the clinical manifestations of chikungunya, their prevalence and duration, and related hospitalization. Embase and MEDLINE were searched with no time restrictions. Subsequently, meta-analyses were conducted to quantify pooled estimates on clinical outcomes, the symptomatic rate, the mortality rate, and the hospitalization rate. The pooling of effects was conducted using the inverse-variance weighting methods and generalized linear mixed effects models, with measures of heterogeneity reported. RESULTS The systematic literature review identified 316 articles. Out of the 28 outcomes of interest, we were able to conduct 11 meta-analyses. The most prevalent symptoms during the acute phase included arthralgia in 90% of cases (95% CI: 83-94%), and fever in 88% of cases (95% CI: 85-90%). Upon employing broader inclusion criteria, the overall symptomatic rate was 75% (95% CI: 63-84%), the chronicity rate was 44% (95% CI: 31-57%), and the mortality rate was 0.3% (95% CI: 0.1-0.7%). The heterogeneity between subpopulations was more than 92% for most outcomes. We were not able to estimate all predefined outcomes, highlighting the existing data gap. CONCLUSION Chikungunya is an emerging public health concern. Consequently, a thorough understanding of the clinical burden of this disease is necessary. Our study highlighted the substantial clinical burden of chikungunya in the acute phase and a potentially long-lasting chronic phase. Understanding this enables health authorities and healthcare professionals to effectively recognize and address the associated symptoms and raise awareness in society.
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Affiliation(s)
- Kris Rama
- Asc Academics B.V., Groningen, Netherlands
| | - Adrianne M de Roo
- Valneva Austria GmbH, Vienna, Austria
- Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - Timon Louwsma
- Asc Academics B.V., Groningen, Netherlands
- Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Division of Pharmacology and Therapy, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Roel D Freriks
- Asc Academics B.V., Groningen, Netherlands
- Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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Rawat SK, Kale D, Nema S, Nema RK, Gupta S, Khadanga S, Biswas D. Detectable Viremia at Presentation Is a Predictor of Disease Severity in Chikungunya. Cureus 2024; 16:e58188. [PMID: 38741833 PMCID: PMC11089836 DOI: 10.7759/cureus.58188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Background Chikungunya is a mosquito-borne re-emerging disease that has caused a significant number of outbreaks recently in diverse geographic settings across the globe. It leads to severe debilitating illness in a significant proportion of persons who are infected. Measures to limit the impact produced by recurrent outbreaks of the disease are limited and there is an urgent clinical need for early identification of those predisposed to develop severe disease. A comprehensive understanding regarding the proportion of individuals predisposed to developing severe disease is lacking as its correlation with detectable viremia is hinted at by some studies. In this context, we hypothesized that detectable viremia reflected in the diagnostic RT-PCR assay could be significantly associated with the development of severe disease in Chikungunya among those diagnosed on the basis of seroconversion. Our study aims to confirm the same in relation to disease severity among the suspected patients of Chikungunya in the setting of a tertiary care center. Methods In a prospective observational study at a tertiary care center, a total number of 1021 Chikungunya suspects presenting within seven days of illness were screened with Chikungunya Virus IgM ELISA from 2021 to 2023. Those having positive IgM results were further tested with RT-PCR in a blinded manner. According to the information entered into the predesigned form and the hospital follow-up/discharge data, the cases where symptoms like fever and joint pain persisted beyond two weeks were classified as severe versus those resolving within two weeks as mild. The patients in each group were compared for their clinical symptoms and association with the disease severity with detectable viremia (RT-PCR positivity). Results We identified a total of 178 (17.4%) lab-confirmed Chikungunya IgM-positive cases amongst the recruited patients. Here a total of 31 (18.9%) cases could be classified as severe and 133 (74.7%) as mild illness, the remaining 14 patients were excluded from analysis due to insufficient clinical data. Severe illness was significantly higher in elderly individuals belonging to more than 60 years (p = 0.01). Viremia was detected in 16 (9%), those with detectable viremia had higher odds (OR = 4.1) of manifesting as severe disease. Among the severe cases, the proportion of cases with RT-PCR positivity (8, 25.8%) at presentation was significantly higher (P = 0.01) versus those who presented with mild disease (7, 5.5%). Conclusion Our study reveals a correlation between detectable viremia in Chikungunya virus (CHIKV) patients and an increased risk of manifesting into a severe disease, where severe cases exhibited a significantly higher proportion of viremia, indicated by RT-PCR positivity. This study hints at the presence of viremia, joint symptoms, and elderly age as potentially useful clinical predictors of disease outcomes, these may serve as indicators for closer monitoring among individuals seeking medical attention due to Chikungunya infection. However, we need to validate these findings in future longitudinal studies incorporating multiple, time-bound follow-up data on clinical outcomes, viral titers, and its long-term complications.
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Affiliation(s)
- Sumit K Rawat
- Microbiology, Bundelkhand Medical College, Sagar, IND
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Dipesh Kale
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Shashwati Nema
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ram K Nema
- Molecular Biology, Indian Council of Medical Research (ICMR) National Institute for Research in Environmental Health, Bhopal, IND
| | - Sudheer Gupta
- Next-Generation Sequencing (NGS) & Bioinformatics Division, 3B Blackbio Dx Ltd., Bhopal, IND
| | - Sagar Khadanga
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Debasis Biswas
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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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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Manzoor KN, Javed F, Ejaz M, Ali M, Mujaddadi N, Khan AA, Khattak AA, Zaib A, Ahmad I, Saeed WK, Manzoor S. The global emergence of Chikungunya infection: An integrated view. Rev Med Virol 2021; 32:e2287. [PMID: 34428335 DOI: 10.1002/rmv.2287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
Chikungunya virus (CHIKV) is one of the emerging viruses around the globe. It belongs to the family Togaviridae and genus Alphavirus and is an arthropod borne virus that transmits by the bite of an infected mosquito, mainly through Aedes aegypti and Aedes albopcitus. It is a spherical, enveloped virus with positive single stranded RNA genome. It was first discovered during 1952-53 in Tanganyika, after which outbreaks were documented in many regions of the world. CHIKV has two transmission cycles; an enzootic sylvatic cycle and an urban cycle. CHIKV genome contains 11,900 nucleotides and two open reading frames and shows great sequence variability. Molecular mechanisms of virus host-cell interactions and the pathogenesis of disease are not fully understood. The disease involves three phases; acute, post-acute and chronic with symptoms including high-grade fever, arthralgia, macupapular rashes and headache. There is no licensed vaccine or specific treatment for CHIKV infection. This lack of specific interventions combined with difficulties in making a precise diagnosis together make the disease difficult to manage. In this review we aim to present the current knowledge of global epidemiology, transmission, structure, various aspects of diagnosis as well as highlight potential antiviral drugs and vaccines against CHIKV.
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Affiliation(s)
| | - Farakh Javed
- Department of Biomedical Sciences, Pak-Autria Fachhochschule: Institute of Applied Sciences & Technology, Haripur, Pakistan
| | - Muhammad Ejaz
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Mubashar Ali
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Neelam Mujaddadi
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Abid Ali Khan
- Institute of Precision Medicine, Hochschule Furtwangen University, Furtwangen im Schwarzwald, Germany
| | - Aamer Ali Khattak
- Department of Medical Lab Technology, The University of Haripur, Haripur, Pakistan
| | - Assad Zaib
- Department of Medical Lab Technology, The University of Haripur, Haripur, Pakistan
| | - Ibrar Ahmad
- Center for Human Genetics, Hazara University, Mansehra, Pakistan
| | - Waqar Khalid Saeed
- Department of Biomedical Sciences, Pak-Autria Fachhochschule: Institute of Applied Sciences & Technology, Haripur, Pakistan
| | - Sobia Manzoor
- Atta-ur-Rehman school of applied biosciences, National University of science and Technology, Islamabad, Pakistan
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Bertolotti A, Thioune M, Abel S, Belrose G, Calmont I, Césaire R, Cervantes M, Fagour L, Javelle É, Lebris C, Najioullah F, Pierre-François S, Rozé B, Vigan M, Laouénan C, Cabié A. Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique): A prospective cohort study. PLoS Negl Trop Dis 2020; 14:e0007327. [PMID: 32163420 PMCID: PMC7100975 DOI: 10.1371/journal.pntd.0007327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/27/2020] [Accepted: 12/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity. METHODOLOGY/PRINCIPAL FINDINGS A total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5-59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4-32.2, p = 0.04). CONCLUSIONS This cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders. TRIAL REGISTRATION clinicaltrials.gov (NCT01099852).
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Affiliation(s)
- Antoine Bertolotti
- INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France
- CHU de la Réunion, service de maladies infectieuses-médecine interne-dermatologie, Saint Pierre, France
| | - Marême Thioune
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Sylvie Abel
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
| | - Gilda Belrose
- CHU de Martinique, Centre de ressource biologique de la Martinique, Fort-de-France, France
| | | | - Raymond Césaire
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Minerva Cervantes
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
| | - Laurence Fagour
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Émilie Javelle
- Hôpital d’instruction des Armées Laveran, service de pathologie infectieuse et tropicale, Marseille, France; Aix Marseille Université, Institut de Recherche pour le Développement (IRD); Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME); Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Catherine Lebris
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Fatiha Najioullah
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | | | - Benoît Rozé
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Marie Vigan
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Cédric Laouénan
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - André Cabié
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
- INSERM, CIC1424, CHU de Martinique, Fort-de-France, France
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Cerny T, Schwarz M, Schwarz U, Lemant J, Gérardin P, Keller E. The Range of Neurological Complications in Chikungunya Fever. Neurocrit Care 2018; 27:447-457. [PMID: 28741102 DOI: 10.1007/s12028-017-0413-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chikungunya fever is a globally spreading mosquito-borne disease that shows an unexpected neurovirulence. Even though the neurological complications have been a major cause of intensive care unit admission and death, to date, there is no systematic analysis of their spectrum available. OBJECTIVE To review evidence of neurological manifestations in Chikungunya fever and map their epidemiology, clinical spectrum, pathomechanisms, diagnostics, therapies and outcomes. METHODS Case report and systematic review of the literature followed established guidelines. All cases found were assessed using a 5-step clinical diagnostic algorithm assigning categories A-C, category A representing the highest level of quality. Only A and B cases were considered for further analysis. After general analysis, cases were clustered according to geospatial criteria for subgroup analysis. RESULTS Thirty-six of 1196 studies were included, yielding 130 cases. Nine were ranked as category A (diagnosis of Neuro-Chikungunya probable), 55 as B (plausible), and 51 as C (disputable). In 15 cases, alternative diagnoses were more likely. Patient age distribution was bimodal with a mean of 49 years and a second peak in infants. Fifty percent of the cases occurred in patients <45 years with no reported comorbidity. Frequent diagnoses were encephalitis, optic neuropathy, neuroretinitis, and Guillain-Barré syndrome. Neurologic conditions showing characteristics of a direct viral pathomechanism showed a peak in infants and a second one in elder patients, and complications and neurologic sequelae were more frequent in these groups. Autoimmune-mediated conditions appeared mainly in patients over 20 years and tended to show longer latencies and better outcomes. Geospatial subgrouping of case reports from either India or Réunion revealed diverging phenotypic trends (Réunion: 88% direct viral vs. India: 81% autoimmune). CONCLUSIONS Direct viral forms of Neuro-Chikungunya seem to occur particularly in infants and elderly patients, while autoimmune forms have to be also considered in middle-aged, previously healthy patients, especially after an asymptomatic interval. This knowledge will help to identify future Neuro-Chikungunya cases and to improve outcome especially in autoimmune-mediated conditions. The genetics of Chikungunya virus might play a key role in determining the course of neuropathogenesis. With further research, this could prove diagnostically significant.
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Affiliation(s)
- T Cerny
- Neurointensive Care Unit, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - M Schwarz
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - U Schwarz
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Lemant
- Intensive Care Unit, CHU de la Réunion, Saint Pierre, Réunion, France
| | - P Gérardin
- INSERM CIC 1410, CHU de la Réunion, Saint Pierre, Réunion, France.,CNRS 9192, INSERM U1187, IRD 249, CHU Réunion, Unité Mixte 134 Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CYROI, Université de La Réunion, Sainte-Clotilde, Réunion, France
| | - E Keller
- Neurointensive Care Unit, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Abstract
PURPOSE OF REVIEW Chikungunya virus (CHIKV) is a mosquito-borne alphavirus. Fever, rash and severe arthralgia are the hallmarks of chikungunya fever (CHIKF), the disease caused by this virus. The acute course of the disease usually lasts few weeks to months. Chronic, relapsing or persistent arthralgia and arthritis have been described mimicking rheumatoid arthritis (RA), requiring immunosuppressive drugs.The purpose of this review is to characterize both the chronic clinical course of CHIKF-associated arthritis and the immunological pathogenic mechanisms involved. RECENT FINDINGS The effect of postepidemic chronic persistent rheumatic course on the functional status of affected individuals, affecting large populations, has been studied. One-third of affected individuals had persistent pain months to years postepidemic and the identified risk factors for functional disability were identified.Inflammatory biomarkers associated with disease severity of RA such as interleukin 6 (IL6), and relevant chemokines have been found to correlate with the severity of postepidemic chronic disease. There are conflicting reports on antinuclear antibodies (ANAs) as well as rheumatoid factor and anti-citrullinated peptide antibody (ACPA) sero-positivity during infections.According to a recent study, eight out of 10 infected individuals developed chronic persistent rheumatic course and met classification criteria for seronegative RA.In a flow cytology analyses, these eight patients, similar to a group of RA patients, had a greater percentage of activated and effector CD4 and CD8 T cells than healthy controls. SUMMARY Patients with CHKV infections may have a chronic persistent course of musculoskeletal disease, overlapping clinical and immunologic features with RA patients. In the appropriate setting and awareness, CHIKV infection should be considered when a patient is evaluated with a new symmetric polyarthritis.The question to be raised: Is it possible that in genetic prone individuals and in a particular environmental and infectious setting, such as CHIKF outbreak, an autoimmune disease will emerge?
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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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Abstract
Chikungunya virus (CHIKV) is an arbovirus transmitted by Aedes mosquitos in tropical and subtropical regions across the
world. After decades of sporadic outbreaks, it re-emerged in Africa, Asia, India
Ocean and America suddenly, causing major regional epidemics recently and becoming a
notable global health problem. Infection by CHIKV results in a spectrum of clinical
diseases including an acute self-limiting febrile illness in most individuals, a
chronic phase of recurrent join pain in a proportion of patients, and long-term
arthralgia for months to years for the unfortunate few. No specific anti-viral drugs
or licensed vaccines for CHIKV are available so far. A better understanding of
virus-host interactions is essential for the development of therapeutics and
vaccines. To this end, we reviewed the existing knowledge on CHIKV’s epidemiology,
clinical presentation, molecular virology, diagnostic approaches, host immune
response, vaccine development, and available animal models. Such a comprehensive
overview, we believe, will shed lights on the promises and challenges in CHIKV
vaccine development.
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Arbovirus Adaptation: Roles in Transmission and Emergence. CURRENT CLINICAL MICROBIOLOGY REPORTS 2017. [DOI: 10.1007/s40588-017-0068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Naqvi S, Bashir S, Rupareliya C, Shams A, Giyanwani PR, Ali Z, Qamar F, Kumar V, Talib V. Clinical Spectrum of Chikungunya in Pakistan. Cureus 2017; 9:e1430. [PMID: 28924518 PMCID: PMC5587410 DOI: 10.7759/cureus.1430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Chikungunya fever is a pandemic disease caused by an arthropod-borne chikungunya virus (CHIKV). The virus spreads through mosquitoes. This mosquito induced viral illness is clinically suspected on symptoms from fever and severe polyarthralgia. The recent outbreak of chikungunya was reported in November 2016 in the metropolitan city Karachi, Pakistan. We emphasis on the awareness of the etiology and vector control to prevent serious consequences. Method A total number of 1275 patients were included in this cross-sectional study. These patients were enrolled based on clinical findings described by Centers for Disease Control and Prevention (CDC). Our exclusion criteria were patients with missing data or having co-infection with dengue or malaria. The patients were tested for chikungunya antibodies, malaria, and dengue. The patients were followed for three months. Results Out of 1275 consenting patients from the emergency department, 564 tested positive for chikungunya antibodies and out of these 564 patients 365 had co-infection of dengue and malaria. So based on exclusion criteria, 199 patients had isolated chikungunya infection and were studied for the frequency of clinical symptoms. The most common finding was joint pain and fever on presentation and joint pain was the only chronic finding which persisted. Conclusion Our study demonstrated the frequency of clinical findings in chikungunya infection. It also signifies the importance of testing for antibodies because it helped in excluding patients with false positive clinical findings and differentiating co-infection with malaria and dengue. It also gauged patient's view about the cause of this disease.
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Affiliation(s)
- Syeda Naqvi
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | | | | | - Abdullah Shams
- Internal Medicine, CMH Lahore Medical and Dental College
| | | | - Zeeshan Ali
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | - Faiza Qamar
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | - Vijesh Kumar
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | - Vikash Talib
- Accident & Emergency, Jinnah Sindh Medical University (SMC)
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Brito CAAD, Sohsten AKAV, Leitão CCDS, Brito RDCCMD, Valadares LDDA, Fonte CAMD, Mesquita ZBD, Cunha RV, Luz K, Leão HMC, Brito CMD, Frutuoso LCV. Pharmacologic management of pain in patients with Chikungunya: a guideline. Rev Soc Bras Med Trop 2017; 49:668-679. [PMID: 28001212 DOI: 10.1590/0037-8682-0279-2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022] Open
Abstract
From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.
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Affiliation(s)
| | - Ana Karla Arraes von Sohsten
- Instituto de Tratamento da Dor, Real Hospital Português de Beneficência em Pernambuco, Recife, Pernambuco, Brazil
| | | | | | | | | | - Zelina Barbosa de Mesquita
- Departamento de Pediatria, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Rivaldo Venâncio Cunha
- Departamento de Infectologia, Universidade Federal de Mato Grosso do Sul, Campo grande, Mato Groso do Sul, Brazil.,Fundação Oswaldo Cruz, Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Kleber Luz
- Departamento de Infectologia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Helena Maria Carneiro Leão
- Escola Superior de Ética e Bioética, Conselho Regional de Medicina de Pernambuco, Recife, Pernambuco, Brazil
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14
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van Aalst M, Nelen CM, Goorhuis A, Stijnis C, Grobusch MP. Long-term sequelae of chikungunya virus disease: A systematic review. Travel Med Infect Dis 2017; 15:8-22. [PMID: 28163198 DOI: 10.1016/j.tmaid.2017.01.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The acute phase of chikungunya is well documented; less so are its long-term effects. This systematic literature review provides an overview of the currently available data. METHODS We performed an electronic search in PubMed/Medline and checked reference lists. We included studies in English on long-term sequelae of chikungunya in adults and on long-term sequelae of congenital infection from 2000 to 2016. Case reports, reviews and studies with a follow-up shorter than 6 weeks were excluded. RESULTS In total, 37 studies were included; with follow-up periods ranging from 1.5 to 72 months. Most studies were questionnaire-based studies only, in which clinical diagnoses such as arthritis, alopecia and depression were mostly recorded without professional verification. Persisting arthralgia/arthritis (arthralgia/joint stiffness plus joint swelling) was the most frequent problem encountered. Further frequently mentioned sequelae were alopecia and depression. Quality of life was reduced in many for months to years after the acute phase of chikungunya. Female gender, older age, some co-morbidities and the severity of the acute phase were associated with persistent arthralgia. Congenital infection was associated with neurocognitive dysfunctioning in early childhood. CONCLUSION Chikungunya leads to (self-perceived) long-term sequelae in a considerable proportion of patients, impacting significantly on quality of life. Long-term chikungunya sequelae must be taken into account when dealing with this disease because of its important effect on public and individual health. Prospective large-scale, long-term studies with objective assessment of signs and symptoms attributed to the disease are needed to optimally quantify and qualify these problems.
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Affiliation(s)
- Mariëlle van Aalst
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Charlotte Marieke Nelen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Cornelis Stijnis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD1100 Amsterdam, The Netherlands.
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15
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Feldstein LR, Ellis EM, Rowhani-Rahbar A, Halloran ME, Ellis BR. The First Reported Outbreak of Chikungunya in the U.S. Virgin Islands, 2014-2015. Am J Trop Med Hyg 2016; 95:885-889. [PMID: 27402523 PMCID: PMC5062794 DOI: 10.4269/ajtmh.16-0288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/06/2016] [Indexed: 01/15/2023] Open
Abstract
The chikungunya virus (CHIKV) epidemic in the Americas is of significant public health importance due to the lack of effective control and prevention strategies, severe disease morbidity among susceptible populations, and potential for persistent arthralgia and long-term impaired physical functionality. Using surveillance data of suspected CHIKV cases, we describe the first reported outbreak in the U.S. Virgin Islands. CHIKV incidence was highest among individuals aged 55-64 years (13.1 cases per 1,000 population) and lowest among individuals aged 0-14 years (1.8 cases per 1,000 population). Incidence was higher among women compared to men (6.6 and 5.0 cases per 1,000 population, respectively). More than half of reported laboratory-positive cases experienced fever lasting 2-7 days, chills/rigor, myalgia, anorexia, and headache. No clinical symptoms apart from the suspected case definition of fever ≥ 38°C and arthralgia were significantly associated with being a reported laboratory-positive case. These results contribute to our knowledge of demographic risk factors and clinical manifestations of CHIKV disease and may aid in mitigating future CHIKV outbreaks in the Caribbean.
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Affiliation(s)
- Leora R Feldstein
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Esther M Ellis
- U.S. Virgin Islands Department of Health, Saint Croix, U.S. Virgin Islands
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Center for Inference and Dynamics of Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Brett R Ellis
- U.S. Virgin Islands Department of Health, Saint Croix, U.S. Virgin Islands
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16
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Uthappa CK, Allam RR, Gunti D, Nalini C, Udaragudi PR, Tadi GP, Murhekar MV. Chikungunya outbreak in Atmakur village, Medak district, Telangana State, India. Indian J Med Res 2016; 142 Suppl:S108-10. [PMID: 26905235 PMCID: PMC4795340 DOI: 10.4103/0971-5916.176637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Manoj V Murhekar
- National Institute of Epidemiology, Chennai 600 077, Tamil Nadu, India
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17
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Cunha BA, Gran A, Klein NC. Fever and Prominent Arthralgia in a Traveler who Returned from Amazonia: Differentiating between Dengue Fever and Chikungunya Fever. Infect Chemother 2015; 47:123-4. [PMID: 26157592 PMCID: PMC4495272 DOI: 10.3947/ic.2015.47.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Burke A. Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, USA
- State University of New York School of Medicine Stony Brook, New York, USA
| | - Arthur Gran
- Infectious Disease Division, Winthrop-University Hospital, Mineola, USA
| | - Natalie C. Klein
- Infectious Disease Division, Winthrop-University Hospital, Mineola, USA
- State University of New York School of Medicine Stony Brook, New York, USA
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