Clinical profile and long-term sequelae of Chikungunya fever

Seropositivity of Chikungunya in Hospital Setting, India: A Systematic Review and Meta-Analysis

Backround

Information about the chikungunya disease burden by age groups and geographic distribution is necessary to guide appropriate control measures. With this, we conducted a systematic review and meta-analysis to estimate the disease burden of chikungunya fever in India.

Material and Methods

We conducted this systematic review according to the Cochrane Collaboration guidelines. We retrieved relevant articles from PubMed and a free online search. Two investigators screened titles and abstracts and extracted data from the relevant articles. Our primary outcome is the proportion of laboratory-confirmed Chikungunya fever among clinically suspected patients. We used a random effect model to estimate the pooled proportion of Chikungunya fever.

Result

A total of 20 articles were included in the quantitative syntheses. The pooled proportion of laboratory-confirmed chikungunya fever from 20 studies estimated using the random effects model is 24% (95%CI: 15-34%). We found the pooled proportion in the southern region was 35% (95%CI: 4-66%), 28% (95%CI: 3-58%) in the western region, 24% (95%CI: 1-48%) in the eastern region, 20% (95%CI: 12-29%) in the northern region, and 4% (95%CI: 1-6%) in North-eastern region.

Conclusion

This review emphasizes the need to strengthen the surveillance of disease burden using multiple diagnostic tests and the need for an appropriate molecular diagnostic for early detection of the chikungunya virus.

Evaluation of Insect Growth Regulators (IGRs) as biological pesticides for control of Aedes aegypti mosquitoes

BACKGROUND OBJECTIVES

Insect growth regulators (IGRs) are biological hormone analogue or mimics used as pesticides to inhibit the growth of larva during their molting and skin shedding. This study aimed to test the effect of IGRs on the eggs hatching and post-hatching inhibition of Aedes mosquitoes and understanding its effect in the mosquito breeding habitats for reduction in adult emergence.

METHODS

Experiments on the evaluation of three insect growth regulators (IGRs) for the control of different stages of Aedes aegypti was carried out during 2020-21. Each experiment consisted of four treatments viz., Pyriproxyfen, Novaluron, and Larvicol at 1.0 ppm and distilled water as a control. All experiments were carried out in completely randomized design (CRD) except eggs which were carried out in factorial design each with three replications.

RESULTS

All tested IGRs performed better in affecting eggs, larval and pupal stages of Ae. aegypti. Highest eggs hatching inhibition (80%) of fresh eggs occurred in Pyriproxyfen followed by Novaluron (66%) and lowest in Larvicol (62%). Eggs hatch inhibition of embryonated eggs was lower than fresh eggs. Pyriproxyfen caused 69%, Novaluron 59% and Larvicol 39% eggs hatch inhibition of embryonated eggs. Both Pyriproxyfen and Novaluron performed better in causing 98-100% larval mortality followed by Larvicol (39%). Larval development to pupal stage was completely prevented by both Pyriproxyfen and Novaluron. Although Larvicol resulted in lowest eggs hatch and larval inhibition but prevented pupae to emerge as adults. Results further showed 70-89% mortality of 3rd instar larvae of Ae. aegypti when exposed to Pyriproxyfen and Novaluron solutions after 30 days storage at lab. temperature (27±2°C), RH 70±5.

INTERPRETATION CONCLUSION

None of the IGRs was more effective at the pupal stage but showed carry-on activity of growth inhibition and mortality of the successive stages of development when used against eggs stages. Therefore, we recommend early application of IGRs at mosquito habitats during the beginning and onset of the season when very early stages of mosquitoes are available in the field.

Extra-articular Manifestations of Chikungunya

Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

Ocular Manifestations of Chikungunya Infection: A Systematic Review

The Chikungunya virus (CHIKV) can cause long lasting symptoms and manifestations. However, there is little information on which ocular ones are most frequent following infection. We performed a systematic review (registered in the International Prospective Register of Systematic Reviews; no CRD42020171928) to establish the most frequent ocular manifestations of CHIKV infection and their associations with gender and age. Articles published until September 2020 were selected from PubMed, Scielo, Cochrane and Scopus databases. Only studies with CHIKV-infected patients and eye alterations were included. Reviews, descriptive studies, or those not investigating the human ocular manifestations of CHIKV, those with patients with other diseases and infections, abstracts and studies without relevant data were excluded. Twenty-five studies were selected for inclusion. Their risk of bias was evaluated by a modified Newcastle-Ottawa scale. The most frequent ocular symptoms of CHIKV infection included ocular pain, inflammation and reduced visual acuity, whilst conjunctivitis and optic neuritis were the most common manifestations of the disease. These occurred mostly in individuals of 42 ± 9.5 years of age and woman. The few available reports on CHIKV-induced eye manifestations highlight the need for further research in the field to gather more substantial evidence linking CHIKV infection, the eye and age/gender. Nonetheless, the data emphasizes that ocular alterations are meaningful occurrences of CHIKV infection which can substantially affect quality of life.

Oral manifestations in chikungunya patients: A systematic review

BACKGROUND

Chikungunya fever is considered an abrupt onset arbovirus transmitted by mosquitoes, mainly Aedes aegypti and Aedes albopictus. The disease has a significant impact on the quality of life of affected persons, and many of its numerous symptoms have not yet been properly clarified, such as the manifestations that can occur in the oral cavity. The aim of this study was to identify the main oral manifestations related to chikungunya fever, as well as describe the demographic characteristics of patients, by conducting a systematic review of the literature.

METHODS AND FINDINGS

Searches were performed in MEDLINE (PubMed), Embase (Elsevier), LILACS (VHL), Cochrane Library, Scopus, and CAPES electronic databases for theses and dissertations published up to January 16, 2021 without language and date restrictions. Additional manual searches of gray literature, reference list, and Google Scholar were carried out. We included 27 studies highlighting mainly oral manifestations that cause masticatory discomfort such as ulcers and oral thrush, gingival bleeding, pain and burning of the oral mucous membranes, temporomandibular joint (TMJ) arthralgia, opportunistic infections, and changes in taste.

CONCLUSIONS

There seems to be a predominance of oral manifestations that cause discomfort when chewing, such as ulcerations in the acute phase of the disease, with complete remission within 3 to 10 days after the onset, apparently mostly affecting women and older persons. These oral manifestations can be compatible with basic viral infections related to inflammatory response and transitory immunosuppression.

Prevalence of and risk factors for long-term disabilities following chikungunya virus disease: A meta-analysis

BACKGROUND

The main aim of this study was to investigate the percentage of individuals who developed long-term disabilities after chikungunya virus (CHIKV) disease on the basis of follow up time interval and its associated risk factors.

METHOD

In this meta-analysis, electronic databases PubMed, Science Direct and Google Scholar were searched to identify cohort studies of CHIKV disease from January 2000 to June 2018. Total 28 eligible studies were selected for analysis. The pooled prevalence rate (PR), risk ratio (RR) and 95% confidence interval (CI) for both effect measures were calculated using a random effects model.

RESULT

Among 28 studies, 24 studies were used for PR calculation and the PR for the long-term disabilities of CHIKV disease patients were found 39.70%, [95% CI: (31.77-47.64), p < 0.01] for follow up time between 6 and 12 months, 35.85%, [95% CI: (24.09-47.61), p < 0.01] for follow up time between 12 and 18 months and 28.20%, [95% CI: (19.74-36.66), p < 0.01] for greater than 18 months respectively. Eighteen studies were used for RR calculation and significant association were found between long-term disabilities after CHIKV disease and gender [RR: 1.46, p < 0.01], age [RR: 1.61, p < 0.01], diabetes [RR: 1.40, p < 0.01], hypertension [RR: 1.37, p < 0.01], severity of pain at acute stage [RR: 2.02, p < 0.01].

CONCLUSION

Approximately 40% patients developed long-term disabilities after 6 months of CHIKV disease and 28% patients still suffer from this disease after 18 months of acute infection.

A scoping review of published literature on chikungunya virus

Chikungunya virus (CHIKV) has caused several major epidemics globally over the last two decades and is quickly expanding into new areas. Although this mosquito-borne disease is self-limiting and is not associated with high mortality, it can lead to severe, chronic and disabling arthritis, thereby posing a heavy burden to healthcare systems. The two main vectors for CHIKV are Aedes aegypti and Aedes albopictus (Asian tiger mosquito); however, many other mosquito species have been described as competent CHIKV vectors in scientific literature. With climate change, globalization and unfettered urban planning affecting many areas, CHIKV poses a significant public health risk to many countries. A scoping review was conducted to collate and categorize all pertinent information gleaned from published scientific literature on a priori defined aspects of CHIKV and its competent vectors. After developing a sensitive and specific search algorithm for the research question, seven databases were searched and data was extracted from 1920 relevant articles. Results show that CHIKV research is reported predominantly in areas after major epidemics have occurred. There has been an upsurge in CHIKV publications since 2011, especially after first reports of CHIKV emergence in the Americas. A list of hosts and vectors that could potentially be involved in the sylvatic and urban transmission cycles of CHIKV has been compiled in this scoping review. In addition, a repository of CHIKV mutations associated with evolutionary fitness and adaptation has been created by compiling and characterizing these genetic variants as reported in scientific literature.

Chikungunya Infection: A Re-emerging Epidemic

Chikungunya (CHIK) is an arboviral infection caused by the chikungunya virus. An unusual feature of CHIK is its long periods of quiescence followed by an epidemic of devastating severity that can involve millions of people. Manifestations of CHIK range from a mild self-limiting febrile illness with arthralgia and rash to crippling acute and lingering debilitating arthritis. In about 10–60% of patients, musculoskeletal symptoms may persist for up to 3–5 years. Management is mainly symptomatic, with analgesics, antipyretics and non-steroidal anti-inflammatory agents. Ecological changes together with alterations in the viral genome facilitate the development of newer variants with greater pathogenicity, a matter of great concern. The social and economic burdens to a society as a result of CHIK epidemics have generated a considerable interest in the scientific community to decipher the reasons underlying myriad manifestations and to develop management strategies for tackling the menace of CHIK across the globe.

Rheumatic-musculoskeletal pain and disorders in a naïve group of individuals 15 months following a Chikungunya viral epidemic in south India: a population based observational study

BACKGROUND

Prospective community data on arthropathy following Chikungunya (CHIKV), a self-limiting, arboviral infection, causing debilitating arthropathy are lacking. The clinical profile of chronic rheumatic-musculoskeletal (RMSK) pain and disorders, captured inadvertently about 15 months following a CHIKV epidemic is described.

MATERIALS AND METHODS

Patients with RMSK pain following the CHIKV epidemic in 2007 were identified from a randomly selected population of 5277 (Age > 15 years) in a village in south India, using a validated questionnaire-based house-to-house survey. Typical narration, records and serology were relied upon to classify CHIKV. Respondents who recorded active pain sites on a human mannequin were evaluated by Rheumatology physicians.

RESULTS

A total of 1396 CHIKV infected individuals with painful MSKD were identified, of whom 437 patients (mean age: 48.37 ± 13.62 years; 71.6% women) who were naïve to RMSK pain prior to the epidemic were studied in detail. Incidence of RMSK pain and disorders in the naïve group was 8.3% (437/5277). Knee was the commonest self-reported pain site (83.3%). Majority of the patients (57%) had postviral non-specific polyarthralgia. Soft tissue rheumatism was very common (27.7%). Rheumatoid arthritis and seronegative spondyloarthritis were observed in 6 and 11 patients, respectively.

CONCLUSIONS

Although a causal association could not be established, this study has unravelled a wide spectrum of unrecognised post-CHIKV chronic RMSK disorders. Aetiopathogenesis and risk factors of chronicity need to be studied further.