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Chang AYH, Hernández AS, Mejía JF, Tritsch SR, Mendoza-Torres E, Encinales L, Bonfanti AC, Proctor AM, Simon GL, Simmens SJ, Firestein GS. The Natural History of Post-Chikungunya Viral Arthritis Disease Activity and T-cell Immunology: A Cohort Study. JOURNAL OF CELLULAR IMMUNOLOGY 2024; 6:64-75. [PMID: 38873035 PMCID: PMC11172407 DOI: 10.33696/immunology.6.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Background Chikungunya virus (CHIKV) is an alphavirus spread by mosquitos that causes arthralgias and arthritis that may last for years. The objective of this study was to describe the arthritis progression and T cell immunology over a two-year period. Methods A cohort of 40 cases of serologically confirmed CHIKV from Magdalena and Atlántico, Colombia were followed in 2019 and again in 2021. Arthritis disease severity, disability, pain, stiffness, physical function, mobility, fatigue, anxiety, sleep disturbances and depression were assessed. Serum cytokines and T-cell subsets were measured and tested for change. Correlations within each of the 2 time periods for laboratory parameters were also examined. Results Although, arthritis disease severity, as measured by the Disease Activity Score-28 (DAS-28) did not change significantly over a two-year period, a new metric- the Chikungunya Disease Activity Score (CHIK-DAS)- was more sensitive to detect changes in disease severity than the Disease Activity Score-28 (DAS-28) and showed some improvement in average disease severity from moderate to mild over two years. Cases were characterized by moderate disability, pain, and stiffness with mild alterations of physical function, mobility, fatigue, anxiety, sleep disturbances and depression that did not change significantly over time. Small joints including the fingers and wrists were most affected without significant change over time. The percentage of effector T cells (Teffs) and regulatory T cells (Tregs) of CD4+ T cells both decreased over time. Teff percentages decreased more significantly resulting in a halving of the Teff/Treg ratio two years later. Furthermore, markers of Treg immunosuppressive function such as CTLA4, Helios, CD28, CD45RA and 41bb decreased over time. Cytokines did not change significantly over time. Conclusions The presented data suggest that arthritis persists almost seven years after chikungunya infection in some patients with waning Teff and Treg numbers and activation markers over time. Treg activation may be a promising therapeutic target for further investigation.
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Affiliation(s)
| | | | - Jose Forero Mejía
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Sarah Renee Tritsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Evelyn Mendoza-Torres
- Advanced Biomedicine Research Group, Universidad Libre de Colombia, Seccional Barranquilla, Barranquilla, Atlántico, Colombia
| | - Liliana Encinales
- Department of Medicine, Allied Research Society, Barranquilla, Atlántico, Colombia
| | | | - Abigale Marie Proctor
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Gary Leonard Simon
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Samuel Joseph Simmens
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Doran C, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Tami A, Bailey A. The clinical manifestation and the influence of age and comorbidities on long-term chikungunya disease and health-related quality of life: a 60-month prospective cohort study in Curaçao. BMC Infect Dis 2022; 22:948. [PMID: 36526964 PMCID: PMC9756924 DOI: 10.1186/s12879-022-07922-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown. METHODS The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3-16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms. RESULTS A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01-11.44; P < .001) and lower (OR: 8.68; CI: 3.47-21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40-10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores. CONCLUSIONS Rheumatic and non-rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype.
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Affiliation(s)
- Churnalisa Doran
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Norediz Lourents
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Yaskara Halabi
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Johannes Burgerhof
- grid.4494.d0000 0000 9558 4598Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Adriana Tami
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ajay Bailey
- grid.5477.10000000120346234Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, 3584 CS Utrecht, The Netherlands
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Simon F, Bossy R, Federico D, Dezaunay J, Demoux AL, Rugard N, Calusi G, Nizzardo A, Watson H, Gane-Troplent F. Determinants of Health-Related Quality of Life in Chronic Chikungunya Disease in Guadeloupe. Pathogens 2022; 11:pathogens11090989. [PMID: 36145421 PMCID: PMC9504273 DOI: 10.3390/pathogens11090989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic chikungunya disease is associated with a poor quality of life and a variety of symptoms, not restricted to the musculoskeletal system. Patients with chronic chikungunya disease in Guadeloupe were evaluated in order to identify the main factors determining the quality of life. Patients were followed up at a mean of 36 months after chikungunya infection, undergoing detailed clinical examination for musculoskeletal involvement, with assessment of subjective symptoms and the impact on mood, physical activity, and quality of life (SF12). Patients had extensive musculoskeletal involvement shown by tenderness in 9 ± 4 joints and stiffness in 5 ± 4 joints. SF12 physical and mental component scores showed a poor health-related quality of life. Measures of joint pain, stiffness, and inflammation contributed to impaired quality of life scores. In addition, fatigue and interrupted sleep appeared to be important predictors for physical aspects of quality of life. The emergence of anxiodepressive syndromes post-chikungunya infection was associated with both physical and mental component scores of SF12. These data confirm that musculoskeletal symptoms are not the only determinants of quality of life in chronic chikungunya disease. Follow-up of patients should include assessment and management of fatigue, poor sleep quality, and anxiodepressive syndromes.
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Affiliation(s)
- Fabrice Simon
- Emerging Virus Unit, University of Aix-Marseille, 13284 Marseille, France
| | - Rémi Bossy
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Denise Federico
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Julien Dezaunay
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | | | - Nadia Rugard
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Giulia Calusi
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Andrea Nizzardo
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Hugh Watson
- Antiviral Research Unit, Evotec ID, 69007 Lyon, France
- Correspondence: ; Tel.: +33-(0)6-71-87-86-19
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Lim JK, Ridde V, Agnandji ST, Lell B, Yaro S, Yang JS, Hoinard D, Weaver SC, Vanhomwegen J, Salje H, Yoon IK. Seroepidemiological Reconstruction of Long-term Chikungunya Virus Circulation in Burkina Faso and Gabon. J Infect Dis 2022; 227:261-267. [PMID: 35710849 PMCID: PMC9833428 DOI: 10.1093/infdis/jiac246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 01/14/2023] Open
Abstract
Chikungunya virus (CHIKV) is a major public health concern worldwide. However, infection levels are rarely known, especially in Africa. We recruited individuals from Ouagadougou, Burkina Faso and Lambaréné, Gabon (age range, 1-55 years), tested their blood for CHIKV antibodies, and used serocatalytic models to reconstruct epidemiological histories. In Ouagadougou, 291 of 999 (29.1%) individuals were seropositive, ranging from 2% among those aged <10 years to 66% in those aged 40-55 years. We estimated there were 7 outbreaks since the 1970s but none since 2001, resulting in 600 000 infections in the city, none of which were reported. However, we could not definitively conclude whether infections were due to CHIKV or o'nyong-nyong, another alphavirus. In Lambaréné, 117 of 427 (27%) participants were seropositive. Our model identified a single outbreak sometime since 2007, consistent with the only reported CHIKV outbreak in the country. These findings suggest sporadic outbreaks in these settings and that the burden remains undetected or incorrectly attributed.
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Affiliation(s)
| | - Valery Ridde
- Montreal School of Public Health, Montreal, Quebec, Canada
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, CampusCentre de Recherches Médicales de Lambaréné, Lambaréné, Gabon,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, CampusCentre de Recherches Médicales de Lambaréné, Lambaréné, Gabon,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Scott C Weaver
- World Reference Center for Emerging Viruses and Arboviruses and Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Henrik Salje
- Correspondence: Henrik Salje, MBioc, MSc, PhD, Department of Genetics, University of Cambridge, Downing Place, Cambridge CB2 3EH ()
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Restrepo BN, Marín K, Romero P, Arboleda M, Muñoz AL, Bosch I, Vásquez-Serna H, Torres OA. Role of cytokines, chemokines, C3a, and mannose-binding lectin in the evolution of the chikungunya infection. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2022; 11:51-63. [PMID: 35874468 PMCID: PMC9301056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED The pathogenesis of the severity of chikungunya infection is not yet fully understood. OBJECTIVE To assess the role of the cytokines/chemokines and system of complement in the evolution of chikungunya infection. METHODS In both acute and chronic phases, we measured the serum levels of 12 cytokines/chemokines and two complement mediators: mannose-binding lectin (MBL) and C3a, in 83 patients with chikungunya infection and ten healthy controls. RESULTS During the acute phase, 75.9% of the patients developed musculoskeletal disorders, and in 37.7% of them, these disorders persisted until the chronic phase. In general, patients had higher levels of cytokines than healthy controls, with significant differences for IFN-γ, IL-6, IL-8, IL-10, and MIP-1. Most cytokines exhibited a downward trend during the chronic phase. However, only IL-10, and MIP-1 levels were significantly lower in the chronic phase. Additionally, these levels never decreased to concentrations found in healthy controls. Moreover, MBL levels were significantly higher in the acute phase compared with the chronic phase. C3a levels were significantly higher in patients with musculoskeletal disorder compared with patients without it, in both acute-phase 118.2 (66.5-252.9), and chronic phase 68.5 (64.4-71.3), P < 0.001. Interestingly, C3a levels were significantly higher when patients had a severe disease version. Besides, in the acute phase, C3a levels were higher in patients that suffer arthritis as opposed to when they suffer arthralgia, 194.3 (69.5-282.2), and 70.9 (62.4-198.8), P = 0.013, respectively. CONCLUSIONS Our results showed an immunological response that persisted until the chronic phase and the role of the complement system in the severity of the disease.
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Affiliation(s)
- Berta N Restrepo
- Instituto Colombiano de Medicina Tropical, Universidad CESSabaneta, Antioquía, Colombia
| | - Katerine Marín
- Instituto Colombiano de Medicina Tropical, Universidad CESSabaneta, Antioquía, Colombia
| | - Paola Romero
- Instituto Colombiano de Medicina Tropical, Universidad CESSabaneta, Antioquía, Colombia
| | - Margarita Arboleda
- Instituto Colombiano de Medicina Tropical, Universidad CESSabaneta, Antioquía, Colombia
| | - Ana L Muñoz
- Science Faculty, Universidad Antonio NariñoBogotá, Cundinamarca, Colombia
| | - Irene Bosch
- Institute for Medical Engineering & Science, Massachusetts Institute of TechnologyCambridge, United States
| | | | - Orlando A Torres
- Faculty of Veterinary Medicine, Universidad Antonio NariñoBogotá, Cundinamarca, Colombia
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Watson HR, Duong V, Ly S, Mandron M, Siqueira AM, Ribeiro GS. Household clustering supports a novel chemoprophylaxis trial design for a mosquito-borne viral disease. Int J Infect Dis 2022; 122:169-173. [PMID: 35568359 DOI: 10.1016/j.ijid.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022] Open
Abstract
Infections because of chikungunya and other mosquito-borne viruses, such as dengue and Zika, represent an area of significant unmet medical need. There are currently no approved medicines for prophylaxis or treatment of these diseases, and the development and implementation of vaccines against these viruses have proved problematic. Although antiviral molecules with treatment and prophylactic potential against the chikungunya virus have been identified, no successful field trials have been reported. Chemoprophylaxis may be attractive for unvaccinated at-risk populations; however, performing a successful chemoprophylaxis trial during a chikungunya outbreak will require a clearly identifiable at-risk population. We propose the application of a household transmission model as used in testing drugs against respiratory viruses. Current evidence on household clustering of chikungunya and other Aedes mosquito-borne viral infections is supportive. We suggest that this model may improve prophylaxis trial feasibility and focus research and future treatment on a population likely to benefit.
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Affiliation(s)
- Hugh R Watson
- Antiviral Research Unit, Evotec ID, 40 avenue Tony Garnier, 69007, Lyon, France; Departments of Clinical Pharmacology, Hepatology and Gastroenterology, Aarhus University, Aarhus, Denmark.
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | - Sowath Ly
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh, Cambodia
| | | | - André M Siqueira
- Instituto Nacional de Infectologia - Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Guilherme S Ribeiro
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
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