1
|
Flandes X, Hansen CA, Palani S, Abbas K, Bennett C, Caro WP, Hutubessy R, Khazhidinov K, Lambach P, Maure C, Marshall C, Rojas DP, Rosewell A, Sahastrabuddhe S, Tufet M, Wilder-Smith A, Beasley DWC, Bourne N, Barrett ADT. Vaccine value profile for Chikungunya. Vaccine 2024; 42:S9-S24. [PMID: 38407992 DOI: 10.1016/j.vaccine.2023.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 07/05/2023] [Accepted: 07/28/2023] [Indexed: 02/28/2024]
Abstract
Chikungunya virus (CHIKV) a mosquito-borne alphavirus is the causative agent of Chikungunya (CHIK), a disease with low mortality but high acute and chronic morbidity resulting in a high overall burden of disease. After the acute disease phase, chronic disease including persistent arthralgia is very common, and can cause fatigue and pain that is severe enough to limit normal activities. On average, around 40% of people infected with CHIKV will develop chronic arthritis, which may last for months or years. Recommendations for protection from CHIKV focus on infection control through preventing mosquito proliferation. There is currently no licensed antiviral drug or vaccine against CHIKV. Therefore, one of the most important public health impacts of vaccination would be to decrease burden of disease and economic losses in areas impacted by the virus, and prevent or reduce chronic morbidity associated with CHIK. This benefit would particularly be seen in Low and Middle Income Countries (LMIC) and socio-economically deprived areas, as they are more likely to have more infections and more severe outcomes. This 'Vaccine Value Profile' (VVP) for CHIK is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of vaccines in the development pipeline and vaccine-like products.This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations. All contributors have extensive expertise on various elements of the CHIK VVP and collectively aimed to identify current research and knowledge gaps.The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- Ximena Flandes
- Department of Preventative Medicine and Population Health and University of Texas Medical Branch, Galveston, TX, United States
| | - Clairissa A Hansen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Sunil Palani
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Kaja Abbas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | | | | | | | - Clara Maure
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Marta Tufet
- Gavi the Vaccine Alliance, Geneva, Switzerland
| | | | - David W C Beasley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States; Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, United States.
| | - Nigel Bourne
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, United States; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States.
| | - Alan D T Barrett
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States.
| |
Collapse
|
2
|
Martins EB, Quintana MSB, Silva MFB, de Bruycker-Nogueira F, Moraes ICV, Rodrigues CDS, Santos CC, Sampaio SA, Pina-Costa A, Fabri AA, Guerra-Campos V, Faria NRC, Filippis AMB, Brasil P, Calvet GA. Predictors of chronic joint pain after Chikungunya virus infection in the INOVACHIK prospective cohort study. J Clin Virol 2023; 169:105610. [PMID: 37837869 DOI: 10.1016/j.jcv.2023.105610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/31/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Chikungunya can cause persistent chronic joint pain. Knowledge of the risk factors for disease progression is important for preventing and controlling complications. This study aimed to identify factors associated with chronic joint pain. METHODS This prospective cohort study was conducted at a reference center in Rio de Janeiro. Men and women (aged ≥ 18 years) in the acute phase of Chikungunya were included. Clinical data and samples were collected over three months. Risk factors were evaluated using multivariate and logistic regression analyses. RESULTS A total of 107 patients were followed up. The incidence rate of joint tenderness was 61.7 %. Female sex (adjusted odds ratio [AOR] 3.24, 95 % confidence interval [CI]:1.07-9.77), diarrhea (AOR 5.08, 95 % CI:1.55-16.67), severe joint pain (AOR 4.26, 95 % CI:1.06-17.06), and CHIKV real-time reverse transcription polymerase chain reaction positivity up to 5 days after the onset of symptoms in urine or saliva (AOR 4.56, 95 % CI:1.41-14.77) were identified as predictors of persistent chronic pain. CONCLUSIONS In a predominantly female population, musculoskeletal symptoms are not the sole determinant of chronic pain, and careful evaluation of CHIKV detection in alternative body fluids (such as saliva and urine) during the early phase of the disease is warranted.
Collapse
Affiliation(s)
- Ezequias B Martins
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil.
| | - Marcel S B Quintana
- Clinical Research Platform, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michele F B Silva
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil
| | | | - Isabella C V Moraes
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil
| | - Cintia D S Rodrigues
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina C Santos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone A Sampaio
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anielle Pina-Costa
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil
| | - Allison A Fabri
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vinícius Guerra-Campos
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nieli R C Faria
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Maria B Filippis
- Flavivirus Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil
| | - Guilherme A Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro 21045-900, Brazil
| |
Collapse
|
3
|
Avila-Trejo AM, Rodríguez-Páez LI, Alcántara-Farfán V, Aguilar-Faisal JL. Multiple Factors Involved in Bone Damage Caused by Chikungunya Virus Infection. Int J Mol Sci 2023; 24:13087. [PMID: 37685893 PMCID: PMC10488091 DOI: 10.3390/ijms241713087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic cases of chikungunya fever represent a public health problem in countries where the virus circulates. The disease is prolonged, in some cases, for years, resulting in disabling pain and bone erosion among other bone and joint problems. As time progresses, tissue damage is persistent, although the virus has not been found in blood or joints. The pathogenesis of these conditions has not been fully explained. Additionally, it has been considered that there are multiple factors that might intervene in the viral pathogenesis of the different conditions that develop. Other mechanisms involved in osteoarthritic diseases of non-viral origin could help explain how damage is produced in chronic conditions. The aim of this review is to analyze the molecular and cellular factors that could be involved in the tissue damage generated by different infectious conditions of the chikungunya virus.
Collapse
Affiliation(s)
- Amanda M. Avila-Trejo
- Laboratorio de Bioquímica Farmacológica, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (A.M.A.-T.); (L.I.R.-P.); (V.A.-F.)
- Laboratorio de Medicina de Conservación, Secretaría de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Lorena I. Rodríguez-Páez
- Laboratorio de Bioquímica Farmacológica, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (A.M.A.-T.); (L.I.R.-P.); (V.A.-F.)
| | - Verónica Alcántara-Farfán
- Laboratorio de Bioquímica Farmacológica, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (A.M.A.-T.); (L.I.R.-P.); (V.A.-F.)
| | - J. Leopoldo Aguilar-Faisal
- Laboratorio de Medicina de Conservación, Secretaría de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| |
Collapse
|
4
|
Yodtaweepornanan P, Pongsittisak W, Satpanich P. Incidence and factors associated with chronic chikungunya arthritis following chikungunya virus infection. Trop Med Int Health 2023; 28:653-659. [PMID: 37326000 DOI: 10.1111/tmi.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chikungunya virus infection is a mosquito-borne illness. First-phase symptoms include fever, malaise, rash, and arthritis (self-limiting). Some patients can have chronic-phase symptoms, including chronic tenosynovitis, bursitis, and arthritis. This study aimed to determine the incidence and risk factors of chronic arthritis in patients with chikungunya infection. METHODS This retrospective cohort study analysed all adults diagnosed with chikungunya infection between 2015 and 2020 at our centre. Baseline and follow-up symptoms were evaluated in serologically confirmed cases. Chronic chikungunya arthritis was persistent arthritis >3 months after the onset. Patients who had preexisting chronic inflammatory arthritis and were lost to follow-up before 3 months from diagnosis were excluded. RESULTS This study enrolled 120 patients. The median age was 51 (IQR 14) years, and 78% were female. The median number of joints with arthritis was 4 (IQR 8). The initial visual analog scale (VAS) score was 50 mm (IQR 40). Small joints of the hands, wrist, and knee (44.2%, 43.3%, and 42.3%, respectively) were the most affected. The incidence of chronic chikungunya arthritis was 40.4%. From the multivariable logistic regression, the initial number of joints with arthritis, initial VAS scores, and female sex were independently associated with chronic chikungunya arthritis with odds ratios of 1.09 (95% confidence interval [CI] 1.01-1.18), 1.03 (95% CI 1.01-1.06), and 4.17 (95% CI, 1.05-16.67), respectively. CONCLUSIONS Chronic chikungunya arthritis is common in patients with chikungunya virus infection. Its predictive factors include the initial number of joints with arthritis, initial VAS scores, and female sex.
Collapse
Affiliation(s)
- Pasathorn Yodtaweepornanan
- Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Wanjak Pongsittisak
- Nephrology and Renal Replacement Therapy Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology and Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Panchalee Satpanich
- Vajira Renal-Rheumatology and Autoimmune Disease Research Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
5
|
Bezerra WP, Moizéis RNC, Salmeron ACA, Pereira HWB, de Araújo JMG, Guedes PMM, Fernandes JV, Nascimento MSL. Innate immune response in patients with acute Chikungunya disease. Med Microbiol Immunol 2023:10.1007/s00430-023-00771-y. [PMID: 37285099 DOI: 10.1007/s00430-023-00771-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
Chikungunya disease (CHIKD) is an arbovirose that presents with high morbidity, mainly due to arthralgia. Inflammatory mediators including IL-6, IL-1β, GM-CSF and others have been implicated in the pathogenesis of CHIKD, whilst type I interferons can be associated with better outcomes. The role of pattern recognition receptors has been studied incompletely. Here, we evaluated the expression of RNA-specific PRRs, their adaptor molecules and downstream cytokines in acute CHIKD patients. Twenty-eight patients were recruited during the 3rd-5th day after the symptoms onset for clinical examination, peripheral blood collection and qRT-PCR analysis of PBMC to compare to the healthy control group (n = 20). We observed common symptoms of acute CHIKD, with fever, arthralgia, headache and myalgia being the most frequent. Compared with uninfected controls, acute CHIKV infection upregulates the expression of the receptors TLR3, RIG-I and MDA5, and also the adaptor molecule TRIF. Regarding cytokine expression, we found an upregulation of IL-6, IL-12, IFN-α, IFN-β and IFN-γ, which are related directly to the inflammatory or antiviral response. The TLR3-TRIF axis correlated with high expression of IL-6 and IFN-α. Interestingly, greater expression of MDA5, IL-12 and IFN-α was related to lower viral loads in CHIKD acute patients. Together, these findings help to complete the picture of innate immune activation during acute CHIKD, while confirming the induction of strong antiviral responses. Drawing the next steps in the understanding of the immunopathology and virus clearance mechanisms of CHIKD should be of utter importance in the aid of the development of effective treatment to reduce the severity of this debilitating disease.
Collapse
Affiliation(s)
- Wallace Pitanga Bezerra
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Raíza Nara Cunha Moizéis
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Amanda Costa Ayres Salmeron
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Rio Grande do Norte, Brazil
| | - Hannaly Wana Bezerra Pereira
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Josélio Maria Galvão de Araújo
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Paulo Marcos Matta Guedes
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - José Veríssimo Fernandes
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil
| | - Manuela Sales Lima Nascimento
- Department of Microbiology and Parasitology, Biosciences Center, Federal University of Rio Grande do Norte. Natal, Rio Grande do Norte, Natal, Rio Grande Do Norte, 59078-970, Brazil.
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Rio Grande do Norte, Brazil.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Hossain S, Choudhury MR, Islam MA, Hassan MM, Yeasmin S, Hossain F, Zaman MM. Post-chikungunya arthritis: a longitudinal study in a tertiary care hospital in Bangladesh. Trop Med Health 2022; 50:21. [PMID: 35260197 PMCID: PMC8903658 DOI: 10.1186/s41182-022-00412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objective To identify the clinical patterns and consequences of post-chikungunya arthritis was the study's objective. Methods This longitudinal study was carried out among 143 Chikungunya virus (CHIKV) infected adult patients at the rheumatology department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the outbreak of CHIKV infection in 2017. The disease was categorized into three phases: acute or febrile (lasting up to 10 days), subacute (11–90 days), and chronic (> 90 days). Patients who progressed towards the chronic phase were followed up to 1-year. Post-CHIKV de novo chronic inflammatory rheumatisms (CIRs) were characterized by persistent mono or oligoarthritis, undifferentiated polyarthritis, or meet the criteria rheumatoid arthritis (RA) or Spondyloarthritis (SpA). In addition, functional status was assessed by the validated Bangla version of the Health Assessment Questionnaire (HAQ). Results Mean age was 43.3 ± 11.5 years, and 51.0% were male. Within 1-year follow-up, 60 (41.9%) patients were suffering from arthralgia/ arthritis. Of them 52 patients did not have any pre-existing arthralgia/arthritis. 35 (65.3%) had undifferentiated arthritis, 10 (19.2%) had SpA, and 7 (13.5%) had RA. Patients with pre-existing rheumatological disorders, 6(4.2%) had SpA, 1(0.7%) had RA and 1(0.7%) had osteoarthritis. Polyarthralgia (n = 33, 55.0%) and polyarthritis (n = 20, 33.3%) were the main presentations. Female gender (OR: 0.45; CI: 0.21–0.96), positive IgG (OR: 0.30; CI: 0.12–0.76), and moderate to severe functional disability (OR: 3.46; CI: 1.62–7.40) were independent predictors of developing chronic post-CHIKV rheumatism. Conclusions At 1-year follow-up, more than one-third of the patients remained symptomatic. Female gender, positive IgG, and moderate to severe functional disability contributed to the development of chronicity.
Collapse
|
9
|
Sahoo RR, Wakhlu A, Agarwal V. Neglected tropical rheumatic diseases. Clin Rheumatol 2022; 41:1293-1304. [PMID: 35142903 DOI: 10.1007/s10067-022-06090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
The complexities of dealing with rheumatic diseases in tropical countries are diverse and likely due to limited health care infrastructure, lack of diagnostic and therapeutic facilities, impact of dominant prevailing diseases, and the challenges of differentiating from infectious and non-infectious disease mimics. Several tropical diseases present with musculoskeletal and rheumatic manifestations and often pose a diagnostic dilemma to rheumatologists. The diagnosis is often delayed or the disease is misdiagnosed, leading to poor patient outcomes. Endemic tropical diseases like tuberculosis and leprosy have myriad rheumatic presentations and remain important differentials to consider in patients with rheumatic manifestations. Infection with human immunodeficiency virus is a great masquerade and can mimic manifestations of multiple diseases. The role of viral infections in triggering and perpetuating autoimmunity is well known and chikungunya arthritis is a classic example of the same. This review highlights the rheumatic manifestations of tropical diseases and aims to create awareness among the caregivers. Key Points • It is crucial to be aware and identify infectious diseases presenting with rheumatic manifestations in the tropics. • Presentations akin to classic rheumatic syndromes such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and vasculitis are common.
Collapse
Affiliation(s)
- Rasmi Ranjan Sahoo
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
| |
Collapse
|
10
|
Locke MC, Fox LE, Dunlap BF, Young AR, Monte K, Lenschow DJ. Interferon Alpha, but Not Interferon Beta, Acts Early To Control Chronic Chikungunya Virus Pathogenesis. J Virol 2022; 96:e0114321. [PMID: 34668781 PMCID: PMC8754211 DOI: 10.1128/jvi.01143-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022] Open
Abstract
Chikungunya virus (CHIKV) is an arthritogenic alphavirus that causes both debilitating acute and chronic disease. Previous work has shown that type I interferons (IFNs) play a critical role in limiting CHIKV pathogenesis and that interferon alpha (IFN-α) and interferon beta (IFN-β) control acute CHIKV infection by distinct mechanisms. However, the role of type I IFNs, especially specific subtypes, during chronic CHIKV disease is unclear. To address this gap in knowledge, we evaluated chronic CHIKV pathogenesis in mice lacking IFN-α or IFN-β. We found that IFN-α was the dominant subtype that controls chronic disease. Despite detecting a varying type I IFN response throughout the course of disease, IFN-α acts within the first few days of infection to control the levels of persistent CHIKV RNA. In addition, using a novel CHIKV-3'-Cre tdTomato reporter system that fate maps CHIKV-infected cells, we showed that IFN-α limits the number of cells that survive CHIKV at sites of dissemination, particularly dermal fibroblasts and immune cells. Though myofibers play a significant role in CHIKV disease, they were not impacted by the loss of IFN-α. Our studies highlight that IFN-α and IFN-β play divergent roles during chronic CHIKV disease through events that occur early in infection and that not all cell types are equally dependent on type I IFNs for restricting viral persistence. IMPORTANCE Chikungunya virus (CHIKV) is a reemerging global pathogen with no effective vaccine or antiviral treatment for acute or chronic disease, and the mechanisms underlying chronic disease manifestations remain poorly defined. The significance of our research is in defining IFN-α, but not IFN-β, as an important host regulator of chronic CHIKV pathogenesis that acts within the first 48 hours of infection to limit persistent viral RNA and the number of cells that survive CHIKV infection 1 month post-infection. Loss of IFN-α had a greater impact on immune cells and dermal fibroblasts than myofibers, highlighting the need to delineate cell-specific responses to type I IFNs. Altogether, our work demonstrates that very early events of acute CHIKV infection influence chronic disease. Continued efforts to delineate early host-pathogen interactions may help stratify patients who are at risk for developing chronic CHIKV symptoms and identify therapeutics that may prevent progression to chronic disease altogether.
Collapse
Affiliation(s)
- Marissa C. Locke
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Lindsey E. Fox
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Bria F. Dunlap
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alissa R. Young
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kristen Monte
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Deborah J. Lenschow
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| |
Collapse
|
11
|
Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC, Cortés-Muñoz AJ. Musculoskeletal disorders due to chikungunya virus: A real experience in a rheumatology department in Neiva, Huila. ACTA ACUST UNITED AC 2021; 17:456-460. [PMID: 34625148 DOI: 10.1016/j.reumae.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread started explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate symptomatic and serological behaviour in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, and to describe the comorbidities associated with the chronic phase of the disease. METHODS An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered. RESULTS Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV. CONCLUSIONS The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.
Collapse
Affiliation(s)
- Juan Sebastián Segura-Charry
- Servicio de Reumatología, Clinica Medilaser, Neiva, Huila, Colombia; Universidad Manuela Beltrán, Laboratorio de Investigación Humana (LIH), Bogotá, Colombia.
| | | | | | | | | | | | | |
Collapse
|
12
|
Evaluation of DNA-Launched Virus-Like Particle Vaccines in an Immune Competent Mouse Model of Chikungunya Virus Infection. Vaccines (Basel) 2021; 9:vaccines9040345. [PMID: 33918409 PMCID: PMC8067036 DOI: 10.3390/vaccines9040345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Chikungunya virus (CHIKV) infection can result in chronic and debilitating arthralgia affecting humans in tropical and subtropical regions around the world, yet there are no licensed vaccines to prevent infection. DNA launched virus like particle (VLP) vaccines represent a potentially safer alternative to traditional live-attenuated vaccines; however, fully characterized immunocompetent mouse models which appropriately include both male and female animals for preclinical evaluation of these, and other, vaccine platforms are lacking. Utilizing virus stocks engineered to express mutations reported to enhance CHIKV virulence in mice, infection of male and female immunocompetent mice was evaluated, and the resulting model utilized to assess the efficacy of candidate DNA launched CHIKV VLP vaccines. Results demonstrate the potential utility of DNA launched VLP vaccines in comparison to a live attenuated CHIKV vaccine and identify gender differences in viral RNA loads that impact interpretation of vaccine efficacy and may have important implications for future CHIKV vaccine development.
Collapse
|
13
|
Silva MMO, Kikuti M, Anjos RO, Portilho MM, Santos VC, Gonçalves TSF, Tauro LB, Moreira PSS, Jacob-Nascimento LC, Santana PM, Campos GS, Siqueira AM, Kitron U, Reis MG, Ribeiro GS. Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil. Int J Infect Dis 2021; 105:608-616. [PMID: 33684559 DOI: 10.1016/j.ijid.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/17/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. METHODS From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. RESULTS Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95-2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01-1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48-1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). CONCLUSIONS These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
Collapse
Affiliation(s)
| | - Mariana Kikuti
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane C Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Laura B Tauro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Biologia Subtropical, CONICET-UNAM, Puerto Iguazú, Argentina
| | | | | | - Perla M Santana
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Gúbio S Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Emory University, Atlanta, GA, USA
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
| |
Collapse
|
14
|
|
15
|
de Moraes L, Cerqueira-Silva T, Nobrega V, Akrami K, Santos LA, Orge C, Casais P, Cambui L, Rampazzo RDCP, Trinta KS, Montalbano CA, Teixeira MJ, Cavalcante LP, Andrade BB, da Cunha RV, Krieger MA, Barral-Netto M, Barral A, Khouri R, Boaventura VS. A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study. PLoS Negl Trop Dis 2020; 14:e0008467. [PMID: 32693402 PMCID: PMC7373495 DOI: 10.1371/journal.pntd.0008467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) has caused worldwide epidemics that impose a major burden on health systems. Approximately half of infected individuals develop chronic debilitating arthralgia, affecting their quality of life. Here, we identified the relevant clinical and demographic variables in the acute phase of CHIKV infection prospectively linked to chronic arthralgia to elaborate a prognostic scoring system. METHODS Acute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined <10 days of disease onset and followed for one year to evaluate for disease progression. Potential risk factors for chronic arthralgia were evaluated by multivariate analysis to develop a prognostic scoring system, which was subsequently tested in an independent validation cohort consisting of 42 individuals. RESULTS A total of 107 out of 134 (80%) acute CHIKV-confirmed cases from the derivation cohort were re-examined one year after enrollment. Chronic arthralgia post-CHIKV infection was diagnosed in 64 (60%). Five of the 12 parameters evaluated in the acute phase were statistically associated with persistent arthralgia and were further tested by Bayesian analysis. These variables were weighted to yield a prognosis score denominated SHERA (Sex, Hypertension, Edema, Retroocular pain, Age), which exhibited 81.3% accuracy in predicting long-term arthralgia post-CHIKV infection in the derivation cohort, and 76.5% accuracy in the validation cohort. CONCLUSIONS The simplified and externally validated prognostic scoring system, SHERA, is a useful method to screen acutely CHIKV-infected patients at elevated risk of chronic arthralgia who will benefit from specific interventions. This tool could guide public health policies, particularly in resource-constrained settings.
Collapse
Affiliation(s)
- Laise de Moraes
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Victor Nobrega
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Kevan Akrami
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- University of California, San Diego, Division of Infectious Disease, Department of Medi- cine, San Diego, California, United States of America
| | | | - Cibele Orge
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Paula Casais
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Lais Cambui
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | | | | | | | | | | | - Bruno B. Andrade
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
| | - Rivaldo Venâncio da Cunha
- Faculdade de Medicina, Universidade do Mato Grosso do Sul, Campo Grande- MS, Brazil
- Fiocruz, Campo Grande, MS, Brazil
| | - Marco Aurélio Krieger
- Instituto de Biologia Molecular do Paraná, Curitiba, PR, Brasil
- Instituto Carlos Chagas—ICC/Fiocruz, Curitiba-PR, Brazil
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Aldina Barral
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Viviane Sampaio Boaventura
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Serviço de Otorrinolaringologia do Hospital Santa Izabel/Santa Casa de Misericórdia da Bahia (HIS/SCMBa), Salvador, Brazil
- * E-mail:
| |
Collapse
|
16
|
Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC, Cortés-Muñoz AJ. Musculoskeletal Disorders due to Chikungunya Virus: A Real Experience in a Rheumatology Department in Neiva, Huila. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30073-5. [PMID: 32576537 DOI: 10.1016/j.reuma.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread starts explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, the symptomatic and serological behavior, and to describe comorbidities associated to the chronic phase of the disease. METHODS An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered. RESULTS Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV. CONCLUSIONS The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.
Collapse
Affiliation(s)
- Juan Sebastián Segura-Charry
- Servicio de Reumatología, Clinica Medilaser, Neiva, Huila, Colombia; Universidad Manuela Beltrán, Laboratorio de Investigación Humana (LIH), Bogotá, Colombia.
| | | | | | | | | | | | | |
Collapse
|
17
|
de la Cruz-Castro IX, Nava-Aguilera E, Morales-Pérez A, Betanzos-Reyes ÁF, Flores-Moreno M, Morales-Nava L, Balanzar-Martínez A, Serrano-de Los Santos FR, Andersson N. Factors Associated with Chikungunya Relapse in Acapulco, Mexico: A Cross-Sectional Study. Vector Borne Zoonotic Dis 2020; 20:782-787. [PMID: 32552425 DOI: 10.1089/vbz.2020.2615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To estimate the occurrence of self-reported chikungunya relapse and identify associated factors. Materials and Methods: A cross-sectional study in December 2015 included 1305 homes in eight urban clusters considered representative of Acapulco in southern Mexico. Administered questionnaires collated information on 5870 individuals, including sociodemographic variables, a history of chronic conditions, and the self-reporting of chikungunya. Bivariate and multivariate analyses relied on a cluster-adjusted Mantel-Haenszel procedure to identify the factors associated with chikungunya and its relapse. Results: Some 66% (3531/5870) of the population reported suffering chikungunya and 31.1% (1098/3531) reported a relapse. Factors associated with relapse included the severity of the chikungunya case (odds ratio [OR]: 3.35; clusters adjusted 95% confidence interval [95% CIca]: 3.16-3.55); history of arthralgia (OR: 2.96; 95% CIca: 2.27-3.86); age 30 years or older (OR: 1.85; 95% CIca: 1.72-1.98); female (OR: 1.64; 95% CIca: 1.42-1.90); and higher education households (OR: 1.18; 95% CIca: 1.11-1.27). Conclusions: The high occurrence of chikungunya and its relapse are a public health problem. The factors associated with relapse do not immediately suggest specific prevention strategies but emphasize the dire need for effective approaches to vector control.
Collapse
Affiliation(s)
| | - Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Arcadio Morales-Pérez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Ángel Francisco Betanzos-Reyes
- Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miguel Flores-Moreno
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Liliana Morales-Nava
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Alejandro Balanzar-Martínez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | | | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México.,Department of Family Medicine, McGill University, Montreal, Canada
| |
Collapse
|
18
|
Guillot X, Ribera A, Gasque P. Chikungunya-Induced Arthritis in Reunion Island: A Long-Term Observational Follow-Up Study Showing Frequently Persistent Joint Symptoms, Some Cases of Persistent Chikungunya Immunoglobulin M Positivity, and No Anticyclic Citrullinated Peptide Seroconversion After 13 Years. J Infect Dis 2020; 222:1740-1744. [DOI: 10.1093/infdis/jiaa261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/12/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reunion Island was struck by a massive Chikungunya outbreak in 2005–2006. Chikungunya infection is characterized by inflammatory joint symptoms, which may evolve into chronic arthritis.
Methods
In this long-term longitudinal observational monocentric study, after the 2005–2006 outbreak in Reunion Island, 159 patients were first referred to a rheumatologist for post-Chikungunya chronic musculoskeletal pain, 73 of them were diagnosed with classifiable Chikungunya-related chronic inflammatory rheumatic diseases (>3 month symptom duration from the initial viral infection). Thirty of these 73 patients were clinically evaluated by a second rheumatologist in 2018–2019. The main objective of this second examination was to estimate the proportion of patients with persistent Chikungunya-related inflammatory joint symptoms after 13 years.
Results
Inflammatory joint symptoms persisted in 17/30 patients after 13 years (therefore in at least 23.3% of the 73 patients initially diagnosed with Chikungunya-related inflammatory joint symptoms and 10.7% of the 159 patients referred for post-Chikungunya chronic musculoskeletal pain). In the symptom persistence subgroup, the prevalence of positive autoantibodies (antinuclear or ACPA) was significantly higher – without any seroconversion, Chikungunya IgG and IgM levels were higher, long-term IgM positivity and radiographic damage were more frequent. Overall, after 13 years, pain and fatigue levels remained significant, 5 patients were still treated by methotrexate, 3 by TNF-blockers, highlighting long-term Chikungunya-related patient burden.
Conclusions
Such a long-term persistence of Chikungunya-related chronic inflammatory rheumatic diseases had not been reported so far. Furthermore, the long-term Chikungunya IgM positivity we observed in some cases might corroborate the hypothesis of residual viral antigen-driven chronic arthritis.
Collapse
Affiliation(s)
- Xavier Guillot
- Department of Rheumatology, Centre Hospitalier Universitaire de la Réunion, Saint-Denis, Reunion Island
- EPI, Université de la Réunion, Saint-Denis, Reunion Island
| | - Anne Ribera
- Department of Internal Medicine, Groupe Hospitalier Est de la Réunion, Saint-Benoit, Reunion Island
- Department of Internal Medicine, Centre Hospitalier Ouest de la Réunion, Saint-Paul, Reunion Island
| | | |
Collapse
|
19
|
Srivastava P, Kumar A, Hasan A, Mehta D, Kumar R, Sharma C, Sunil S. Disease Resolution in Chikungunya-What Decides the Outcome? Front Immunol 2020; 11:695. [PMID: 32411133 PMCID: PMC7198842 DOI: 10.3389/fimmu.2020.00695] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/27/2020] [Indexed: 12/14/2022] Open
Abstract
Chikungunya disease (CHIKD) is a viral infection caused by an alphavirus, chikungunya virus (CHIKV), and triggers large outbreaks leading to epidemics. Despite the low mortality rate, it is a major public health concern owing to high morbidity in affected individuals. The complete spectrum of this disease can be divided into four phases based on its clinical presentation and immunopathology. When a susceptible individual is bitten by an infected mosquito, the bite triggers inflammatory responses attracting neutrophils and initiating a cascade of events, resulting in the entry of the virus into permissive cells. This phase is termed the pre-acute or the intrinsic incubation phase. The virus utilizes the cellular components of the innate immune system to enter into circulation and reach primary sites of infection such as the lymph nodes, spleen, and liver. Also, at this point, antigen-presenting cells (APCs) present the viral antigens to the T cells thereby activating and initiating adaptive immune responses. This phase is marked by the exhibition of clinical symptoms such as fever, rashes, arthralgia, and myalgia and is termed the acute phase of the disease. Viremia reaches its peak during this phase, thereby enhancing the antigen-specific host immune response. Simultaneously, T cell-mediated activation of B cells leads to the formation of CHIKV specific antibodies. Increase in titres of neutralizing IgG/IgM antibodies results in the clearance of virus from the bloodstream and marks the initiation of the post-acute phase. Immune responses mounted during this phase of the infection determine the degree of disease progression or its resolution. Some patients may progress to a chronic arthritic phase of the disease that may last from a few months to several years, owing to a compromised disease resolution. The present review discusses the immunopathology of CHIKD and the factors that dictate disease progression and its resolution.
Collapse
Affiliation(s)
- Priyanshu Srivastava
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Ankit Kumar
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Abdul Hasan
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Divya Mehta
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Ramesh Kumar
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Chetan Sharma
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Sujatha Sunil
- Vector-Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| |
Collapse
|
20
|
Noor FM, Hossain MB, Islam QT. Prevalence of and risk factors for long-term disabilities following chikungunya virus disease: A meta-analysis. Travel Med Infect Dis 2020; 35:101618. [PMID: 32160972 DOI: 10.1016/j.tmaid.2020.101618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Md Belal Hossain
- Department of Statistics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | | |
Collapse
|
21
|
Bertolotti A, Thioune M, Abel S, Belrose G, Calmont I, Césaire R, Cervantes M, Fagour L, Javelle É, Lebris C, Najioullah F, Pierre-François S, Rozé B, Vigan M, Laouénan C, Cabié A. Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique): A prospective cohort study. PLoS Negl Trop Dis 2020; 14:e0007327. [PMID: 32163420 PMCID: PMC7100975 DOI: 10.1371/journal.pntd.0007327] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/27/2020] [Accepted: 12/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity. METHODOLOGY/PRINCIPAL FINDINGS A total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5-59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4-32.2, p = 0.04). CONCLUSIONS This cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders. TRIAL REGISTRATION clinicaltrials.gov (NCT01099852).
Collapse
Affiliation(s)
- Antoine Bertolotti
- INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France
- CHU de la Réunion, service de maladies infectieuses-médecine interne-dermatologie, Saint Pierre, France
| | - Marême Thioune
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Sylvie Abel
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
| | - Gilda Belrose
- CHU de Martinique, Centre de ressource biologique de la Martinique, Fort-de-France, France
| | | | - Raymond Césaire
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Minerva Cervantes
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
| | - Laurence Fagour
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Émilie Javelle
- Hôpital d’instruction des Armées Laveran, service de pathologie infectieuse et tropicale, Marseille, France; Aix Marseille Université, Institut de Recherche pour le Développement (IRD); Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME); Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Catherine Lebris
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Fatiha Najioullah
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | | | - Benoît Rozé
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Marie Vigan
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Cédric Laouénan
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - André Cabié
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
- INSERM, CIC1424, CHU de Martinique, Fort-de-France, France
| | | |
Collapse
|
22
|
Paixão ES, Rodrigues LC, Costa MDCN, Itaparica M, Barreto F, Gérardin P, Teixeira MG. Chikungunya chronic disease: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2019; 112:301-316. [PMID: 30007303 DOI: 10.1093/trstmh/try063] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background Chikungunya is a mosquito-borne disease caused by an arthritogenic alphavirus, with four genotypes: East Central South African (ECSA), West African, ECSA-diverged or Indian Ocean Lineage (IOL) and Asian lineage. Overall, the disease is self-limited; however, in some patients, joint pain and other non-specific symptoms can last for months or years. This systematic review and meta-analysis aims to estimate the proportion of people that self-report chikungunya-related chronic non-specific symptoms. Methods Medline, EMBASE, Global Health Library and Scopus were searched for articles published before March 2017. Case-control, cohort, cross-sectional, clinical trials studies and outcome-independent case series were eligible. It was estimated that the proportion of patients who did not recover, by virus genotype, and by the time between disease onset and assessment of chronic symptoms. Results A total of 38 studies were included in the review and 34 in the meta-analysis. Of 6532 chikungunya patients, 3157 did not recover fully after 3 months. The overall no recovery rate associated with chikungunya was 43% (95% CI, 35-52%); Inter-genotype group heterogeneity was observed, the highest prevalence in the ECSA-diverged genotype: 50% (95% CI; 40-60%), followed by the Asian lineage genotype: 36% (95% CI; 20-52%). After 12 months follow-up, the overall no-recovery rate was 21% (95% CI; 19-22%). Conclusion The evidence suggests that the prevalence of chronic discomfort associated with chikungunya illness varies by virus lineage. The proportion of people that do not fully recovered after chikungunya was high and, therefore, health authorities must prepare to treat patients with symptoms of long-lasting chikungunya adequately addressing the physical, psychological and social needs.
Collapse
Affiliation(s)
- Enny S Paixão
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, UK.,Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n. Canela. CEP 40110040. Salvador, Bahia, Brasil
| | - Laura C Rodrigues
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, UK
| | | | - Martha Itaparica
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n. Canela. CEP 40110040. Salvador, Bahia, Brasil
| | - Florisneide Barreto
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n. Canela. CEP 40110040. Salvador, Bahia, Brasil
| | - Patrick Gérardin
- INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion/UM 134 PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion), CYROI, Sainte Clotilde, Reunion
| | - Maria Glória Teixeira
- Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n. Canela. CEP 40110040. Salvador, Bahia, Brasil
| |
Collapse
|
23
|
Murillo-Zamora E, Mendoza-Cano O, Trujillo-Hernández B, Guzmán-Esquivel J, Lugo-Radillo A, Higareda-Almaraz MA, Evangelista-Salazar JJ, Higareda-Almaraz E, Benítes-Godínez V. Development of a concise clinical index for predicting chronic chikungunya arthritis. Int J Infect Dis 2019; 86:1-4. [DOI: 10.1016/j.ijid.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022] Open
|
24
|
Alvarado LI, Lorenzi OD, Torres-Velásquez BC, Sharp TM, Vargas L, Muñoz-Jordán JL, Hunsperger EA, Pérez-Padilla J, Rivera A, González-Zeno GE, Galloway RL, Glass Elrod M, Mathis DL, Oberste MS, Nix WA, Henderson E, McQuiston J, Singleton J, Kato C, García-Gubern C, Santiago-Rivera W, Muns-Sosa R, Ortiz-Rivera JD, Jiménez G, Rivera-Amill V, Andújar-Pérez DA, Horiuchi K, Tomashek KM. Distinguishing patients with laboratory-confirmed chikungunya from dengue and other acute febrile illnesses, Puerto Rico, 2012-2015. PLoS Negl Trop Dis 2019; 13:e0007562. [PMID: 31329598 PMCID: PMC6645456 DOI: 10.1371/journal.pntd.0007562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.
Collapse
Affiliation(s)
- Luisa I. Alvarado
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Olga D. Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Brenda C. Torres-Velásquez
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Luzeida Vargas
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Jorge L. Muñoz-Jordán
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Elizabeth A. Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC), Kenya, Africa
| | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Aidsa Rivera
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, United States of America
| | - Gladys E. González-Zeno
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - Mindy Glass Elrod
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - Demetrius L. Mathis
- Bacterial Special Pathogens Branch, Zoonoses and Select Agent Laboratory, CDC, Atlanta, Georgia, United States of America
| | - M. Steven Oberste
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - W. Allan Nix
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Elizabeth Henderson
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Jennifer McQuiston
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Joseph Singleton
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Cecilia Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, CDC, Atlanta, Georgia, United States of America
| | - Carlos García-Gubern
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - William Santiago-Rivera
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Robert Muns-Sosa
- Saint Luke’s Episcopal Hospital, Guayama, Puerto Rico, United States of America
| | | | - Gerson Jiménez
- Saint Luke’s Episcopal Hospital, Guayama, Puerto Rico, United States of America
| | - Vanessa Rivera-Amill
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Doris A. Andújar-Pérez
- Ponce Health Sciences University /Ponce Research Institute, Saint Luke's Episcopal Hospital, Ponce, Puerto Rico, United States of America
| | - Kalanthe Horiuchi
- Office of the Director, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado, United States of America
| | - Kay M. Tomashek
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| |
Collapse
|
25
|
Establishment and Comparison of Pathogenicity and Related Neurotropism in Two Age Groups of Immune Competent Mice, C57BL/6J Using an Indian Isolate of Chikungunya Virus (CHIKV). Viruses 2019; 11:v11060578. [PMID: 31242674 PMCID: PMC6631960 DOI: 10.3390/v11060578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
Chikungunya (CHIK) is a febrile arboviral illness caused by chikungunya virus (CHIKV) and has been identified in more than 60 countries across the globe. A major public health concern, the infection occurs as an acute febrile phase and a chronic arthralgic phase. The disease manifests differently in different age groups that can range from asymptomatic infection in the younger age group to a prolonged chronic phase in the elderly population. The present study was undertaken to evaluate strain-specific pathogenesis of ECSA genotype of CHIKV strains derived from clinical isolates in adult C57BL/6J mice model. The strain that was pathogenic and developed distinct acute and post-acute phase of CHIK infection was further evaluated for dose-dependent pathogenesis. Upon arriving on the optimal dose to induce clinical symptoms in the mice, the disease progression was evaluated across the acute and the post-acute phase of infection for a period of 15 days post-infection in two age groups of mice, namely eight weeks old and 20 weeks old mice groups. Biochemical, hematological, and virology attributes were measured and correlated to morbidity and linked neurotropism and limb thickness in the two age groups. Our results show that CHIKV exhibit strain-specific pathogenesis in C57BL/6J mice. Distinct dissimilarities were observed between the two age groups in terms of pathogenesis, viral clearance and host response to CHIKV infection.
Collapse
|
26
|
Amaral JK, Taylor PC, Teixeira MM, Morrison TET, Schoen RT. The Clinical Features, Pathogenesis and Methotrexate Therapy of Chronic Chikungunya Arthritis. Viruses 2019; 11:E289. [PMID: 30909365 PMCID: PMC6466451 DOI: 10.3390/v11030289] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022] Open
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 acute illness and persistent disabling arthritis. The rheumatic symptoms associated with chikungunya virus (CHIKV) infection include polyarthralgia, polyarthritis, morning stiffness, joint edema, and erythema. Chronic CHIK arthritis (CCA) often causes severe pain and associated disability. The pathogenesis of CCA is not well understood. Proposed hypotheses include the persistence of a low level of replicating virus in the joints, the persistence of viral RNA in the synovium, and the induction of autoimmunity. In this review, we describe the main hypotheses of CCA pathogenesis, some of which support methotrexate (MTX) treatment which has been shown to be effective in preliminary studies in CCA.
Collapse
Affiliation(s)
- J Kennedy Amaral
- Department of Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil. jkennedy-@hotmail.com
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK.
| | - Mauro Martins Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.
| | - Thomas E Tem Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Robert T Schoen
- Section of Rheumatology, Allery and Immunology, Yale University School of Medicine, New Haven, CT 06510, USA.
| |
Collapse
|
27
|
Dias JP, Costa MDCN, Campos GS, Paixão ES, Natividade MS, Barreto FR, Itaparica MSC, Goes C, Oliveira FLS, Santana EB, Silva NSJ, Brito CAA, Rodrigues LC, Sardi SI, Saavedra RC, Teixeira MG. Seroprevalence of Chikungunya Virus after Its Emergence in Brazil. Emerg Infect Dis 2019; 24:617-624. [PMID: 29553317 PMCID: PMC5875253 DOI: 10.3201/eid2404.171370] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October-December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons.
Collapse
|
28
|
Vega FLR, Bezerra JMT, Said RFDC, Gama Neto AND, Cotrim EC, Mendez D, Amâncio FF, Carneiro M. Emergence of chikungunya and Zika in a municipality endemic to dengue, Santa Luzia, MG, Brazil, 2015-2017. Rev Soc Bras Med Trop 2019; 52:e20180347. [PMID: 30652797 DOI: 10.1590/0037-8682-0347-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/13/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The recent circulation of arboviruses transmitted by vectors, such as dengue, chikungunya, and Zika, is concerning due to the high morbidity rates, clinical complications, and increased demand on health services. The objective of this study was to analyze the clinical and epidemiological aspects of an epidemic caused by arboviruses in the municipality of Santa Luzia, Minas Gerais, Brazil. METHODS Longitudinal study of patients with acute febrile disease and suspected arbovirus infection reported to Brazilian Notifiable Disease Information System (Sistema de Informação de Agravos de Notificação) from the epidemiological week 44 of 2015 to epidemiological week 52 of 2016. Patients with confirmed chikungunya were followed-up for 18 months and those with Zika for 15 months. Additionally, we analyzed and described the temporal distribution of confirmed cases of these arboviruses in this municipality. RESULTS Overall 3,531 arboviruses cases, including 3,481 (98.7%) cases of dengue, 38 (1.0%) cases of chikungunya, and 12 (0.3%) cases of Zika were confirmed. The highest incidence of arbovirus infection occurred in the first quarter of 2016 (epidemiological week 7 to 14). The most frequent symptoms were for dengue, which included fever, headache, retro-orbital pain, and exanthema. Chikungunya infection was associated with fever, myalgia, arthralgia, and rash while Zika infection with pruritus and rash. CONCLUSIONS Given the similarities in the initial clinical profiles of these arboviruses, it is important to perform a detailed clinical analysis, laboratory diagnosis, and patient follow-up.
Collapse
Affiliation(s)
- Farley Liliana Romero Vega
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| | - Juliana Maria Trindade Bezerra
- Universidade Federal de Minas Gerais, Departamento de Parasitologia, Instituto de Ciências Biológicas, Laboratório de Epidemiologia de Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Rodrigo Fabiano de Carmo Said
- Secretaria de Saúde Estadual de Minas Gerais, Subsecretaria de Vigilância e Proteção à Saúde, Programa Estadual de Controle das Doenças Transmitidas pelo Aedes, Belo Horizonte, MG, Brasil
| | | | | | - Dora Mendez
- Núcleo de Ações e Pesquisa em Apoio Diagnostico, Laboratório de Genética e Biologia Molecular, Belo Horizonte, MG, Brasil
| | | | - Mariângela Carneiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Departamento de Parasitologia, Instituto de Ciências Biológicas, Laboratório de Epidemiologia de Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| |
Collapse
|
29
|
Forechi L, Silveira-Nunes G, Barbosa MA, Barbosa ÉG, Santos DLD, Vieira ER, Barbosa AC. Pain, balance, grip strength and gait parameters of older adults with and without post-chikungunya chronic arthralgia. Trop Med Int Health 2018; 23:1394-1400. [PMID: 30281868 DOI: 10.1111/tmi.13154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the levels of pain, grip strength, balance and gait in older adults with and without post-Chikungunya chronic arthralgia (PCCA). METHODS Sixty-two older adults, 30 with and 32 without PCCA participated in the study. Pain level was assessed using a Visual Analogue Scale (VAS). Gait during a 10-m walk was assessed using inertial sensors. Semi-static balance was assessed during an eyes-closed bipedal balance test on a force platform, and grip strength was assessed using a hand dynamometer. RESULTS Participants with PCCA presented severe levels of pain (VAS > 7.5), poorer balance, lower grip strength, walked slower, with lower cadence and stride length and higher stride time and stride length variability than participants without PCCA (P < 0.001 for all variables). CONCLUSIONS Older adults with PCCA had high levels of pain, impaired balance and gait and lower grip strength compared to older adults without PCCA.
Collapse
Affiliation(s)
- Ludimila Forechi
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Gabriela Silveira-Nunes
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Michelle Almeida Barbosa
- Department of Physical Therapy, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | | | | | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | | |
Collapse
|
30
|
Prevalence and risk factors of post chikungunya rheumatic musculoskeletal disorders: a prospective follow-up study in French Guiana. Eur J Clin Microbiol Infect Dis 2018; 37:2159-2164. [PMID: 30120648 DOI: 10.1007/s10096-018-3353-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
Abstract
The estimated seroprevalence in the general population after chikungunya virus (CHIKV) epidemics ranged from 38 to 63%. Despite a low case fatality, subacute and chronic rheumatic forms of CHIKV infection generate significant morbidity and have a socioeconomic impact. The objective of the study was to estimate the prevalence of chronic post-CHIKV rheumatic or musculoskeletal pain (pCHIK-RMSP) at 3 and 6 months after the initial symptoms. An observational study was conducted at Cayenne General Hospital in French Guiana between April 1 and June 30, 2014. All patients seen for CHIKV infection confirmed by RT-PCR were prospectively included. Pregnant women and children under 15 were excluded from the study. All patients were called by phone at 3 and 6 months to enquire about the presence of pCHIK-RMSP. Out of a total of 254 eligible patients, 168 were selected. The mean age was 45.3 years (SD ± 1.4 yo) and the sex ratio (M/F) was 0.75. No death was reported. At 3 months, 40.2% (95% CI 31.1-49.3) of patients (n = 45/112) had pCHIK-RMSP and 31.3% (95% CI 22.2-40.4) of patients (n = 31/99) at 6 months. The median time of end to pain was 2 weeks after the date of onset of signs. The present study provides succinct but informative data about pCHIK-RMSP, which represents the real burden of the disease. There are few studies on that subject in the Amazonian region, but our study shows a lower impact than in the Indian Ocean islands where the population is older.
Collapse
|
31
|
McCarthy MK, Davenport BJ, Reynoso GV, Lucas ED, May NA, Elmore SA, Tamburini BA, Hickman HD, Morrison TE. Chikungunya virus impairs draining lymph node function by inhibiting HEV-mediated lymphocyte recruitment. JCI Insight 2018; 3:121100. [PMID: 29997290 DOI: 10.1172/jci.insight.121100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/06/2018] [Indexed: 01/01/2023] Open
Abstract
Chikungunya virus (CHIKV) causes acute and chronic rheumatologic disease. Pathogenic CHIKV strains persist in joints of immunocompetent mice, while the attenuated CHIKV strain 181/25 is cleared by adaptive immunity. We analyzed the draining lymph node (dLN) to define events in lymphoid tissue that may contribute to CHIKV persistence or clearance. Acute 181/25 infection resulted in dLN enlargement and germinal center (GC) formation, while the dLN of mice infected with pathogenic CHIKV became highly disorganized and depleted of lymphocytes. Using CHIKV strains encoding ovalbumin-specific TCR epitopes, we found that lymphocyte depletion was not due to impaired lymphocyte proliferation. Instead, the accumulation of naive lymphocytes transferred from the vasculature to the dLN was reduced, which was associated with fewer high endothelial venule cells and decreased CCL21 production. Following NP-OVA immunization, NP-specific GC B cells in the dLN were decreased during pathogenic, but not attenuated, CHIKV infection. Our data suggest that pathogenic, persistent strains of CHIKV disable the development of adaptive immune responses within the dLN.
Collapse
Affiliation(s)
- Mary K McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bennett J Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Glennys V Reynoso
- Viral Immunity and Pathogenesis Unit, Laboratory of Clinical Microbiology and Immunology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Erin D Lucas
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas A May
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan A Elmore
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Beth A Tamburini
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather D Hickman
- Viral Immunity and Pathogenesis Unit, Laboratory of Clinical Microbiology and Immunology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Thomas E Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
32
|
Couzigou B, Criquet-Hayot A, Javelle E, Tignac S, Mota E, Rigaud F, Alain A, Troisgros O, Pierre-Francois S, Abel S, Banydeen R, Cabié A. Occurrence of Chronic Stage Chikungunya in the General Population of Martinique during the First 2014 Epidemic: A Prospective Epidemiological Study. Am J Trop Med Hyg 2018; 99:182-190. [PMID: 29848408 DOI: 10.4269/ajtmh.17-0543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Chronic stage chikungunya (CHIK), defined by persisting symptoms more than 3 months after initial diagnosis of acute infection, is frequent. However, its burden and impact have rarely been described prospectively in a general population during an ongoing epidemic in the Caribbean. From January 2014 to January 2015, a severe CHIK outbreak occurred in Martinique. Our objective was to describe epidemiological characteristics and outcomes of chronic stage CHIK in its local population. Participants, clinically diagnosed with probable CHIK infection, were included prospectively by general practitioners during the epidemic's peak from April to October 2014. All identified cases benefited from a follow-up phone call 3 months or more after initial diagnosis during which they were interrogated about persisting clinical signs, past and ongoing treatment, and quality of life. Five hundred and nine subjects participated in the study. Mean age at initial diagnosis was 43.2 ± 23.6 years with a female-male ratio of 1.98. Two hundred participants (39.3%) had probable chronic stage CHIK: 98.5% still experienced pain at least 3 months after acute infection, with 84.3% of reported joint pains; 21.2% were woken up by the pain; 47.2% felt depressed/anxious; and 31.3% experienced memory/concentration disorders. Resumption of daily activity and work was complicated for 55.8% and 36.2% of cases. Persistent impact on morbidity, health outcomes, psychological, and economic aspects further underline the crucial role of community-based medicine and the necessity of an evidence-based multidisciplinary approach toward chronic stage CHIK identification, management, and follow-up in this particular world region.
Collapse
Affiliation(s)
- Brieg Couzigou
- Department of General Medicine, University Hospital of Martinique, Fort de France, France
| | - Anne Criquet-Hayot
- Department of General Medicine, University Hospital of Martinique, Fort de France, France
| | - Emilie Javelle
- Department of Tropical and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France
| | - Sandrine Tignac
- Department of General Medicine, University Hospital of Martinique, Fort de France, France
| | - Edith Mota
- Department of General Medicine, University Hospital of Martinique, Fort de France, France
| | - François Rigaud
- Department of General Medicine, University Hospital of Martinique, Fort de France, France
| | - Alizé Alain
- Department of Critical Care and Emergency, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Odile Troisgros
- Rehabilitation Unit, University Hospital of Martinique, Le Lamentin, France
| | - Sandrine Pierre-Francois
- Department of Tropical and Infectious Diseases, University Hospital of Martinique, Fort-de-France, France
| | - Sylvie Abel
- Department of Tropical and Infectious Diseases, University Hospital of Martinique, Fort-de-France, France
| | - Rishika Banydeen
- Clinical Research Department, University Hospital of Martinique, Fort-de-France, France
| | - André Cabié
- Department of Tropical and Infectious Diseases, University Hospital of Martinique, Fort-de-France, France.,University of the French West Indies, EA4537; INSERM CIC1424, Fort-de-France, France
| |
Collapse
|
33
|
Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study. Epidemiol Infect 2018; 146:1056-1064. [PMID: 29720285 PMCID: PMC5998769 DOI: 10.1017/s0950268818000341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of the study was to weigh the community burden of chikungunya determinants on Reunion island. Risk factors were investigated within a subset of 2101 adult persons from a population-based cross-sectional serosurvey, using Poisson regression models for dichotomous outcomes. Design-based risk ratios and population attributable fractions (PAF) were generated distinguishing individual and contextual (i.e. that affect individuals collectively) determinants. The disease burden attributable to contextual determinants was twice that of individual determinants (overall PAF value 89.5% vs. 44.1%). In a model regrouping both categories of determinants, the independent risk factors were by decreasing PAF values: an interaction term between the reporting of a chikungunya history in the neighbourhood and individual house (PAF 45.9%), a maximal temperature of the month preceding the infection higher than 28.5 °C (PAF 25.7%), a socio-economically disadvantaged neighbourhood (PAF 19.0%), altitude of dwelling (PAF 13.1%), cumulated rainfalls of the month preceding the infection higher than 65 mm (PAF 12.6%), occupational inactivity (PAF 11.6%), poor knowledge on chikungunya transmission (PAF 7.3%) and obesity/overweight (PAF 5.2%). Taken together, these covariates and their underlying causative factors uncovered 80.8% of chikungunya at population level. Our findings lend support to a major role of contextual risk factors in chikungunya virus outbreaks.
Collapse
|
34
|
Huits R, De Kort J, Van Den Berg R, Chong L, Tsoumanis A, Eggermont K, Bartholomeeusen K, Ariën KK, Jacobs J, Van Esbroeck M, Bottieau E, Cnops L. Chikungunya virus infection in Aruba: Diagnosis, clinical features and predictors of post-chikungunya chronic polyarthralgia. PLoS One 2018; 13:e0196630. [PMID: 29709007 PMCID: PMC5927412 DOI: 10.1371/journal.pone.0196630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.
Collapse
Affiliation(s)
- Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jaclyn De Kort
- Department of Internal Medicine, Horacio Oduber Hospital, Oranjestad, Aruba
| | | | - Luis Chong
- Landslaboratorium Aruba, Oranjestad, Aruba
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kaat Eggermont
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Koen Bartholomeeusen
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
35
|
Murillo-Zamora E, Mendoza-Cano O, Trujillo-Hernández B, Guzmán-Esquivel J, Higareda-Almaraz E, Higareda-Almaraz MA, Sánchez-Piña RA, Lugo-Radillo A. Persistent Arthralgia and Related Risks Factors: A Cohort Study at 12 Months from Laboratory-Confirmed Chikungunya Infection. Arch Med Res 2018; 49:65-73. [PMID: 29703609 DOI: 10.1016/j.arcmed.2018.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 04/11/2018] [Indexed: 01/04/2023]
Abstract
AIM OF THE STUDY To assess the cumulative incidence and clinical markers associated with persistent arthralgia (PA) at 12 months from acute chikungunya virus (CHIKV) infection. METHODS A multicenter retrospective cohort study was conducted in the state of Colima, Mexico, and 217 serologically confirmed cases of CHIKV infection were enrolled. Participants aged 15 years and older were interviewed on 6 months basis from acute illness onset and the main binary outcome was self-reported PA at 12 months. To assess clinical markers associated with PA we used a generalized linear model. The 2-item Patient Health Questionnaire (PHQ-2) was used to screen for depressive symptoms among PA-positive individuals. RESULTS The cumulative incidence of PA was 31.8%. In the generalized linear model, individuals ≥40 years of age (risk ratio (RR) = 1.68; 95% confidence interval (CI), 1.10-2.55) and those with 8 or more arthralgia sites (RR = 2.91, 95% CI 1.87-4.53) at acute disease had a significantly increased risk of PA at 12 months from CHIKV infection. Self-reported arthralgia (any site) at 3 months post-infection, a sub-chronic clinical marker, was also associated with a significantly increased risk of long-term articular manifestations (RR = 7.06, 95% CI 2.97-16.81). Depressive symptoms (PHQ-2 score ≥3) were reported by 33.3% of PA-positive participants. CONCLUSIONS Our findings suggest that chronic CHKV-related articular manifestations were a frequent event in the study sample and the impact on functional status was potential. These results may be useful in health care settings in the risk-stratification of PA after CHIKV infection.
Collapse
Affiliation(s)
- Efrén Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, México; Programa de Doctorado en Ciencias Médicas, Universidad de Colima, Facultad de Medicina, Colima, Colima, México
| | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Coquimatlán, Colima, México; T.H. Chan School of Public Health, Center for Health and the Global Environment, Harvard University, Boston, Massachusetts, USA.
| | | | - José Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Colima, Colima, México; Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, Colima, México
| | - Enrique Higareda-Almaraz
- Jefatura de Servicios de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Colima, Colima, México
| | | | - Ramón Alberto Sánchez-Piña
- T.H. Chan School of Public Health, Center for Health and the Global Environment, Harvard University, Boston, Massachusetts, USA
| | - Agustin Lugo-Radillo
- CONACYT-Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Oaxaca, México
| |
Collapse
|
36
|
Guaraldo L, Wakimoto MD, Ferreira H, Bressan C, Calvet GA, Pinheiro GC, Siqueira AM, Brasil P. Treatment of chikungunya musculoskeletal disorders: a systematic review. Expert Rev Anti Infect Ther 2018; 16:333-344. [PMID: 29533103 DOI: 10.1080/14787210.2018.1450629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/07/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists' opinion and experience instead of using higher rated evidence. Areas covered: A systematic review of the literature was performed- not restricted to clinical trials - reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase. Expert commentary: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.
Collapse
Affiliation(s)
- Lusiele Guaraldo
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Mayumi Duarte Wakimoto
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Heloisa Ferreira
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Clarisse Bressan
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Guilherme Amaral Calvet
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Geraldo Castelar Pinheiro
- b Departamento de Reumatologia , Universidade Estadual do Rio de Janeiro , Rio de Janeiro , RJ , Brazil
| | - Andre Machado Siqueira
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| | - Patrícia Brasil
- a Instituto Nacional de Infectologia Evandro Chagas , Fundação Oswaldo Cruz , Rio de Janeiro , RJ , Brazil
| |
Collapse
|
37
|
Elsinga J, Halabi Y, Gerstenbluth I, Tami A, Grobusch MP. Consequences of a recent past dengue infection for acute and long-term chikungunya outcome: A retrospective cohort study in Curaçao. Travel Med Infect Dis 2018; 23:34-43. [PMID: 29614385 DOI: 10.1016/j.tmaid.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/12/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Dengue and chikungunya co-infections are an emerging threat to public health in tropical and sub-tropical areas. This study investigates acute and long-term clinical presentation patterns of chikungunya against a backdrop of preceding dengue infection and determines predicting factors for long-term chikungunya sequelae. METHODS A retrospective cohort study was performed in 2015, including 299 previously confirmed chikungunya cases, of which 162 subjects were assessed for dengue serology at disease onset. RESULTS Those with previous dengue infection (35.2% of the examined population) had a similar acute disease presentation, and suffered (not statistically significantly) more frequently from long-term musculoskeletal and neuropsychological symptoms compared to chikungunya-only patients. Patients with a preceding dengue infection (vs. those without) (OR = 4.17; p = 0.004), female sex (OR = 3.17; p = 0.034) and pre-existing joint disease (OR = 2.95; p = 0.031) had a higher risk of developing aggravated long-term chikungunya. Chronic disease (sequelae lasting >90 days) was predicted by an age between 41 and 60 (OR = 3.07; p = 0.009) and concomitant cardiovascular disease (OR = 4.08; p = 0.010), but not by a preceding dengue infection. CONCLUSIONS This study suggests several predicting factors of, and a possible link between preceding dengue and chikungunya infection and aggravated long-term sequelae, which should be interpreted in the light of the limitations of this study.
Collapse
Affiliation(s)
- Jelte Elsinga
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Yaskara Halabi
- Medical and Health Service Curaçao, Department of Epidemiology and Research, Curaçao.
| | - Izzy Gerstenbluth
- Medical and Health Service Curaçao, Department of Epidemiology and Research, Curaçao; Curaçao Biomedical & Health Research Institute, Curaçao.
| | - Adriana Tami
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands.
| |
Collapse
|
38
|
Dias JP, Costa MDCN, Campos GS, Paixão ES, Natividade MS, Barreto FR, Itaparica MSC, Goes C, Oliveira FL, Santana EB, Silva NS, Brito CA, Rodrigues LC, Sardi SI, Saavedra RC, Teixeira MG. Seroprevalence of Chikungunya Virus after Its Emergence in Brazil. Emerg Infect Dis 2018. [DOI: 10.3201/eid2403.171370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
39
|
Zaid A, Gérardin P, Taylor A, Mostafavi H, Malvy D, Mahalingam S. Chikungunya Arthritis: Implications of Acute and Chronic Inflammation Mechanisms on Disease Management. Arthritis Rheumatol 2018; 70:484-495. [PMID: 29287308 DOI: 10.1002/art.40403] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
In the past decade, arboviruses-arthropod-borne viruses-have been the focus of public health institutions worldwide following a spate of devastating outbreaks. Chikungunya virus, an arbovirus that belongs to the alphavirus genus, is a reemerging arthritogenic virus that has caused explosive outbreaks since 2006, notably on Réunion Island, and more recently in the Caribbean, South America, India, and Southeast Asia. The severity of arthritic disease caused by chikungunya virus has prompted public health authorities in affected countries to develop specific guidelines to tackle this pathogen. Chikungunya virus disease manifests first as an acute stage of severe joint inflammation and febrile illness, which later progresses to a chronic stage, during which patients may experience debilitating and persisting articular pain for extended periods. This review aims to provide a broad perspective on current knowledge of chikungunya virus pathogenesis by identifying key clinical and experimental studies that have contributed to our understanding of chikungunya virus to date. In addition, the review explores the practical aspects of treatment and management of both acute and chronic chikungunya virus based on clinical experience during chikungunya virus outbreaks. Finally, recent findings on potential therapeutic solutions-from antiviral agents to immunomodulators-are reviewed to provide both viral immunologists and clinical rheumatologists with a balanced perspective on the nature of a reemerging arboviral disease of significant public health concern, and insight into future therapeutic approaches to better address the treatment and management of chikungunya virus.
Collapse
Affiliation(s)
- Ali Zaid
- Griffith University, Gold Coast, Queensland, Australia
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France, and CNRS 9192, INSERM U1187, Université de la Réunion, Sainte Clotilde, Réunion, France
| | - Adam Taylor
- Griffith University, Gold Coast, Queensland, Australia
| | | | - Denis Malvy
- Department of Tropical Medicine and Clinical International Health, University Hospital Center and INSERM 1219, University of Bordeaux, Bordeaux, France
| | | |
Collapse
|
40
|
Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: the TELECHIK cohort study on Reunion island. Epidemiol Infect 2018; 146:633-641. [PMID: 29486812 PMCID: PMC5892425 DOI: 10.1017/s0950268818000031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.
Collapse
|
41
|
Leao JC, Marques C, Duarte A, de Almeida OP, Porter S, Gueiros LA. Chikungunya fever: General and oral healthcare implications. Oral Dis 2018; 24:233-237. [PMID: 29480628 DOI: 10.1111/odi.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 12/11/2022]
Abstract
Chikungunya virus (CHIKV) was first isolated in humans in 1952, following an epidemic in Tanzania. The origin of the name means "to bend forward or become contorted," in reference to the posture adopted by patients due to the joint pain that occurs during the infection. Epidemiology data suggest that by the end of 2015, about 1.6 million people had been infected with CHIKV. The acute period of the disease is characterized by high fever, myalgia, joint pain, and severe and disabling polyarthritis, sometimes accompanied by headache, backache, and maculopapular rash, predominantly on the thorax. Around half of the patients will progress to the subacute and chronic phases, that is manifested by persistent polyarthritis/polyarthralgia, accompanied by morning stiffness and fatigue, which could remain for years. Oral features may include gingivitis possibly as a consequence of arthralgia of the hands leading to limited oral health measures as well as burning sensation and oral mucosal ulceration. Treatment in the acute phase includes acetaminophen, and weak opioids (tramadol or codeine) should be used in cases of severe or refractory pain. For patients who have progressed to the subacute stage and who have not had notable benefit from common analgesics or opioids, NSAIDs, or adjunctive pain medications (anticonvulsants or antidepressants) may be of benefit. In patients with moderate-to-severe musculoskeletal pain or in those who cannot be given or tolerate NSIADs or opiates, prednisolone should be prescribed.
Collapse
Affiliation(s)
- J C Leao
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| | - Cdl Marques
- Rheumatology Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Albp Duarte
- Rheumatology Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - O P de Almeida
- Área de Patologia, Departamento de Diagnóstico Oral, Facldade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - S Porter
- UCL Eastman Dental Institute, Oral Theme of the UCL/UCLH NIHR Biomedical Research Centre, London, UK
| | - L A Gueiros
- Oral Medicine Unit, Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
| |
Collapse
|
42
|
Mogami R, Pereira Vaz JL, de Fátima Barcelos Chagas Y, de Abreu MM, Torezani RS, de Almeida Vieira A, Junqueira Filho EA, Barbosa YB, Carvalho ACP, Lopes AJ. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:511-520. [PMID: 28786505 DOI: 10.1002/jum.14344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.
Collapse
Affiliation(s)
- Roberto Mogami
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Luiz Pereira Vaz
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yêdda de Fátima Barcelos Chagas
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirhelen Mendes de Abreu
- Department of Rheumatology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Sperling Torezani
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - André de Almeida Vieira
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Yasmin Baptista Barbosa
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Carlos Pires Carvalho
- Department of Radiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programe in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
43
|
Heath CJ, Lowther J, Noël TP, Mark-George I, Boothroyd DB, Mitchell G, MacPherson C, Desiree LaBeaud A. The Identification of Risk Factors for Chronic Chikungunya Arthralgia in Grenada, West Indies: A Cross-Sectional Cohort Study. Open Forum Infect Dis 2018; 5:ofx234. [PMID: 29308412 PMCID: PMC5753193 DOI: 10.1093/ofid/ofx234] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background Chikungunya virus (CHIKV) is a re-emerging arboviral pathogen. In 2014, an explosive CHIKV outbreak occurred in Grenada, West Indies, infecting approximately 60% of the population. In approximately 50% of cases, CHIKV infection transitions to painful arthralgia that can persist for years. Elucidation of the risk factors for chronic disease is imperative to the development of effective risk management strategies and specific therapeutics. Methods We conducted a cross-sectional study of 240 people who were tested for CHIKV during the outbreak. We administered questionnaires to examine demographic, behavioral, psychological, social, and environmental factors to identify associations with chronic disease. Physical examinations were performed and persistent symptoms were recorded. Results Ethnicity and socioeconomic status were not associated with risk of chronic joint pain. Female sex increased risk, and age was demonstrated to be predictive of chronic CHIKV sequelae. Mosquito avoidance behaviors did not reduce risk. Patients suffering joint pains, generalized body ache, and weakness in the extremities during acute infection were more likely to develop chronic arthralgia, and an increased duration of acute disease also increased risk. Conclusions These data demonstrate that chronic CHIKV affects people across the ethnic and socioeconomic spectrum, and it is not reduced by vector avoidance activity. Increased duration of acute symptoms, in particular acute joint pain, was strongly correlated with the risk of persistent arthralgia, thus effective clinical management of acute CHIKV disease could reduce burden of chronic CHIKV.
Collapse
Affiliation(s)
- Claire J Heath
- Stanford University, School of Medicine, California.,WINDREF, St. George's, Grenada
| | - Jason Lowther
- WINDREF, St. George's, Grenada.,St. George's University, School of Medicine, Grenada
| | - Trevor P Noël
- WINDREF, St. George's, Grenada.,St. George's University, School of Medicine, Grenada
| | | | | | | | - Calum MacPherson
- WINDREF, St. George's, Grenada.,St. George's University, School of Medicine, Grenada
| | | |
Collapse
|
44
|
McCarthy MK, Davenport BJJ, Morrison TE. Chronic Chikungunya Virus Disease. Curr Top Microbiol Immunol 2018; 435:55-80. [DOI: 10.1007/82_2018_147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
45
|
Haist KC, Burrack KS, Davenport BJ, Morrison TE. Inflammatory monocytes mediate control of acute alphavirus infection in mice. PLoS Pathog 2017; 13:e1006748. [PMID: 29244871 PMCID: PMC5747464 DOI: 10.1371/journal.ppat.1006748] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/29/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022] Open
Abstract
Chikungunya virus (CHIKV) and Ross River virus (RRV) are mosquito-transmitted alphaviruses that cause debilitating acute and chronic musculoskeletal disease. Monocytes are implicated in the pathogenesis of these infections; however, their specific roles are not well defined. To investigate the role of inflammatory Ly6ChiCCR2+ monocytes in alphavirus pathogenesis, we used CCR2-DTR transgenic mice, enabling depletion of these cells by administration of diptheria toxin (DT). DT-treated CCR2-DTR mice displayed more severe disease following CHIKV and RRV infection and had fewer Ly6Chi monocytes and NK cells in circulation and muscle tissue compared with DT-treated WT mice. Furthermore, depletion of CCR2+ or Gr1+ cells, but not NK cells or neutrophils alone, restored virulence and increased viral loads in mice infected with an RRV strain encoding attenuating mutations in nsP1 to levels detected in monocyte-depleted mice infected with fully virulent RRV. Disease severity and viral loads also were increased in DT-treated CCR2-DTR+;Rag1-/- mice infected with the nsP1 mutant virus, confirming that these effects are independent of adaptive immunity. Monocytes and macrophages sorted from muscle tissue of RRV-infected mice were viral RNA positive and had elevated expression of Irf7, and co-culture of Ly6Chi monocytes with RRV-infected cells resulted in induction of type I IFN gene expression in monocytes that was Irf3;Irf7 and Mavs-dependent. Consistent with these data, viral loads of the attenuated nsP1 mutant virus were equivalent to those of WT RRV in Mavs-/- mice. Finally, reconstitution of Irf3-/-;Irf7-/- mice with CCR2-DTR bone marrow rescued mice from severe infection, and this effect was reversed by depletion of CCR2+ cells, indicating that CCR2+ hematopoietic cells are capable of inducing an antiviral response. Collectively, these data suggest that MAVS-dependent production of type I IFN by monocytes is critical for control of acute alphavirus infection and that determinants in nsP1, the viral RNA capping protein, counteract this response. Mosquito-transmitted arthritogenic alphaviruses, such as chikungunya virus (CHIKV), Mayaro virus, and Ross River virus (RRV), cause large disease outbreaks. Infection with these viruses results in severe pain and inflammation in joints, tendons, and muscles, likely due to direct viral infection of these tissues, that can persist for years. Monocytes and macrophages have been implicated in the damaging effects of the inflammation, however, the role of these cell types in control of alphaviral infection are poorly understood. Using mouse models and an attenuated RRV with mutations in the nsP1 gene, we found that monocytes are critical to control acute infection and to reduce disease severity. Furthermore, we found that monocytes respond to virus-infected cells by increasing expression levels of type I interferon, a critical antiviral defense system. The induction of type I interferon in monocytes was dependent on MAVS, a signaling protein downstream of cytosolic viral RNA sensor proteins. Similar to monocytes, MAVS was required to control infection with the nsP1 mutant RRV. These studies suggest that monocytes control acute alphavirus infection and that determinants in nsP1, the viral RNA capping protein, counteract this response. Thus, therapeutic strategies targeting these cells for the treatment of these viral inflammatory diseases should do so without compromising their role in innate immunity.
Collapse
MESH Headings
- Adaptor Proteins, Signal Transducing/deficiency
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/immunology
- Alphavirus Infections/immunology
- Alphavirus Infections/virology
- Animals
- Antigens, Ly/metabolism
- Chikungunya virus/immunology
- Chikungunya virus/pathogenicity
- Diphtheria Toxin/pharmacology
- Heparin-binding EGF-like Growth Factor/genetics
- Heparin-binding EGF-like Growth Factor/immunology
- Humans
- Inflammation/virology
- Interferon Regulatory Factor-3/deficiency
- Interferon Regulatory Factor-3/genetics
- Interferon Regulatory Factor-3/immunology
- Interferon Regulatory Factor-7/deficiency
- Interferon Regulatory Factor-7/genetics
- Interferon Regulatory Factor-7/immunology
- Interferon Type I/biosynthesis
- Interferon Type I/genetics
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Monocytes/drug effects
- Monocytes/immunology
- Monocytes/virology
- Receptors, CCR2/genetics
- Receptors, CCR2/metabolism
- Ross River virus/genetics
- Ross River virus/immunology
- Ross River virus/pathogenicity
- Viral Load
- Virulence/genetics
- Virulence/immunology
Collapse
Affiliation(s)
- Kelsey C. Haist
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Kristina S. Burrack
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Bennett J. Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Thomas E. Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
| |
Collapse
|
46
|
Schwameis M, Buchtele N, Wadowski PP, Schoergenhofer C, Jilma B. Chikungunya vaccines in development. Hum Vaccin Immunother 2017; 12:716-31. [PMID: 26554522 PMCID: PMC4964651 DOI: 10.1080/21645515.2015.1101197] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chikungunya virus has become a global health threat, spreading to the industrial world of Europe and the Americas; no treatment or prophylactic vaccine is available. Since the late 1960s much effort has been put into the development of a vaccine, and several heterogeneous strategies have already been explored. Only two candidates have recently qualified to enter clinical phase II trials, a chikungunya virus-like particle-based vaccine and a recombinant live attenuated measles virus-vectored vaccine. This review focuses on the current status of vaccine development against chikungunya virus in humans and discusses the diversity of immunization strategies, results of recent human trials and promising vaccine candidates.
Collapse
Affiliation(s)
- Michael Schwameis
- a Departments of Clinical Pharmacology and Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | - Nina Buchtele
- a Departments of Clinical Pharmacology and Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | - Patricia Pia Wadowski
- a Departments of Clinical Pharmacology and Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | | | - Bernd Jilma
- a Departments of Clinical Pharmacology and Internal Medicine I , Medical University of Vienna , Vienna , Austria
| |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW Chikungunya virus (CHIKV) infection has become increasingly prevalent in the last decade not only across the southern hemisphere but also, because of a recently documented viral mutation, in southern Europe and the USA. With the global spread of CHIKV infection, practitioners should know its epidemiology, pathophysiology and clinical features. RECENT FINDINGS The acute phase of CHIKV disease is characterised by a fever-arthralgia-rash syndrome. Chronic rheumatic manifestations can persist for months to years with very variable clinical presentations. Some cases mimic inflammatory rheumatism such as rheumatoid arthritis. Several risk factors for persistent joint pain, notably older age, have been identified in cohort studies. Despite a low mortality rate with CHIKV infection, the rate of disability with chronic joint symptoms is high, and effective treatments are lacking. Current research is focusing on the development of vaccines and antiviral drugs, and data on treatment of CHIKV-induced chronic arthritis are needed.
Collapse
|
48
|
Elsinga J, Gerstenbluth I, van der Ploeg S, Halabi Y, Lourents NT, Burgerhof JG, van der Veen HT, Bailey A, Grobusch MP, Tami A. Long-term Chikungunya Sequelae in Curaçao: Burden, Determinants, and a Novel Classification Tool. J Infect Dis 2017; 216:573-581. [PMID: 28931219 DOI: 10.1093/infdis/jix312] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Beyond the acute illness phase, chikungunya constitutes a public health problem given its chronic disease phase, which may include long-term arthralgia, arthritis, fatigue, and depression. Currently, there is no consensus on how to define chikungunya chronicity. Methods A comprehensive cross-sectional survey was performed in Curaçao in June and July 2015 to evaluate 304 adult laboratory-confirmed chikungunya patients 3-16 months after diagnosis. We developed a novel tool, the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score, to classify chronic chikungunya disease and estimate its burden regarding disease duration, clinical presentation, and impact on quality of life. Results Disease persistence was estimated to be 79% one month after symptom onset and 64% after 400 days. Chikungunya persistence was characterized by higher proportions of arthralgia, weakness, myalgia, and age 41-60 years. Individuals were classified as "highly affected," "mildly affected," and "recovered." "Highly affected" disease status was associated with clinical complaints (arthralgia, weakness, loss of vitality, and being diabetic) and major decreases in quality-of-life scores. Conclusions In the Caribbean, a high proportion of chikungunya patients remains chronically affected. We propose the CLTCS as a suitable score to easily and rapidly classify the severity of chikungunya chronic disease and to assess the need for symptom-alleviating treatment.
Collapse
Affiliation(s)
- Jelte Elsinga
- University of Groningen, Department of Medical Microbiology, University Medical Center Groningen,The Netherlands
| | - Izzy Gerstenbluth
- Department of Epidemiology and Research, Medical and Health Service Curaçao.,Curaçao Biomedical and Health Research Institute
| | | | - Yaskara Halabi
- Department of Epidemiology and Research, Medical and Health Service Curaçao
| | - Norédiz T Lourents
- Department of Epidemiology and Research, Medical and Health Service Curaçao
| | | | | | - Ajay Bailey
- Population Research Center, Faculty of Spatial Sciences, University of Groningen, The Netherlands.,Transdisciplinary Centre for Qualitative Methods, Manipal University, India
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Adriana Tami
- University of Groningen, Department of Medical Microbiology, University Medical Center Groningen,The Netherlands
| |
Collapse
|
49
|
Amdekar S, Parashar D, Alagarasu K. Chikungunya Virus-Induced Arthritis: Role of Host and Viral Factors in the Pathogenesis. Viral Immunol 2017; 30:691-702. [PMID: 28910194 DOI: 10.1089/vim.2017.0052] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chikungunya virus (CHIKV), a member of Alphavirus genus, is responsible for chikungunya fever (CHIKF), which is characterized by the presence of fever, rash, myalgia, and arthralgia. Reemergence of CHIKV has become a significant public health concern in Asian and African countries and is newly emerging in the Middle East, Pacific, American, and European countries. Cytokines, innate (monocytes, natural killer cells) and adaptive immune response (role of B cells and T cells i.e. CD4+ and CD8+), and/or viral factors contribute to CHIKV-induced arthritis. Vector factors such as vector competence (that includes extrinsic and intrinsic factors) and effect of genome mutations on viral replication and fitness in mosquitoes are responsible for the spread of virus, although they are not directly responsible for CHIKV-induced arthritis. CHIKV-induced arthritis mimics arthritis by involving joints and a common pattern of leukocyte infiltrate, cytokine production, and complement activation. Successful establishment of CHIKV infection and induction of arthritis depends on its ability to manipulate host cellular processes or host factors. CHIKV-induced joint damage is due to host inflammatory response mediated by macrophages, T cells, and antibodies, as well as the possible persistence of the virus in hidden sites. This review provides insight into mechanisms of CHIKV-induced arthritis. Understanding the pathogenesis of CHIKV-induced arthritis will help in developing novel strategies to predict and prevent the disease in virus-infected subjects and combat the disease, thereby decreasing the worldwide burden of the disease.
Collapse
Affiliation(s)
- Sarika Amdekar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology , Pune, India
| | - Deepti Parashar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology , Pune, India
| | | |
Collapse
|
50
|
Landis ET, Strowd LC, Taxter AJ. Post-Chikungunya Rheumatic Disease in a 13-Year-Old Boy. Pediatr Dermatol 2017; 34:e294-e295. [PMID: 28884916 DOI: 10.1111/pde.13246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chikungunya is a mosquito-borne viral infection that causes an acute febrile illness and can result in acute or chronic musculoskeletal disease. A 13-year-old boy presented with post-Chikungunya rheumatic disease featuring connective tissue disease signs including digital ulcerations, cuticular dystrophy, dilated capillary loops, and digital tapering.
Collapse
Affiliation(s)
- Erin T Landis
- Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Lindsay C Strowd
- Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Alysha J Taxter
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| |
Collapse
|