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Management of chikungunya arthritis. Clin Rheumatol 2017; 36:2179-2186. [PMID: 28776302 DOI: 10.1007/s10067-017-3766-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022]
Abstract
Chikungunya fever (CHIKF) is an emerging viral infection that has spread widely, along with its Aedes vectors, throughout the tropics and beyond, causing explosive epidemics of both acute illness and persistent disabling arthritis. There is an urgent need to mitigate the devastating impact of this illness, through vector control, personal protection, and possibly vaccine development. There is also a need to improve treatment for both acute illness and chronic arthritis. In this review, we will review the emergence of CHIK, what is known about pathogenesis and clinical manifestations, and then focus on current understanding of how to treat individual patients, in particular, those who develop chronic arthritis.
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Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57 Suppl 2:421-437. [PMID: 28751131 DOI: 10.1016/j.rbre.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/22/2017] [Indexed: 01/26/2023] Open
Abstract
Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.
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Abstract
Chikungunya virus (CHIKV) has been involved in epidemics in African and Asian subcontinents and, of late, has transcended to affect the Americas. Aedes aegypti and Aedes albopictus are the major vectors for CHIKV infection, which results in dissemination of virus to various vital organs. Entry of virus into these tissues causes infiltration of innate immune cells, monocytes, macrophages, neutrophils, natural killer cells, and adaptive immune cells. Macrophages bearing the replicating virus, in turn, secrete pro-inflammatory cytokines IL-1β, TNF-α, and IL-17. Together, this pro-inflammatory milieu induces osteoclastogenesis, bone loss, and erosion. CHIKV is characterized by fever, headache, myalgia, rash, and symmetric polyarthritis, which is generally self-limiting. In a subset of cases, however, musculoskeletal symptoms may persist for up to 3-5 years. Viral culture and isolation from blood cells of infected patients are the gold standards for diagnosis of CHIKV. In routine practice, however, assays for anti-CHIKV IgM antibodies are used for diagnosis, as elevated levels in blood of infected patients are noted from 10 days following infection for up to 3-6 months. Early diagnosis of CHIKV is possible by nucleic acid detection techniques. Treatment of acute CHIKV is mainly symptomatic, with analgesics, non-steroidal anti-inflammatory agents (NSAIDs), and low-dose steroids. No vaccines or anti-viral medicines have been approved for clinical therapy in CHIKV as yet. Hydroxychloroquine and methotrexate have been used in chronic CHIKV infection with variable success.
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Martí-Carvajal A, Ramon-Pardo P, Javelle E, Simon F, Aldighieri S, Horvath H, Rodriguez-Abreu J, Reveiz L. Interventions for treating patients with chikungunya virus infection-related rheumatic and musculoskeletal disorders: A systematic review. PLoS One 2017; 12:e0179028. [PMID: 28609439 PMCID: PMC5469465 DOI: 10.1371/journal.pone.0179028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background Chikungunya virus infection (CHIKV) is caused by a mosquito-borne alphavirus. CHIKV causes high fever and painful rheumatic disorders that may persist for years. Because little is known about interventions for treating CHIKV-related illness, we conducted a systematic review. Methods We used Cochrane methods. We searched PubMed, EMBASE, Cochrane Library, LILACS and other sources from the earliest records to March 2016. We had no language restrictions. We included randomized controlled trials assessing any intervention for treating acute or chronic CHIKV-related illness. Our primary outcomes were pain relief, global health status (GHS) or health related quality of life (HRQL), and serious adverse events (SAEs). We assessed bias risk with the Cochrane tool and used GRADE to assess evidence quality. Results We screened 2,229 records and found five small trials with a total of 402 participants. Patients receiving chloroquine (CHQ) had better chronic pain relief than those receiving placebo (relative risk [RR] 2.67, 95% confidence interval [CI] 1.23 to 5.77, N = 54), but acute pain relief was marginally not different between groups (mean difference [MD] 1.46, 95% CI 0.00 to 2.92, N = 54). SAEs were similar (RR = 15.00, 95% CI 0.90 to 250.24, N = 54). Comparing CHQ with paracetamol (PCM), CHQ patients had better pain relief (RR = 1.52, 95% CI 1.20 to 1.93, N = 86). Compared with hydroxychloroquine (HCHQ), disease-modifying anti-rheumatic drugs (DMARDs) reduced pain (MD = -14.80, 95% CI -19.12 to -10.48, N = 72). DMARDs patients had less disability (MD = -0.74, 95% CI -0.92 to -0.56, N = 72) and less disease activity (MD = -1.35; 95% CI -1.70 to -1.00; N = 72). SAEs were similar between DMARDs and HCHQ groups (RR = 2.84, 95% CI 0.12 to 67.53, N = 72). Comparing meloxicam (MXM) with CHQ, there was no difference in pain relief (MD = 0.24, 95% CI = -0.81 to 1.29; p = 0.65, N = 70), GHS or HRQL (MD = -0.31, 95% CI -2.06 to 1.44, N = 70) or SAEs (RR = 0.85, 95% CI 0.30 to 2.42, N = 70). Finally, a four-arm trial (N = 120) compared aceclofenac (ACF) monotherapy to ACF+HCHQ, ACF+ prednisolone (PRD), or ACF+HCHQ+PRD. Investigators found reduced pain (p<0.001) and better HRQL (p<0.001) in the two patient groups receiving PRD, compared to those receiving ACF monotherapy or ACF+HCHQ. Trials were at high risk of bias. GRADE evidence quality for all outcomes was very low. Conclusion Results from these small trials provide insufficient evidence to draw conclusions about the efficacy or safety of CHIKV interventions. Physicians should be cautious in prescribing and policy-makers should be cautious in recommending any intervention reviewed here. Rigorous trials with sufficient statistical power are urgently needed, with results stratified by disease stage and symptomology.
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Affiliation(s)
| | - Pilar Ramon-Pardo
- Communicable Diseases and Health Analysis (CHA), Pan American Health Organization, Washington DC, United States of America
- * E-mail:
| | - Emilie Javelle
- Hôpital d’Instruction des Armées Alphonse Laveran, Marseille, France
| | - Fabrice Simon
- Hôpital d’Instruction des Armées Alphonse Laveran, Marseille, France
| | - Sylvain Aldighieri
- PAHO Health Emergencies Department (PHE), Pan American Health Organization, Washington DC, United States of America
| | - Hacsi Horvath
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Julia Rodriguez-Abreu
- Knowledge Management, Bioethics and Research (KBR), Pan American Health Organization, Washington DC, United States of America
| | - Ludovic Reveiz
- Knowledge Management, Bioethics and Research (KBR), Pan American Health Organization, Washington DC, United States of America
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Murillo-Zamora E, Mendoza-Cano O, Trujillo-Hernández B, Sánchez-Piña RA, Guzmán-Esquivel J. Persistent arthralgia and related risks factors in laboratory-confirmed cases of Chikungunya virus infection in Mexico. Rev Panam Salud Publica 2017; 41:e72. [PMID: 28614481 PMCID: PMC6645375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/10/2016] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE To estimate the cumulative incidence of persistent arthralgia at 6 months from acute Chikungunya virus (CHIKV) infection and to evaluate the association of clinical markers with the risk of long-term arthralgia. METHODS This multicenter retrospective cohort study was conducted in the Mexican state of Colima. A total of 136 individuals aged 15 years and older with serologically confirmed CHIKV infection were enrolled. Participants were interviewed at 6 months from the onset of symptoms, and self-reported persistent arthralgia (PA) was the main binary outcome. A self-report numeric rating scale (NRS) ranging from 0 to 10 was used to estimate the severity of articular pain. RESULTS The cumulative incidence of PA was 41.9%. Severe pain (NRS ≥ 7) presented in 36.8% of participants with PA. In multiple analysis, individuals aged 40 years and older (risk ratio (RR) = 1.60; 95% confidence interval (CI), 1.03-2.48) and those with articular pain at 3 months post-infection (RR = 3.95; 95% CI, 1.95-8.01) had a significantly increased risk of PA at 6 months from CHIKV infection. CONCLUSIONS To the best of our knowledge, this is first report of a CHIKV-associated long-term outcome in Mexico, where the incidence of the infection has been high. This is also the first study in Latin America evaluating several factors associated with the risk of PA. Our findings may be useful in health care settings to stratify the risk of chronic arthralgia secondary to CHIKV infection and to identify patients who would benefit clinically from early medical intervention.
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Affiliation(s)
- Efrén Murillo-Zamora
- University of Colima, School of MedicineDoctorate in Health Science programColimaMexicoUniversity of Colima, School of Medicine, Doctorate in Health Science program, Colima, Colima, Mexico.
| | - Oliver Mendoza-Cano
- University of Colima, School of Civil Engineering, CoquimatlanUniversity of Colima, School of Civil Engineering, CoquimatlanColimaMexicoUniversity of Colima, School of Civil Engineering, Coquimatlan, Colima, Mexico.
| | - Benjamín Trujillo-Hernández
- University of Colima, School of Medicine, ColimaUniversity of Colima, School of Medicine, ColimaColimaMexicoUniversity of Colima, School of Medicine, Colima, Colima, Mexico.
| | - Ramón Alberto Sánchez-Piña
- Harvard University, T.H. Chan School of Public HealthCenter for Health and the Global EnvironmentBostonMassachusettsUnited States of AmericaHarvard University, T.H. Chan School of Public Health, Center for Health and the Global Environment, Boston, Massachusetts, United States of America.
| | - José Guzmán-Esquivel
- Mexican Institute of Social SecurityClinical Epidemiology Research UnitColimaMassachusettsMexicoMexican Institute of Social Security, Clinical Epidemiology Research Unit, Colima, Colima, Mexico.
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Mendoza-Cano O, Murillo-Zamora E, Trujillo-Hernández B, Sánchez-Piña RA, Guzmán-Esquivel J. Persistent arthralgia and related risks factors in laboratory-confirmed cases of Chikungunya virus infection in Mexico. Rev Panam Salud Publica 2017. [PMID: 28614481 PMCID: PMC6645375 DOI: 10.26633/rpsp.2017.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. To estimate the cumulative incidence of persistent arthralgia at 6 months from acute Chikungunya virus (CHIKV) infection and to evaluate the association of clinical markers with the risk of long-term arthralgia. Methods. This multicenter retrospective cohort study was conducted in the Mexican state of Colima. A total of 136 individuals aged 15 years and older with serologically confirmed CHIKV infection were enrolled. Participants were interviewed at 6 months from the onset of symptoms, and self-reported persistent arthralgia (PA) was the main binary outcome. A self-report numeric rating scale (NRS) ranging from 0 to 10 was used to estimate the severity of articular pain. Results. The cumulative incidence of PA was 41.9%. Severe pain (NRS ≥ 7) presented in 36.8% of participants with PA. In multiple analysis, individuals aged 40 years and older (risk ratio (RR) = 1.60; 95% confidence interval (CI), 1.03-2.48) and those with articular pain at 3 months post-infection (RR = 3.95; 95% CI, 1.95-8.01) had a significantly increased risk of PA at 6 months from CHIKV infection. Conclusions. To the best of our knowledge, this is first report of a CHIKV-associated longterm outcome in Mexico, where the incidence of the infection has been high. This is also the first study in Latin America evaluating several factors associated with the risk of PA. Our findings may be useful in health care settings to stratify the risk of chronic arthralgia secondary to CHIKV infection and to identify patients who would benefit clinically from early medical intervention.
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Affiliation(s)
- Oliver Mendoza-Cano
- University of Colima, School of Civil Engineering, Coquimatlan, Colima, Mexico
| | - Efrén Murillo-Zamora
- University of Colima, School of Medicine, Doctorate in Health Science program, Colima, Colima, Mexico
| | | | - Ramón Alberto Sánchez-Piña
- Harvard University, T.H. Chan School of Public Health, Center for Health and the Global Environment, Boston, Massachusetts, United States of America
| | - José Guzmán-Esquivel
- Mexican Institute of Social Security, Clinical Epidemiology Research Unit, Colima, Colima, Mexico
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Nawas ZY, Tong Y, Kollipara R, Peranteau AJ, Woc-Colburn L, Yan AC, Lupi O, Tyring SK. Emerging infectious diseases with cutaneous manifestations: Viral and bacterial infections. J Am Acad Dermatol 2017; 75:1-16. [PMID: 27317512 DOI: 10.1016/j.jaad.2016.04.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/16/2022]
Abstract
Given increased international travel, immigration, and climate change, bacterial and viral infections that were once unrecognized or uncommon are being seen more frequently in the Western Hemisphere. A delay in diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. We review the epidemiology, cutaneous manifestations, diagnosis, and management of these emerging bacterial and viral diseases.
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Affiliation(s)
| | - Yun Tong
- Center for Clinical Studies, Houston, Texas
| | - Ramya Kollipara
- Department of Dermatology, Texas Tech Health Sciences Center, Lubbock, Texas
| | | | - Laila Woc-Colburn
- Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Albert C Yan
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Omar Lupi
- Federal University of the State of Rio de Janeiro and Policlinica Geral do Rio de Janeiro, Rio de Janerio, Brazil
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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Eyer-Silva WDA, Pinto HDB, Silva GARD, Ferry FRDA. A case of chikungunya virus disease presenting with remarkable acute arthritis of a previously damaged finger joint. Rev Soc Bras Med Trop 2017; 49:790-792. [PMID: 28001232 DOI: 10.1590/0037-8682-0204-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/08/2016] [Indexed: 11/21/2022] Open
Abstract
Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.
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Affiliation(s)
- Walter de Araujo Eyer-Silva
- Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Guilherme Almeida Rosa da Silva
- Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Raphael de Almeida Ferry
- Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Mejía CR, López-Vélez R. Tropical arthritogenic alphaviruses. ACTA ACUST UNITED AC 2017; 14:97-105. [PMID: 28365217 DOI: 10.1016/j.reuma.2017.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
Tropical alphaviruses have special tropism for bone and joint tissue. Patients can develop chronic rheumatic disorders similar to rheumatoid arthritis and ankylosing spondylitis. The prototype is Chikungunya virus, although other lesser known viruses in our environment such as Sindbis, Ross River, Mayaro, O'nyong nyong and Barmah Forest viruses have the potential to be sped through vectors and cause chronic rheumatic disease. International population movements have increased the numbers of patients diagnosed with these tropical viruses in areas in which they are not endemic. Since they can leave persistent symptoms and affect the quality of life of the patients, it is important that we be aware of them. Changes in ecosystems have favored the expansion of competent mosquitoes, making fears of local transmission in southern Europe a reality. The objective of this review is to provide a clinical approach to the different arthritogenic tropical alphaviruses, especially those in which chronic rheumatic disease is more frequent.
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Affiliation(s)
- Carla-Ruth Mejía
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rogelio López-Vélez
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
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Silva LA, Dermody TS. Chikungunya virus: epidemiology, replication, disease mechanisms, and prospective intervention strategies. J Clin Invest 2017; 127:737-749. [PMID: 28248203 PMCID: PMC5330729 DOI: 10.1172/jci84417] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Chikungunya virus (CHIKV), a reemerging arbovirus, causes a crippling musculoskeletal inflammatory disease in humans characterized by fever, polyarthralgia, myalgia, rash, and headache. CHIKV is transmitted by Aedes species of mosquitoes and is capable of an epidemic, urban transmission cycle with high rates of infection. Since 2004, CHIKV has spread to new areas, causing disease on a global scale, and the potential for CHIKV epidemics remains high. Although CHIKV has caused millions of cases of disease and significant economic burden in affected areas, no licensed vaccines or antiviral therapies are available. In this Review, we describe CHIKV epidemiology, replication cycle, pathogenesis and host immune responses, and prospects for effective vaccines and highlight important questions for future research.
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Bouquillard E, Fianu A, Bangil M, Charlette N, Ribéra A, Michault A, Favier F, Simon F, Flipo RM. Rheumatic manifestations associated with Chikungunya virus infection: A study of 307 patients with 32-month follow-up (RHUMATOCHIK study). Joint Bone Spine 2017; 85:207-210. [PMID: 28238882 DOI: 10.1016/j.jbspin.2017.01.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In the wake of the Chikungunya epidemic which struck Reunion Island in 2005 and 2006, we conducted a prospective, multicentre study (RHUMATOCHIK) whose main objective was analyse the characteristics and progression of rheumatic manifestations in patients with post-Chikungunya joint pain. METHODS A cohort of 307 consecutively included patients underwent rheumatological examinations for pain secondary to Chikungunya virus infection. The long-term evaluation was conducted by telephone survey 1 and 2 years after the onset of the viral infection. RESULTS At inclusion, mean age was 54 years (24-87) and 83.1% of the patients were female. Chronic joint pain was associated with synovitis in 64.2% of the patients, affecting primarily the wrists, the proximal interphalangeal joints of the fingers, and the ankles. Attempts to detect the viral genome in joint fluid (10 patients) and synovial tissue (6 patients) using the RT-PCR technique were repeatedly unsuccessful. With a mean follow-up of 32 months, joint pain persisted in 83.1% of the patients. Functional impairment, however, was moderate, with a HAQ score of 0.44±0.5. CONCLUSION Chikungunya virus infection is frequently the cause of joint manifestations that can persist for several months, or even several years. In some cases, the clinical symptoms closely resemble those usually associated with rheumatoid arthritis. Further studies are necessary to improve the therapeutic management of these patients.
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Affiliation(s)
| | - Adrian Fianu
- Inserm CIC 1410, CHU de La Réunion, 97448 Saint-Pierre cedex, Reunion
| | | | | | | | - Alain Michault
- Department of Bacteriology, Parasitology & Virology, CHR, Reunion
| | - François Favier
- Inserm CIC 1410, CHU de La Réunion, 97448 Saint-Pierre cedex, Reunion
| | - Fabrice Simon
- Department of Infectious and Tropical Diseases, Laveran Military Training Hospital, 13013 Marseille, France
| | - René-Marc Flipo
- Department of Rheumatology, Roger-Salengro Hospital, University of Lille 2, avenue du Professeur-Emile-Laine, 59047 Lille cedex, France.
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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: 115] [Impact Index Per Article: 16.4] [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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Arroyo-Ávila M, Cabán A, García-Rivera EJ, Irizarry-Pérez M, Torres H, Gorbea H, Vilá LM. Clinical Manifestations Associated with Peripheral Joint Involvement in Patients with Acute Chikungunya Virus Infection. Am J Trop Med Hyg 2017; 96:916-921. [PMID: 28138049 DOI: 10.4269/ajtmh.16-0890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AbstractChikungunya virus (CHIKV) causes an acute febrile illness usually accompanied by severe polyarthralgia and polyarthritis. Previous studies have shown that older age, female gender, and some comorbid conditions are associated with chronic CHIKV arthritis. However, the factors associated with acute arthralgia and arthritis are not well known. Thus, we studied the clinical manifestations associated with acute peripheral joint involvement in a group of CHIKV patients from Puerto Rico. Patients with a history of fever for < 7 days evaluated at the emergency department of a university-based hospital were tested for several pathogens including CHIKV. All patients with laboratory-positive CHIKV infection were studied. Demographic features, clinical manifestations, and comorbidities were determined. Patients with and without peripheral joint involvement were compared using bivariable and multivariable analyses. In total, 172 patients with CHIKV fever were evaluated; 52.9% were women. The mean (standard deviation) age was 21.1 years (19.3). Peripheral arthralgia and/or arthritis were seen in 156 (90.7%) patients. In the multivariable analysis adjusted for age and gender, peripheral joint involvement was associated with myalgia (odds ratio [OR] = 4.65, 95% confidence interval [CI] = 1.48-14.72), back pain (OR = 16.77, 95% CI = 3.07-313.82), ocular pain (OR = 8.88, 95% CI = 1.65-165.19), headache (OR = 3.63, 95% CI = 1.06-12.53), anorexia (OR = 5.68, 95% CI = 1.87-18.97), and nausea (OR = 6.88, 95% CI = 2.05-31.49). In conclusion, in this population of patients with acute CHIKV infection, peripheral joint involvement was associated with myalgia and back pain as well as nonmusculoskeletal manifestations such as headache, ocular pain, anorexia, and nausea.
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Affiliation(s)
- Mariangelí Arroyo-Ávila
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Amanda Cabán
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Enid J García-Rivera
- Endowed Health Services Research Center, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Marisela Irizarry-Pérez
- Endowed Health Services Research Center, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Hilda Torres
- Endowed Health Services Research Center, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Héctor Gorbea
- Division of Infectious Diseases, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG, Rocha Junior LFD, Valadares LDDA, Melo AKGD, Freire EAM, Teixeira R, Bezerra Neto FA, Medeiros MMDC, Carvalho JFD, Santos MSF, Océa RADLC, Levy RA, Andrade CAFD, Pinheiro GDRC, Abreu MM, Verztman JF, Merenlender S, Ribeiro SLE, Costa IPD, Pileggi G, Trevisani VFM, Lopes MIB, Brito C, Figueiredo E, Queiroga F, Feitosa T, Tenório ADS, Siqueira GRD, Paiva R, Vasconcelos JTS, Christopoulos G. Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 1 – Diagnóstico e situações especiais. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Krutikov M, Manson J. Chikungunya Virus Infection: An Update on Joint Manifestations and Management. Rambam Maimonides Med J 2016; 7:RMMJ.10260. [PMID: 27824550 PMCID: PMC5101007 DOI: 10.5041/rmmj.10260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The advent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne viruses like Chikungunya. This infection has become increasingly prevalent in the last 10 years across the Indian Ocean and has been brought to media attention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air travel, allowing infected individuals to transport the virus to previously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA. The duration and extent of the arthritis seen peri- and post infection has become a topic of academic interest. Although published data are largely observational, there has been a definite increase in original research focusing on this. Symptoms can persist for years, particularly in older patients with pre-existing medical conditions. The etiology is still not fully understood, but viral persistence and immune activation within synovial fluid have been shown in mouse models. There have been no prospective clinical trials of treatment in humans; however, animal trials are in process. The mainstay of treatment remains anti-inflammatories and steroids where necessary. The clinical presentation seems to mimic common rheumatological conditions like rheumatoid arthritis; therefore recent recommendations suggest the use disease-modifying agents as a common practice for the specific syndrome. This review uses recent published data and draws on our own clinical experience to provide an overview of joint complications of Chikungunya infection.
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Affiliation(s)
- Maria Krutikov
- Department of Infectious Diseases, University College London Hospital, London, UK
| | - Jessica Manson
- Department of Rheumatology, University College London Hospital, London, UK
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Rodríguez-Morales AJ, Cardona-Ospina JA, Fernanda Urbano-Garzón S, Sebastian Hurtado-Zapata J. Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016; 68:1849-1858. [PMID: 27015439 DOI: 10.1002/acr.22900] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the percentage of patients who would develop chronic inflammatory rheumatism (CIR) following chikungunya (CHIK) virus disease. METHODS We conducted a systematic review of the literature in 3 databases (PubMed, Science Citation Index, and Scopus) to identify studies assessing the proportion of patients who progress to CHIK-CIR. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence intervals (95% CIs). A 2-tailed alpha level of 5% was used for hypothesis testing. Measures of heterogeneity, including Cochran's Q statistic, the I2 index, and the tau-squared test, were calculated and reported. Subgroup analyses were conducted by type of study and country, by studies evaluating chronic arthritis, and by studies with ≥200 patients and followup ≥18 months. Publication bias was assessed using a funnel-plot. RESULTS Up to June 15, 2015, our literature search yielded 578 citations. The pooled prevalence of CHIK-CIR in 18 selected studies among 5,702 patients was 40.22% (95% CI 31.11-49.34; τ2 = 0.0838). From studies derived from India, prevalence was 27.27% (95% CI 15.66-38.88; τ2 = 0.0411), while from France, prevalence was 50.25% (95% CI 25.38-75.12; τ2 = 0.1797). The prevalence of CHIK chronic arthritis was 13.66% (95% CI 9.31-18.00; τ2 = 0.0060). Considering just those studies with ≥200 patients assessed, prevalence was 34.14% (95% CI 23.99-44.29; τ2 = 0.0525). In studies with a followup ≥18 months, prevalence was 32.13% (95% CI 22.21-42.04; τ2 = 0.0453). CONCLUSION According to our results in the most conservative scenario, approximately 25% of CHIK cases would develop CHIK-CIR (34% if we just consider the most representative studies), and 14% would develop chronic arthritis.
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Affiliation(s)
- Alfonso J Rodríguez-Morales
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, and Organización Latinoamericana para el Fomento de la Investigación en Salud, Bucaramanga, Santander, Colombia
| | - Jaime A Cardona-Ospina
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia
| | - Sivia Fernanda Urbano-Garzón
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia
| | - Juan Sebastian Hurtado-Zapata
- Research Group Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia
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Blettery M, Brunier L, Polomat K, Moinet F, Deligny C, Arfi S, Jean-Baptiste G, De Bandt M. Brief Report: Management of Chronic Post-Chikungunya Rheumatic Disease: The Martinican Experience. Arthritis Rheumatol 2016; 68:2817-2824. [PMID: 27273928 DOI: 10.1002/art.39775] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 05/19/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe chronic chikungunya manifestations seen during the outbreak in the Caribbean from December 2013 to January 2015. METHODS Patients were seen at our center, the only rheumatology department in Martinique Island, and were examined by a senior rheumatologist using a standard care report form. Chikungunya was diagnosed collectively based on consensus among all clinicians. The median time from onset of acute chikungunya to the first rheumatology consultation was calculated, severity was evaluated based on clinical scales and the degree of joint destruction, and each patient's treatment was recorded. RESULTS For the 147 patients analyzed, the median time between onset of acute chikungunya and the first rheumatology consultation was 8 months. After review of each patient's medical record, 19 (12.9%) were diagnosed as having epidemic-influenced chikungunya. Four distinct rheumatologic patterns were observed in the remaining patients (those with compatible history and positive serologic findings): 47 patients (32%) had reactivation of painful chronic mechanical manifestations, 9 patients (6.1%) had fibromyalgia, 45 patients (30.6%) met criteria for spondyloarthritis (as evaluated before the chikungunya virus infection in all patients) and experienced a flare, and 27 patients (18.4%), with no history of joint disease, developed de novo bilateral symmetric chronic inflammatory joint disease in response to chikungunya virus infection. For inflammatory arthritis, most patients were treated with methotrexate (up to 25 mg/week), with good response and tolerance. Thirteen patients were treated with conventional doses of anti-tumor necrosis factor agents, with good tolerance and efficacy as expected. CONCLUSION The term "chronic chikungunya syndrome" covers multiple etiologies. Compliance with the French Society of Rheumatology recommendations, careful recording of patient histories, and serologic verification help prevent errors inherent to the epidemic context and ensure early therapeutic intervention for these patients. To avoid late initiation of treatment, patients should receive rheumatologic consultation as early as possible.
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Affiliation(s)
- Marie Blettery
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Lauren Brunier
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Kathleen Polomat
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Florence Moinet
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Christophe Deligny
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Serge Arfi
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Georges Jean-Baptiste
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies
| | - Michel De Bandt
- University Hospital of Martinique (site Pierre Zobda Quitman), Fort-de-France, Martinique, French West Indies.
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Sam IC, Kümmerer BM, Chan YF, Roques P, Drosten C, AbuBakar S. Updates on chikungunya epidemiology, clinical disease, and diagnostics. Vector Borne Zoonotic Dis 2016; 15:223-30. [PMID: 25897809 DOI: 10.1089/vbz.2014.1680] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chikungunya virus (CHIKV) is an Aedes-borne alphavirus, historically found in Africa and Asia, where it caused sporadic outbreaks. In 2004, CHIKV reemerged in East Africa and spread globally to cause epidemics, including, for the first time, autochthonous transmission in Europe, the Middle East, and Oceania. The epidemic strains were of the East/Central/South African genotype. Strains of the Asian genotype of CHIKV continued to cause outbreaks in Asia and spread to Oceania and, in 2013, to the Americas. Acute disease, mainly comprising fever, rash, and arthralgia, was previously regarded as self-limiting; however, there is growing evidence of severe but rare manifestations, such as neurological disease. Furthermore, CHIKV appears to cause a significant burden of long-term morbidity due to persistent arthralgia. Diagnostic assays have advanced greatly in recent years, although there remains a need for simple, accurate, and affordable tests for the developing countries where CHIKV is most prevalent. This review focuses on recent important work on the epidemiology, clinical disease and diagnostics of CHIKV.
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Affiliation(s)
- I-Ching Sam
- 1 Department of Medical Microbiology, Faculty of Medicine, University Malaya , Kuala Lumpur, Malaysia
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First Chikungunya Outbreak in Suriname; Clinical and Epidemiological Features. PLoS Negl Trop Dis 2016; 10:e0004625. [PMID: 27082985 PMCID: PMC4833344 DOI: 10.1371/journal.pntd.0004625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/23/2016] [Indexed: 12/16/2022] Open
Abstract
Background In June 2014, Suriname faced the first Chikungunya outbreak. Since international reports mostly focus on hospitalized patients, the least affected group, a study was conducted to describe clinical characteristics of mainly outpatients including children. In addition, the cumulative incidence of this first epidemic was investigated. Methodology During August and September 2014, clinically suspected Chikungunya cases were included in a prospective follow-up study. Blood specimens were collected and tested for viral RNA presence. Detailed clinical information was gathered through multiple telephone surveys until day 180. In addition, a three stage household-based cluster with a cross-sectional design was conducted in October, December 2014 and March 2015 to assess the cumulative incidence. Principal Findings Sixty-eight percent of symptomatic patients tested positive for Chikungunya virus (CHIKV). Arthralgia and pain in the fingers were distinctive for viremic CHIKV infected patients. Viremic CHIKV infected children (≤12 years) characteristically displayed headache and vomiting, while arthralgia was less common at onset. The disease was cleared within seven days by 20% of the patients, while 22% of the viremic CHIKV infected patients, mostly women and elderly reported persistent arthralgia at day 180. The extrapolated cumulative CHIKV incidence in Paramaribo was 249 cases per 1000 persons, based on CHIKV self-reported cases in 53.1% of the households and 90.4% IgG detected in a subset of self-reported CHIKV+ persons. CHIKV peaked in the dry season and a drastic decrease in CHIKV patients coincided with a governmental campaign to reduce mosquito breeding sites. Conclusions/Significance This study revealed that persistent arthralgia was a concern, but occurred less frequently in an outpatient setting. The data support a less severe pathological outcome for Caribbean CHIKV infections. This study augments incidence data available for first outbreaks in the region and showed that actions undertaken at the national level to mount responses may have positively impacted containment of this CHIKV outbreak. Chikungunya virus is transmitted to humans by mosquito bites and causes fever and joint pain. Chikungunya was first detected in Africa, but recently became a worldwide concern with outbreaks in many (sub)-tropical countries. We report the characteristics of the first outbreak in Suriname (2014–2015). Mainly non-hospitalized patients were followed-up to study the clinical manifestations and course of the disease, after presentation in the respective clinics with the standard Chikungunya symptoms (fever and arthralgia). Twenty percent of follow-up patients could clear the disease within one week and 22% (mostly women and elderly) still had complaints about arthralgia up to 6 months after infection. This is consistent with the assumption that Caribbean Chikungunya viral infection has a less severe pathological outcome. Furthermore, more insight was gained into the symptomatology of children (≤12 years). In addition, house-to-house surveys in Paramaribo were carried out to identify suspected cases to assess the incidence. Almost 25% of the survey participants experienced symptoms consistent with Chikungunya during the nine months spanning the investigation. The launch of a governmental campaign to eliminate mosquito breeding sites coincided with a sharp decline of Chikungunya cases, suggesting that such measures may be important in the containment of future CHIKV outbreaks.
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Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, Chica-Quintero LA, Murillo-García DR, García-Robledo JE, Castrillón-Spitia JD, Londoño JJ, Bedoya-Rendón HD, Cárdenas-Pérez JDJ, Cardona-Ospina JA, Lagos-Grisales GJ. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. F1000Res 2016; 5:360. [PMID: 27081477 PMCID: PMC4813633 DOI: 10.12688/f1000research.8235.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 02/02/2023] Open
Abstract
Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).
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Affiliation(s)
- Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia; Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia; Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogota, Colombia; Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, UK
| | - Andrés F Gil-Restrepo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Valeria Ramírez-Jaramillo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Cindy P Montoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Wilmer F Acevedo-Mendoza
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E Bedoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Laura A Chica-Quintero
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - David R Murillo-García
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E García-Robledo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia; School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Jose J Londoño
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | | | - Jaime A Cardona-Ospina
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Guillermo J Lagos-Grisales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
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Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, Montoya-Arias CP, Acevedo-Mendoza WF, Bedoya-Arias JE, Chica-Quintero LA, Murillo-García DR, García-Robledo JE, Castrillón-Spitia JD, Londoño JJ, Bedoya-Rendón HD, Cárdenas-Pérez JDJ, Cardona-Ospina JA, Lagos-Grisales GJ. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. F1000Res 2016; 5:360. [PMID: 27081477 PMCID: PMC4813633 DOI: 10.12688/f1000research.8235.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. METHODS We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. RESULTS Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). CONCLUSIONS According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).
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Affiliation(s)
- Alfonso J. Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
- Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia
- Committee on Zoonoses and Haemorrhagic Fevers, Asociación Colombiana de Infectología (ACIN), Bogota, Colombia
- Working Group on Zoonoses, International Society for Chemotherapy, Aberdeen, UK
| | - Andrés F. Gil-Restrepo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Valeria Ramírez-Jaramillo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Cindy P. Montoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Wilmer F. Acevedo-Mendoza
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E. Bedoya-Arias
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Laura A. Chica-Quintero
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - David R. Murillo-García
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan E. García-Robledo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Jose J. Londoño
- School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | | | - Jaime A. Cardona-Ospina
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Guillermo J. Lagos-Grisales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Colombia
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McCarthy MK, Morrison TE. Chronic chikungunya virus musculoskeletal disease: what are the underlying mechanisms? Future Microbiol 2016; 11:331-4. [PMID: 26939523 DOI: 10.2217/fmb.15.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Mary K McCarthy
- Department of Immunology & Microbiology, University of Colorado School of Medicine, CO 80045, USA
| | - Thomas E Morrison
- Department of Immunology & Microbiology, University of Colorado School of Medicine, CO 80045, USA
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Post-chikungunya rheumatic disorders in travelers after return from the Caribbean. Travel Med Infect Dis 2016; 14:21-25. [PMID: 26872414 DOI: 10.1016/j.tmaid.2016.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Due to increasing concerns about post-chikungunya (pCHIK) rheumatic disorders in Latin America we aimed to evaluate its occurrence in travelers returning to NYC from the Caribbean. METHOD Patients diagnosed with chikungunya (CHIK) during 2014 at the Bronx-Lebanon Hospital Center (Bronx, NewYork) were identified by reviewing laboratory and electronic medical records. Patients and caregivers of pediatric patients were interviewed by phone ≥9 months after the CHIK diagnosis to survey for chronic symptomatology and current health care needs. Reported chronic musculoskeletal complaints were categorized according to validated criteria. RESULTS A total of 28 patients (54% females, median age [range] of 51.5 [0, 88] years) diagnosed with CHIK at our center were identified. Most (82%) had returned from the Dominican Republic. Nineteen (68%) patients were successfully contacted at a median (range) of 13 (9, 16) months since the acute diagnosis. A third (37%) reported ongoing complaints related to CHIK including joint pain (32%), muscle pain (32%), and joint swelling (26%). A presumptive diagnosis of pCHIK chronic inflammatory arthritis (n = 4) and pCHIK musculoskeletal disorder (n = 3) was established. CONCLUSIONS A third of travelers with CHIK acquired in the Caribbean may be at risk for developing persistent symptoms suggestive of pCHIK rheumatic disorder.
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Madariaga M, Ticona E, Resurrecion C. Chikungunya: bending over the Americas and the rest of the world. Braz J Infect Dis 2015; 20:91-8. [PMID: 26707971 PMCID: PMC9425360 DOI: 10.1016/j.bjid.2015.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
Chikungunya is an arthropod-borne virus transmitted by Aedes mosquito bites. A viral mutation has allowed Aedes albopictus to become the preferred vector extending the geographic spread of the condition. The virus causes an acute febrile illness occasionally followed by a chronic rheumatic condition causing severe impairment. The diagnosis is usually confirmed with serology. No specific treatment is currently available. This article reviews the condition with emphasis on his dissemination in the Americas.
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Affiliation(s)
- Miguel Madariaga
- Section of Infectious Diseases, Naples Community Hospital, Naples, United States.
| | - Eduardo Ticona
- Hospital Nacional Dos de Mayo, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Galán-Huerta K, Rivas-Estilla A, Fernández-Salas I, Farfan-Ale J, Ramos-Jiménez J. Chikungunya virus: A general overview. MEDICINA UNIVERSITARIA 2015. [DOI: 10.1016/j.rmu.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Rodriguez-Morales AJ, Cardona-Ospina JA, Villamil-Gómez W, Paniz-Mondolfi AE. How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America? Rheumatol Int 2015; 35:2091-4. [PMID: 26045218 DOI: 10.1007/s00296-015-3302-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/29/2015] [Indexed: 01/26/2023]
Abstract
Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.
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Affiliation(s)
- A J Rodriguez-Morales
- Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, 660001, Colombia.
| | - J A Cardona-Ospina
- Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, 660001, Colombia
| | - W Villamil-Gómez
- Internal Medicine and Infectious Diseases, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - A E Paniz-Mondolfi
- Department of Pathology and Laboratory Medicine, Hospital Internacional, Barquisimeto, Venezuela and Laboratory of Biochemistry, Instituto de Biomedicina/IVSS, Caracas, Venezuela
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Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012. PLoS Negl Trop Dis 2015; 9:e0003603. [PMID: 25760632 PMCID: PMC4356515 DOI: 10.1371/journal.pntd.0003603] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/06/2015] [Indexed: 12/31/2022] Open
Abstract
Background Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients. Patients and methods We conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria. Results We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy. Conclusion Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials. With a 6-year insight, we extensively and retrospectively describe clinical profiles and specific treatments of mechanical and inflammatory post-chikungunya rheumatic disorders. In the current context of chikungunya’s global spread, we provide the first diagnostic and therapeutic algorithm to guide physicians according to the amount of time that has elapsed since the acute CHIK infection.
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Marimoutou C, Ferraro J, Javelle E, Deparis X, Simon F. Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later. Clin Microbiol Infect 2015; 21:688-93. [PMID: 25752222 DOI: 10.1016/j.cmi.2015.02.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 11/17/2022]
Abstract
This study presents the 6-year follow-up of French gendarmes exposed to the chikungunya (CHIK) infection in 2006 on Reunion Island. The aim was to see to what extent the subjective health differences observed in 2008 (30 months after infection) between CHIK infected (CHIK+) and noninfected (CHIK-) gendarmes still persisted in 2012, and to investigate a possible return to a pre-CHIK health status for CHIK+ subjects. Gendarmes were contacted by mail in 2012 and asked to complete a self-questionnaire asking for morbidity, health care and medicines consumption since the last follow-up in 2008. Quality of life (QoL) after 6 years was evaluated using the SF-36 scale. In comparison with CHIK- subjects (n = 171), CHIK+ (n = 81) presented with higher rheumatic but also nonspecific morbidity such as headaches and fatigue associated with a large psychological impact, frequent depressive moods and social disabilities, leading to a significant impairment of the QoL and higher health care consumption. When restricted to CHIK+ subjects, comparing the data with that of 2008 showed persistent but decreasing self-reported rheumatic morbidity, and an increase over time of chronic discomfort (headache, fatigue) and depressive moods, resulting in no overall improvement in QoL. Despite possible cohort attrition bias, the comparability of CHIK+/CHIK- subjects allows the assumption of a long-term impact of CHIK infection with less chance of returning to a previous health status. Although these results may be specific to the 2006 virus strain, we recommend that public health strategies in the epidemic-prone countries include a response to the consequences of chronic post-CHIK disorders.
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Affiliation(s)
- C Marimoutou
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), Marseille, UMR 912-SESSTIM, Aix-Marseille University, Marseille, France.
| | - J Ferraro
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - E Javelle
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - X Deparis
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), Marseille, UMR 912-SESSTIM, Aix-Marseille University, Marseille, France
| | - F Simon
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
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Teng TS, Kam YW, Lee B, Hapuarachchi HC, Wimal A, Ng LC, Ng LFP. A Systematic Meta-analysis of Immune Signatures in Patients With Acute Chikungunya Virus Infection. J Infect Dis 2015; 211:1925-35. [PMID: 25635123 PMCID: PMC4442625 DOI: 10.1093/infdis/jiv049] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/20/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Individuals infected with chikungunya virus (CHIKV) normally exhibit a variety of clinical manifestations during the acute phase of infection. However, studies in different patient cohorts have revealed that disease manifestations vary in frequency. METHODS Disease profiles between patients with acute CHIKV-infection and febrile patients without CHIKV were compared and examined to determine whether any clinical presentations were associated with the clinical outcome of CHIKV infection. Circulatory immune mediators profiles were then characterized and compared with data from 14 independent patient cohort studies. The particular immune mediator signature that defines acute CHIKV infection was determined. RESULTS Our findings revealed a specific pattern of clinical presentations of joint-specific arthralgia from this CHIKV cohort. More importantly, we identified an immune mediator signature dominated by proinflammatory cytokines, which include interferon α and γ and interleukin 2, 2R, 6, 7, 12, 15, 17, and 18, across different patient cohorts of CHIKV load associated with arthralgia. CONCLUSIONS To our knowledge, this is the first study that associated levels of CHIKV load with arthralgia as an indicator of acute CHIKV infection. Importantly, our findings also revealed specific immune mediator signatures that can be used to better define CHIKV infection.
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Affiliation(s)
- Terk-Shin Teng
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis
| | - Yiu-Wing Kam
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis
| | | | - Abeyewickreme Wimal
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
| | - Lisa F P Ng
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Biopolis Institute of Infection and Global Health, University of Liverpool, United Kingdom
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Moyen N, Thiberville SD, Pastorino B, Nougairede A, Thirion L, Mombouli JV, Dimi Y, Leparc-Goffart I, Capobianchi MR, Lepfoundzou AD, de Lamballerie X. First reported chikungunya fever outbreak in the republic of Congo, 2011. PLoS One 2014; 9:e115938. [PMID: 25541718 PMCID: PMC4277398 DOI: 10.1371/journal.pone.0115938] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/29/2014] [Indexed: 12/21/2022] Open
Abstract
Background Chikungunya is an Aedes -borne disease characterised by febrile arthralgia and responsible for massive outbreaks. We present a prospective clinical cohort study and a retrospective serological study relating to a CHIK outbreak, in the Republic of Congo in 2011. Methodology and Findings We analysed 317 suspected cases, of which 308 (97.2%) lived in the city of Brazzaville (66.6% in the South area). Amongst them, 37 (11.7%) were CHIKV+ve patients (i.e., biologically confirmed by a real-time RT-PCR assay), of whom 36 (97.3%) had fever, 22 (66.7%) myalgia and 32 (86.5%) arthralgia. All tested negative for dengue. The distribution of incident cases within Brazzaville districts was compared with CHIKV seroprevalence before the outbreak (34.4% in 517 blood donors), providing evidence for previous circulation of CHIKV. We applied a CHIK clinical score to 126 patients recruited within the two first day of illness (including 28 CHIKV+ves (22.2%)) with sensitivity (78.6%) and specificity (72.4%) values comparing with those of the referent study in Reunion Island. The negative predictive value was high (92%), but the positive predictive value (45%) indicate poor potential contribution to medical practice to identify CHIKV+ve patients in low prevalence outbreaks. However, the score allowed a slightly more accurate follow-up of the evolution of the outbreak than the criterion "fever+arthralgia". The complete sequencing of a Congolase isolate (Brazza_MRS1) demonstrated belonging to the East/Central/South African lineage and was further used for producing a robust genome-scale CHIKV phylogenetic analysis. Conclusions/Significance We describe the first Chikungunya outbreak declared in the Republic of Congo. The seroprevalence study conducted amongst blood donors before outbreak provided evidence for previous CHIKV circulation. We suggest that a more systematic survey of the entomological situation and of arbovirus circulation is necessary in Central Africa for better understanding the environmental, microbiological and sociological determinants of emergence.
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Affiliation(s)
- Nanikaly Moyen
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
- * E-mail:
| | - Simon-Djamel Thiberville
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
| | - Boris Pastorino
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
| | - Antoine Nougairede
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
| | - Laurence Thirion
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
| | | | - Yannick Dimi
- Centre National de Transfusion Sanguine, Brazzaville, Republic of Congo
| | - Isabelle Leparc-Goffart
- French National Reference Centre for Arboviruses, IRBA Armed Forces Biomedical Research Institute, 13013, Marseille, France
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy
| | | | - Xavier de Lamballerie
- Aix Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales" 13005, Marseille, France
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Yaseen HM, Simon F, Deparis X, Marimoutou C. Identification of initial severity determinants to predict arthritis after chikungunya infection in a cohort of French gendarmes. BMC Musculoskelet Disord 2014; 15:249. [PMID: 25059583 PMCID: PMC4121301 DOI: 10.1186/1471-2474-15-249] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/06/2014] [Indexed: 11/27/2022] Open
Abstract
Background The objective was to identify severity characteristics of initial chikungunya infection (CHIKV) stages associated with post-CHIKV arthritis and arthralgia. Methods French gendarmes exposed to the 2005–2006 CHIKV epidemic in Reunion Island who completed the 2006 (self-reporting acute and early chronic [median: 6 months] symptoms) and 2008 (Endpoint [median: 30 months]: self-perceived recovery and rheumatic disorders (RDs)) surveys were included. Multinomial logistic regression and multiple correspondence analysis (MCA) were used. Arthralgia was defined by joint pain and/or stiffness and arthritis by joint swelling in addition to pain and/or stiffness. Results In 2008, 124 (31.3%)/403 participants (101 CHIKV+/302 CHIKV-) reported arthralgia and 57 (14.1%) arthritis. The multivariate model kept CHIKV infection, comorbidity and acute stage depressed mood as independent prognostic factors for both arthralgia and arthritis, but found early chronic stage RD as the main determinant of the same RD two years later. The MCA performed with the 85 CHIKV + patients who answered the question on self-perceived recovery enabled the calculation of severity scores based on initial symptoms that were strongly associated with persistent arthritis and, to a lesser extent, to arthralgia in bivariate analyses. The MCA graph clearly distinguished arthritis as the only RD associated with early severity indicators represented by sick leave, joint swelling and depressed mood during the acute stage, and early chronification of arthritis and depressed mood. Conclusion Initial CHIKV severity predicted recovery, with higher severity associated with arthritis and lower severity with arthralgia. More interestingly, specific markers of post-CHIKV arthritis, which can easily be used by clinicians for case management, were identified.
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Affiliation(s)
| | | | | | - Catherine Marimoutou
- Centre d'Epidémiologie et Santé Publique des Armées (CESPA), BP 40026, Marseille 13568 cedex 02, France.
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Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, de Lamballerie X. Chikungunya fever: epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res 2013; 99:345-70. [PMID: 23811281 PMCID: PMC7114207 DOI: 10.1016/j.antiviral.2013.06.009] [Citation(s) in RCA: 304] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 05/21/2013] [Accepted: 06/18/2013] [Indexed: 12/11/2022]
Abstract
Chikungunya fever is caused by a mosquito-borne alphavirus originating in East Africa. During the past 7 years, the disease has spread to islands of the Indian Ocean, Asia and Europe. Its spread has been facilitated by a mutation favouring replication in the mosquito Ae. albopictus. No vaccines or antiviral drugs are available to prevent or treat chikungunya fever. This paper provides an extensive review of the virus and disease, including Supplementary Tables.
Chikungunya virus (CHIKV) is the aetiological agent of the mosquito-borne disease chikungunya fever, a debilitating arthritic disease that, during the past 7 years, has caused immeasurable morbidity and some mortality in humans, including newborn babies, following its emergence and dispersal out of Africa to the Indian Ocean islands and Asia. Since the first reports of its existence in Africa in the 1950s, more than 1500 scientific publications on the different aspects of the disease and its causative agent have been produced. Analysis of these publications shows that, following a number of studies in the 1960s and 1970s, and in the absence of autochthonous cases in developed countries, the interest of the scientific community remained low. However, in 2005 chikungunya fever unexpectedly re-emerged in the form of devastating epidemics in and around the Indian Ocean. These outbreaks were associated with mutations in the viral genome that facilitated the replication of the virus in Aedes albopictus mosquitoes. Since then, nearly 1000 publications on chikungunya fever have been referenced in the PubMed database. This article provides a comprehensive review of chikungunya fever and CHIKV, including clinical data, epidemiological reports, therapeutic aspects and data relating to animal models for in vivo laboratory studies. It includes Supplementary Tables of all WHO outbreak bulletins, ProMED Mail alerts, viral sequences available on GenBank, and PubMed reports of clinical cases and seroprevalence studies.
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Affiliation(s)
- Simon-Djamel Thiberville
- UMR_D 190 "Emergence des Pathologies Virales" (Aix-Marseille Univ. IRD French Institute of Research for Development EHESP French School of Public Health), Marseille, France; University Hospital Institute for Infectious Disease and Tropical Medicine, Marseille, France.
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Schilte C, Staikovsky F, Couderc T, Madec Y, Carpentier F, Kassab S, Albert ML, Lecuit M, Michault A. Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis 2013; 7:e2137. [PMID: 23556021 PMCID: PMC3605278 DOI: 10.1371/journal.pntd.0002137] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/11/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Arthritogenic alphaviruses, including Chikungunya virus (CHIKV), are responsible for acute fever and arthralgia, but can also lead to chronic symptoms. In 2006, a Chikungunya outbreak occurred in La Réunion Island, during which we constituted a prospective cohort of viremic patients (n = 180) and defined the clinical and biological features of acute infection. Individuals were followed as part of a longitudinal study to investigate in details the long-term outcome of Chikungunya. METHODOLOGY/PRINCIPAL FINDINGS Patients were submitted to clinical investigations 4, 6, 14 and 36 months after presentation with acute CHIKV infection. At 36 months, 22 patients with arthralgia and 20 patients without arthralgia were randomly selected from the cohort and consented for blood sampling. During the 3 years following acute infection, 60% of patients had experienced symptoms of arthralgia, with most reporting episodic relapse and recovery periods. Long-term arthralgias were typically polyarthralgia (70%), that were usually symmetrical (90%) and highly incapacitating (77%). They were often associated with local swelling (63%), asthenia (77%) or depression (56%). The age over 35 years and the presence of arthralgia 4 months after the disease onset are risk factors of long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases. These data helped define the features of CHIKV-associated chronic arthralgia and permitted an estimation of the economic burden associated with arthralgia. CONCLUSIONS/SIGNIFICANCE This study demonstrates that chronic arthralgia is a frequent complication of acute Chikungunya disease and suggests that it results from a local rather than systemic inflammation.
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Affiliation(s)
- Clémentine Schilte
- Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U818, Paris, France
| | - Frédérik Staikovsky
- Emergency Department, Pôle des Spécialités de l'Urgence, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
| | - Thérèse Couderc
- Biology of Infection Unit, Institut Pasteur, Paris, France
- INSERM U1117, Paris, France
| | - Yoann Madec
- Unité d'Epidémiologie des maladies émergentes, Institut Pasteur, Paris, France
| | - Florence Carpentier
- AgroParisTech, Ecologie Adaptation et Interaction, Paris, France
- INRA, UR1290, Thiverval-Grignon, France
| | - Somar Kassab
- Emergency Department, Pôle des Spécialités de l'Urgence, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
| | - Matthew L. Albert
- Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U818, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Lecuit
- Biology of Infection Unit, Institut Pasteur, Paris, France
- INSERM U1117, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Division of Infectious Diseases, Hôpital Necker Enfants malades, Paris, France
- * E-mail: (ML); (AM)
| | - Alain Michault
- Department of Microbiology, Pôle de biologie, Centre Hospitalier Régional de La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
- * E-mail: (ML); (AM)
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