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Liao X, Xin J, Yu Z, Yan W, Li C, Cao L, Zhang H, Wang W. Unlocking the antiviral potential of rosmarinic acid against chikungunya virus via IL-17 signaling pathway. Front Cell Infect Microbiol 2024; 14:1396279. [PMID: 38800832 PMCID: PMC11127627 DOI: 10.3389/fcimb.2024.1396279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background The Chikungunya virus is an Alphavirus that belongs to the Togaviridae family and is primarily transmitted by mosquitoes. It causes acute infection characterized by fever, headache, and arthralgia. Some patients also experience persistent chronic osteoarthritis-like symptoms. Dedicated antiviral treatments are currently unavailable for CHIKV. This study aims to explore the potential anti-CHIKV effect of rosmarinic acid using network pharmacology. Methods This study employed network pharmacology to predict and verify the molecular targets and pathways associated with ROSA in the context of CHIKV. The analysis outcomes were further validated using molecular docking and in vitro experiments. Results The analysis of CHIKV targets using the Kyoto Encyclopedia of Genes and Genomes and MCODE identified IL-17 as an important pathogenic pathway in CHIKV infection. Among the 30 targets of ROSA against CHIKV, nearly half were found to be involved in the IL-17 signaling pathway. This suggests that ROSA may help the host in resisting CHIKV invasion by modulating this pathway. Molecular docking validation results showed that ROSA can stably bind to 10 core targets out of the 30 identified targets. In an in vitro CHIKV infection model developed using 293T cells, treatment with 60 μM ROSA significantly improved the survival rate of infected cells, inhibited 50% CHIKV proliferation after CHIKV infection, and reduced the expression of TNF-α in the IL-17 signaling pathway. Conclusion This study provides the first confirmation of the efficacy of ROSA in suppressing CHIKV infection through the IL-17 signaling pathway. The findings warrant further investigation to facilitate the development of ROSA as a potential treatment for CHIKV infection.
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Affiliation(s)
- Xinfei Liao
- Wenzhou Polytechnic, Wenzhou, Zhejiang, China
| | - Jialiang Xin
- Institute of Virology, Wenzhou University, Wenzhou, Zhejiang, China
| | - Ziping Yu
- Institute of Virology, Wenzhou University, Wenzhou, Zhejiang, China
| | - Weiming Yan
- Institute of Virology, Wenzhou University, Wenzhou, Zhejiang, China
| | - Chenghui Li
- College of Agriculture, Yanbian University, Yanji, Jilin, China
| | - Liang Cao
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, Jilin, China
| | - He Zhang
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, Jilin, China
| | - Wei Wang
- Institute of Virology, Wenzhou University, Wenzhou, Zhejiang, China
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, Jilin, China
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2
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Chuong C, Cereghino C, Rai P, Bates TA, Oberer M, Weger-Lucarelli J. Enhanced attenuation of chikungunya vaccines expressing antiviral cytokines. NPJ Vaccines 2024; 9:59. [PMID: 38472211 PMCID: PMC10933427 DOI: 10.1038/s41541-024-00843-x] [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: 01/03/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Alphaviruses are vector-borne, medically relevant, positive-stranded RNA viruses that cause disease in animals and humans worldwide. Of this group, chikungunya virus (CHIKV) is the most significant human pathogen, responsible for generating millions of infections leading to severe febrile illness and debilitating chronic joint pain. Currently, there are limited treatments to protect against alphavirus disease; thus, there is a tremendous need to generate safe and effective vaccines. Live-attenuated vaccines (LAVs) are cost-effective and potent immunization strategies capable of generating long-term protection in a single dose. However, LAVs often produce systemic viral replication, which can lead to unwanted post-vaccination side effects and pose a risk of reversion to a pathogenic phenotype and transmission to mosquitoes. Here, we utilized a chimeric infectious clone of CHIKV engineered with the domain C of the E2 gene of Semliki Forest virus (SFV) to express IFNγ and IL-21-two potent antiviral and immunomodulatory cytokines-in order to improve the LAV's attenuation while maintaining immunogenicity. The IFNγ- and IL-21-expressing vaccine candidates were stable during passage and significantly attenuated post-vaccination, as mice experienced reduced footpad swelling with minimal systemic replication and dissemination capacity compared to the parental vaccine. Additionally, these candidates provided complete protection to mice challenged with WT CHIKV. Our dual attenuation strategy represents an innovative way to generate safe and effective alphavirus vaccines that could be applied to other viruses.
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Affiliation(s)
- Christina Chuong
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA
- Center for Emerging, Zoonotic, and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA
| | - Chelsea Cereghino
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA
- Center for Emerging, Zoonotic, and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA
| | - Pallavi Rai
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA
- Center for Emerging, Zoonotic, and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA
| | - Tyler A Bates
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA
| | - Megan Oberer
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA
| | - James Weger-Lucarelli
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, USA.
- Center for Emerging, Zoonotic, and Arthropod-borne Pathogens, Virginia Tech, Blacksburg, VA, USA.
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Warnes CM, Bustos Carrillo FA, Zambrana JV, Lopez Mercado B, Arguello S, Ampié O, Collado D, Sanchez N, Ojeda S, Kuan G, Gordon A, Balmaseda A, Harris E. Longitudinal analysis of post-acute chikungunya-associated arthralgia in children and adults: A prospective cohort study in Managua, Nicaragua (2014-2018). PLoS Negl Trop Dis 2024; 18:e0011948. [PMID: 38416797 PMCID: PMC10962812 DOI: 10.1371/journal.pntd.0011948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/25/2024] [Accepted: 01/27/2024] [Indexed: 03/01/2024] Open
Abstract
Chikungunya can result in debilitating arthralgia, often presenting as acute, self-limited pain, but occasionally manifesting chronically. Little is known about differences in chikungunya-associated arthralgia comparing children to adults over time. To characterize long-term chikungunya-associated arthralgia, we recruited 770 patients (105 0-4 years old [y/o], 200 5-9 y/o, 307 10-15 y/o, and 158 16+ y/o) with symptomatic chikungunya virus infections in Managua, Nicaragua, during two consecutive chikungunya epidemics (2014-2015). Participants were assessed at ~15 days and 1, 3, 6, 12, and 18 months post-fever onset. Following clinical guidelines, we defined participants by their last reported instance of arthralgia as acute (≤10 days post-fever onset), interim (>10 and <90 days), or chronic (≥90 days) cases. We observed a high prevalence of arthralgia (80-95%) across all ages over the study period. Overall, the odds of acute arthralgia increased in an age-dependent manner, with the lowest odds of arthralgia in the 0-4 y/o group (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.14-0.51) and the highest odds of arthralgia in the 16+ y/o participants (OR: 4.91, 95% CI: 1.42-30.95) relative to 10-15 y/o participants. Females had higher odds of acute arthralgia than males (OR: 1.63, 95% CI: 1.01-2.65) across all ages. We found that 23-36% of pediatric and 53% of adult participants reported an instance of post-acute arthralgia. Children exhibited the highest prevalence of post-acute polyarthralgia in their legs, followed by the hands and torso - a pattern not seen among adult participants. Further, we observed pediatric chikungunya presenting in two distinct phases: the acute phase and the subsequent interim/chronic phases. Thus, differences in the presentation of arthralgia were observed across age, sex, and disease phase in this longitudinal chikungunya cohort. Our results elucidate the long-term burden of chikungunya-associated arthralgia among pediatric and adult populations.
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Affiliation(s)
- Colin M. Warnes
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Fausto Andres Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | | | | | | | | | | | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States of America
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
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Amaral JK, Taylor PC, Weinblatt ME, Bandeira Í, Schoen RT. Quality of Life and Disability in Chikungunya Arthritis. Curr Rheumatol Rev 2024; 20:65-71. [PMID: 37605393 DOI: 10.2174/1573397119666230726113647] [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: 04/16/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Chikungunya virus infection, transmitted by Aedes mosquito vectors, causes outbreaks of chikungunya fever (CHIKF), throughout the tropical and subtropical world. Following acute infection, many CHIKF patients develop a second phase, chronic and disabling arthritis. OBJECTIVE To evaluate the impact of chikungunya arthritis (CHIKA) on quality of life and disability in a cohort of Brazilian CHIKA patients. METHODS We conducted a descriptive, non-interventionist, retrospective cross-sectional study analysing data collected from the medical records of chikungunya virus-infected patients treated between June 1, 2022, and June 30, 2022, in the Brazilian rheumatology clinic of one of us (JKA). To assess disability, quality of life, and pain, patients were evaluated using the Health Assessment Questionnaire Disability Index (HAQ-DI), 12-Item Short-Form Health Survey (SF-12), and Visual Analog Scale (VAS) pain. RESULTS Forty-two women with a mean (± SD) age of 57.83 (± 13.05) years had CHIKF confirmed by chikungunya-specific serology. The mean (± SD) time between the onset of chikungunya symptoms and the first clinic visit was 55.19 (± 25.88) days. At this visit, the mean (± SD) VAS pain score and DAS28-ESR were 77.26 (± 23.71) and 5.8 (± 1.29), respectively. The mean (± SD) HAQDI score was 1.52 (± 0.67). The mean (± SD) SF-12 PCS-12 was 29.57 (± 8.62) and SF-12 MCS-12 was 38.42 (± 9.85). CONCLUSION CHIKA is often highly disabling. As the mosquito vectors that transmit this illness have spread to every continent except Antarctica, there is a potential for widespread public health impact from CHIKA and the need for more effective, early intervention to prevent CHIKA.
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Affiliation(s)
- Jose Kennedy Amaral
- Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Ceará, Brazil
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Windmill Road, University of Oxford, Oxford, UK
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation and Immunity, Harvard Medical School, Harvard University, USA
| | - Ícaro Bandeira
- Faculty of Medicine FAPAraripina, Araripina, Pernambuco, Brazil
| | - Robert T Schoen
- Section of Rheumatology, Yale University School of Medicine, Yale University, New Haven, Connecticut, USA
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5
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Vinay K, Thind A, Mehta H, Bishnoi A. Mucocutaneous manifestations of chikungunya fever: an update. Int J Dermatol 2023; 62:1475-1484. [PMID: 37781980 DOI: 10.1111/ijd.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/16/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Chikungunya is a viral disease transmitted by female Aedes mosquitoes that has been increasingly reported in many parts of the world across the geographical borders. In addition to fever and joint pain, mucocutaneous manifestations of chikungunya have been reported in 40-75% of infected patients. Dermatological manifestations of chikungunya are often under-recognized and misdiagnosed as clinicians are not sensitized or educated regarding these. The early-onset cutaneous manifestations of chikungunya fever, occurring within 1 month of the fever, include maculopapular rashes, vesiculobullous eruptions, Steven-Johnson syndrome/toxic epidermal necrolysis-like eruptions, flagellate lesions, scrotal dermatitis, oro-genital ulcers, and exacerbation of preexisting dermatoses like psoriasis. Hyperpigmentation, lichenoid eruptions, diffuse hair fall, and exacerbation of acne usually occur as a late manifestation. Diagnosis of these mucocutaneous manifestations can be challenging as they often resemble other common dermatoses. This review article elaborates on various mucocutaneous manifestations of chikungunya fever, based on literature review and authors' clinical experience.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Thind
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Doran C, Duits A, Tami A, Gerstenbluth I, Bailey A. "It's very saddening, you keep on wondering when the symptoms will be over": A qualitative study exploring the long-term chikungunya disease impact on daily life and well-being, 6 years after disease onset. PLoS Negl Trop Dis 2023; 17:e0011793. [PMID: 38055664 DOI: 10.1371/journal.pntd.0011793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Long-term chikungunya is a mosquito-borne disease, characterized by disabling rheumatic symptoms persisting for years, after infection with the chikungunya virus. Previous studies focused on assessing the well-being of affected individuals from a quantitative perspective using generic instruments, and have reported physical and psychological impairment. However, a common critique is that generic instrument's structured responses and pre-defined health domains selected by health professionals, may not capture the full extent of well-being impairment experienced by patients. This study aimed to explore in-depth to which extent long-term chikungunya disease impacts daily living and the physical, psychological, and social well-being from the experiences and perspective of affected individuals. METHODOLOGY/PRINCIPAL FINDINGS Using open-ended questions, in-depth interviews were conducted with 20 purposively selected individuals with long-term chikungunya disease, in Curaçao. Interview audio-recordings were transcribed verbatim. The data were thematically analyzed. Living with persistent rheumatic symptoms affected the participant's daily living and well-being in several ways: experience of physical impact (restricted physical functioning and limitations in activities of daily life); experience of psychological impact (altered emotional state, fear of walking and running, psychosocial aspects of footwear adaptations, and uncertainty about disease progression and future health); and experience of social impact (social isolation and impaired relational maintenance, social dependency, challenges of social support, at-work productivity loss, and giving up leisure activities after work). CONCLUSIONS/SIGNIFICANCE This study, the first of its kind, indicated that the adverse impact of long-term chikungunya disease is currently underreported. The persistent rheumatic symptoms had a negative effect on functional ability, which in turn impacted broad aspects of daily life and well-being, beyond what is captured by generic instruments. In the view of the findings, physical exercise programs including manual therapy, aerobics, resistance and stretching exercises, and orthopaedic footwear interventions in a multidisciplinary patient-centred approach may improve physical function and subsequently overall well-being.
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Affiliation(s)
- Churnalisa Doran
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Ashley Duits
- Red Cross Blood Bank Foundation, Willemstad, Curaçao
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
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Torales J, Barrios I, Estigarribia G, Sequera G, Almirón-Santacruz J, O'Higgins M, Navarro R, Melgarejo O, González-Urbieta I, Caycho-Rodríguez T, Castaldelli-Maia JM, Ventriglio A, Bhugra D. The Chikungunya anxiety scale (CHIKAS): Development, validation, and relationship between its items and illness-related factors. Ind Psychiatry J 2023; 32:S117-S126. [PMID: 38370942 PMCID: PMC10871425 DOI: 10.4103/ipj.ipj_210_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 02/20/2024] Open
Abstract
Background Paraguay has recently experienced an exponential increase in chikungunya cases, leading to psychological distress, particularly anxiety. Aim To develop and validate the Chikungunya Anxiety Scale (CHIKAS). Materials and Methods An initial scale of 18 items was used, which was subjected to validation by expert judgment to obtain 14 items. To determine construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been employed, and internal and convergent validity were determined. Demographic, socioeconomic, and health status data were also collected. Results The study included 974 participants. The final scale consisted of 12 items with evidence of a two-factor model (psychological and physical). The internal validity was good (McDonald's omega = 0.882). The CFA showed good adjustment indices. Regarding participant characteristics, a relationship was found between anxiety due to chikungunya and gender, employment, mental diagnosis, medication use, and chikungunya infection. Conclusion The final 12-item CHIKAS had strong psychometric properties and was a two-factor model.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo
- Regional Institute for Health Research, National University of Caaguazú, Coronel Oviedo
- Scholl of Medical Sciences, Universidad Sudamericana, Pedro Juan Caballero
| | - Iván Barrios
- Scholl of Medical Sciences, Universidad Sudamericana, Pedro Juan Caballero
- Department of Statistics, School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray Campus, Santa Rosa del Aguaray
| | - Gladys Estigarribia
- Regional Institute for Health Research, National University of Caaguazú, Coronel Oviedo
- Department of Research Methodology, School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray Campus, Santa Rosa del Aguaray
| | - Guillermo Sequera
- Directorate of Health Surveillance, Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - José Almirón-Santacruz
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo
| | - Marcelo O'Higgins
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo
| | - Rodrigo Navarro
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo
| | - Osvaldo Melgarejo
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo
| | | | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André
- Department of Psychiatry, University of São Paulo, São Paulo, SP, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Costa LB, Barreto FKDA, Barreto MCA, Santos THPD, Andrade MDMOD, Farias LABG, Freitas ARRD, Martinez MJ, Cavalcanti LPDG. Epidemiology and Economic Burden of Chikungunya: A Systematic Literature Review. Trop Med Infect Dis 2023; 8:301. [PMID: 37368719 DOI: 10.3390/tropicalmed8060301] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Chikungunya (CHIK) is a re-emerging viral infection endemic in tropical and subtropical areas. While the typical clinical presentation is an acute febrile syndrome, long-term articular complications and even death can occur. This review characterizes the global epidemiological and economic burden of chikungunya. The search included studies published from 2007 to 2022 in MEDLINE, Embase, LILACS, and SciELO for a thorough evaluation of the literature. Rayyan software was used for data analysis, and data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-six publications were included. Chikungunya is widely distributed in the tropics, including Africa, Asia, South America, and Oceania/the Pacific Islands, and co-circulates with other simultaneous arboviruses such as DENV, ZIKV, and YFV. Chikungunya infection can lead to chronic articular manifestations with a significant impact on the quality of life in the long term. In addition, it generates absenteeism and economic and social losses and can cause fatal infections in vulnerable populations, mainly in high-risk patients with co-morbidities and at the extremes of age. Reported costs associated with CHIKV diseases are substantial and vary by region, age group, and public/private delivery of healthcare services. The chikungunya disease burden includes chronicity, severe infections, increased hospitalization risks, and associated mortality. The disease can impact the economy in several spheres, significantly affecting the health system and national economies. Understanding and measuring the full impact of this re-emerging disease is essential.
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Affiliation(s)
- Lourrany Borges Costa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Ceara (UFC), Ceara 60020-181, Brazil
- Faculdade de Medicina, Universidade de Fortaleza (UNIFOR), Ceara 60811-905, Brazil
| | | | | | | | | | - Luís Arthur Brasil Gadelha Farias
- Hospital São Jose de Doenças Infecciosas, Ceara 60455-610, Brazil
- Faculdade de Medicina, Centro Universitário Christus (UNICHRISTUS), Ceara 60192-345, Brazil
| | | | - Miguel Julian Martinez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Luciano Pamplona de Góes Cavalcanti
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Ceara (UFC), Ceara 60020-181, Brazil
- Faculdade de Medicina, Centro Universitário Christus (UNICHRISTUS), Ceara 60192-345, Brazil
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9
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Warnes CM, Carrillo FAB, Zambrana JV, Mercado BL, Arguello S, Ampié O, Collado D, Sanchez N, Ojeda S, Kuan G, Gordon A, Balmaseda A, Harris E. Longitudinal Analysis of the Burden of Post-Acute Chikungunya-Associated Arthralgia in Children and Adults: A Prospective Cohort Study in Managua, Nicaragua (2014-2019). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.09.23289726. [PMID: 37214808 PMCID: PMC10197786 DOI: 10.1101/2023.05.09.23289726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Chikungunya can result in debilitating arthralgia, often presenting as acute, self-limited pain, but occasionally manifesting chronically. Little is known about differences in chikungunya-associated arthralgia comparing children to adults over time. To characterize long-term chikungunya-associated arthralgia, we recruited 770 patients (105 0-4 year olds [y/o], 200 5-9 y/o, 307 10-15 y/o, and 158 16+ y/o) with symptomatic chikungunya virus infections in Managua, Nicaragua, during two chikungunya epidemics (2014-2015). Participants were assessed at ~15 days and 1, 3, 6, 12, and 18 months post-fever onset. Following clinical guidelines, we defined participants by their last reported instance of arthralgia as acute (≤10 days post-fever onset), interim (>10 and <90 days), or chronic (≥90 days) cases. We observed a high prevalence of arthralgia (80-95%) across all ages over the study period. Overall, the odds of acute arthralgia increased in an age-dependent manner, with the lowest odds of arthralgia in the 0-4 y/o group (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.14-0.51) and the highest odds of arthralgia in the 16+ y/o participants (OR: 4.91, 95% CI: 1.42-30.95) relative to 10-15 y/o participants. Females had a higher odds of acute arthralgia than males (OR: 1.63, 95% CI: 1.01-2.65) across all ages. We found that 23-36% of pediatric and 53% of adult participants reported an instance of post-acute arthralgia. Children exhibited the highest prevalence of post-acute polyarthralgia in their legs, followed by the hands and torso - a pattern not seen among adult participants. Further, we observed pediatric chikungunya presenting in two distinct phases: the acute phase and the associated interim and chronic phases. Differences in the presentation of arthralgia were observed across age, sex, and disease phase in this longitudinal chikungunya cohort. Our results elucidate the long-term burden of chikungunya-associated arthralgia among pediatric and adult populations.
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Affiliation(s)
- Colin M. Warnes
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Fausto Andres Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | | | | | | | | | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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10
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Chen CR, Ma Y, Wang HX, Liu XY, Liu Y, Meng QG, Jin YS. Design, synthesis and anti-Chikungunya virus activity of lomerizine derivatives. Bioorg Med Chem Lett 2023; 83:129188. [PMID: 36804408 DOI: 10.1016/j.bmcl.2023.129188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Chikungunya fever is an acute infectious disease caused by Chikungunya virus (CHIKV) and transmitted by Aedes mosquito. It is characterized by fever, rash and arthralgia with no effective drugs. Lomerizine (Lom) is a new generation calcium antagonist, which is mainly used in the treatment of migraine. Certain antiviral function of Lom was shown by some research. In our study, a series of new derivatives of Lom were designed and synthesized, and their in-vitro anti-CHIKV activity was tested. The results showed that Lom and its derivatives had potent anti-CHIKV activity and low cytotoxicity. Among them, compounds B1 and B7 showed most potent antiviral activity. Besides, structure-activity relationships, in-silico ADMET properties were also analyzed. Molecular docking study was performed to rationalize the SAR and analyze the possible binding modes between B1 and amino acid residues in the active site of nsP3 protein to enhance the understanding of their action as antiviral agents. These finding provides research basis for the design and synthesis of effective anti-CHIKV drugs with Lom as the lead compound.
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Affiliation(s)
- Chu-Ran Chen
- School of Pharmacy, Naval Medical University, Shanghai 200433, China
| | - Ying Ma
- School of Pharmacy, Yantai University, Yantai, Shandong Province 264005, China
| | - Han-Xuan Wang
- Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200433, China
| | - Xin-Yang Liu
- School of Basic Medicine, Naval Medical University, Shanghai 200433, China
| | - Yan Liu
- Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - Qing-Guo Meng
- School of Pharmacy, Yantai University, Yantai, Shandong Province 264005, China
| | - Yong-Sheng Jin
- School of Pharmacy, Naval Medical University, Shanghai 200433, China.
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11
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Deubiquitinating Enzyme Inhibitors Block Chikungunya Virus Replication. Viruses 2023; 15:v15020481. [PMID: 36851696 PMCID: PMC9966916 DOI: 10.3390/v15020481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Ubiquitination and deubiquitination processes are widely involved in modulating the function, activity, localization, and stability of multiple cellular proteins regulating almost every aspect of cellular function. Several virus families have been shown to exploit the cellular ubiquitin-conjugating system to achieve a productive infection: enter the cell, promote genome replication, or assemble and release viral progeny. In this study, we analyzed the role of deubiquitinating enzymes (DUBs) during chikungunya virus (CHIKV) infection. HEK293T, Vero-E6, and Huh-7 cells were treated with two DUB inhibitors (PR619 or WP1130). Then, infected cells were evaluated by flow cytometry, and viral progeny was quantified using the plaque assay method. The changes in viral proteins and viral RNA were analyzed using Western blotting and RT-qPCR, respectively. Results indicate that treatment with DUB inhibitors impairs CHIKV replication due to significant protein and viral RNA synthesis deregulation. Therefore, DUB activity may be a pharmacological target for blocking CHIKV infection.
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12
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Suzuki Y. Interferon-induced restriction of Chikungunya virus infection. Antiviral Res 2023; 210:105487. [PMID: 36657882 DOI: 10.1016/j.antiviral.2022.105487] [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: 11/17/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Chikungunya virus (CHIKV) is an enveloped RNA virus that causes Chikungunya fever (CHIKF), which is transmitted to humans through the bite of infected Aedes mosquitos. Although CHIKVF had been regarded as an endemic disease in limited regions of Africa and Asia, the recent global reemergence of CHIKV heightened awareness of this infectious disease, and CHIKV infection is currently considered an increasing threat to public health. However, no specific drug or licensed vaccine is available for CHIKV infection. As seen in other RNA virus infections, CHIKV triggers the interferon (IFN) response that plays a central role in host defense against pathogens. Experimental evidence has demonstrated that control of CHIVK replication by the IFN response is achieved by antiviral effector molecules called interferon-stimulated genes (ISGs), whose expressions are upregulated by IFN stimulation. This review details the molecular basis of the IFN-mediated suppression of CHIKV, particularly the ISGs restricting CHIKV replication.
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Affiliation(s)
- Youichi Suzuki
- Department of Microbiology and Infection Control, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
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13
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Tran QM, Soda J, Siraj A, Moore S, Clapham H, Alex Perkins T. Expected endpoints from future chikungunya vaccine trial sites informed by serological data and modeling. Vaccine 2023; 41:182-192. [PMID: 36424258 DOI: 10.1016/j.vaccine.2022.11.028] [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: 05/16/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
In recent decades, there has been an increased interest in developing a vaccine for chikungunya. However, due to its unpredictable transmission, planning for a chikungunya vaccine trial is challenging. To inform decision making on the selection of sites for a vaccine efficacy trial, we developed a new framework for projecting the expected number of endpoint events at a given site. In this framework, we first accounted for population immunity using serological data collated from a systematic review and used it to estimate parameters related to the timing and size of past outbreaks, as predicted by an SIR transmission model. Then, we used that model to project the infection attack rate of a hypothetical future outbreak, in the event that one were to occur at the time of a future trial. This informed projections of how many endpoint events could be expected if a trial were to take place at that site. Our results suggest that some sites may have sufficient transmission potential and susceptibility to support future vaccine trials, in the event that an outbreak were to occur at those sites. In general, we conclude that sites that have experienced outbreaks within the past 10 years may be poorer targets for chikungunya vaccine efficacy trials in the near future. Our framework also generates projections of the numbers of endpoint events by age, which could inform study participant recruitment efforts.
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Affiliation(s)
- Quan Minh Tran
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, United States.
| | - James Soda
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, United States
| | - Amir Siraj
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, United States
| | - Sean Moore
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, United States
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - T Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, United States
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14
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Doran C, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Tami A, Bailey A. The clinical manifestation and the influence of age and comorbidities on long-term chikungunya disease and health-related quality of life: a 60-month prospective cohort study in Curaçao. BMC Infect Dis 2022; 22:948. [PMID: 36526964 PMCID: PMC9756924 DOI: 10.1186/s12879-022-07922-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown. METHODS The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3-16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms. RESULTS A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01-11.44; P < .001) and lower (OR: 8.68; CI: 3.47-21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40-10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores. CONCLUSIONS Rheumatic and non-rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype.
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Affiliation(s)
- Churnalisa Doran
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Norediz Lourents
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Yaskara Halabi
- Epidemiology and Research Unit, Medical and Public Health Service Curaçao, Piscaderaweg 49, Willemstad, Curaçao
| | - Johannes Burgerhof
- grid.4494.d0000 0000 9558 4598Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Adriana Tami
- grid.4494.d0000 0000 9558 4598Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ajay Bailey
- grid.5477.10000000120346234Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, 3584 CS Utrecht, The Netherlands
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15
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Fianu A, Aissaoui H, Naty N, Lenclume V, Casimir AF, Chirpaz E, Maillard O, Spodenkiewicz M, Bouscaren N, Kelly-Irving M, Rachou E, Delpierre C, Gérardin P. Health Impacts of the COVID-19 Lockdown Measure in a Low Socio-Economic Setting: A Cross-Sectional Study on Reunion Island. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13932. [PMID: 36360811 PMCID: PMC9657094 DOI: 10.3390/ijerph192113932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
In March 2020, the French government implemented nation-wide measures to reduce social contact and slow the progression of the emerging coronavirus responsible for COVID-19, the most significant being a complete home lockdown that lasted 8 weeks. Reunion Island is a French overseas department marked by large social inequalities. We draw the hypothesis that distancing and lockdown measures may have contributed to an increase in the social inequalities in health (SIH) on Reunion Island. The aim of our study was to describe the SIH during lockdown in the Reunionese population. We implemented a cross-sectional telephone survey conducted between 13 May and 22 July 2020, using a retrospective data collection on the lockdown period. A total of 892 adult participants (≥18 years) were recruited in the 114 large Reunionese neighborhoods using the quota method within the national "White Pages" telephone directory. Degraded psychological states, an increase in addictive behaviors, difficulties in accessing food, a decrease in physical activity, delayed medical appointments, violence against women, and health problems in children were driven by the socio-economic characteristics of the population, most often to the disadvantage of social groups exposed to poor living conditions. These results suggest that the COVID-19 lockdown contributed to an increase in SIH.
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Affiliation(s)
- Adrian Fianu
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paul Sabatier (UPS), 31000 Toulouse, France
| | - Hind Aissaoui
- Unité de Soutien Méthodologique, Centre Hospitalier Universitaire de La Réunion, 97400 Saint-Denis, France
| | - Nadège Naty
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Victorine Lenclume
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Anne-Françoise Casimir
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Emmanuel Chirpaz
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Olivier Maillard
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Michel Spodenkiewicz
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
- Moods Team, Centre de Recherche en Épidémiologie et Santé des Populations UMR-1178, 94275 Le Kremlin-Bicetre, France
| | - Nicolas Bouscaren
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
| | - Michelle Kelly-Irving
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paul Sabatier (UPS), 31000 Toulouse, France
| | - Emmanuelle Rachou
- Observatoire Régional de la Santé—La Réunion, 97400 Saint-Denis, France
| | - Cyrille Delpierre
- Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paul Sabatier (UPS), 31000 Toulouse, France
| | - Patrick Gérardin
- Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d’Investigation Clinique CIC1410, Centre Hospitalier Universitaire de La Réunion, CEDEX, 97448 Saint-Pierre, France
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16
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Machado GLR, Castro RQ, Forechi L, Souza HDC, Fonseca DS, Garcia MAC. The impact of Chikungunya chronic arthralgia on women’s upper limbs motor function: a cross-sectional study. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22011229042022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
ABSTRACT Post-Chikungunya chronic arthralgia (PCCA) may lead to musculoskeletal repercussions and functional loss. The objective was to assess the upper limb physical disability and symptoms during daily, work, and leisure activities of women presenting PCCA compared to healthy controls (HC). This was a cross-sectional study conducted with 52 women. The participants were divided into PCCA (37) and HC (15) groups. Handgrip strength, range of motion, level of pain (numerical rating scale), and participants’ physical disability and symptoms (Disabilities of the Arm, Shoulder, and Hand Questionnaire - DASH) were evaluated. Differences between groups were evaluated using the Students t-test and Pearson’s correlations. The chi-square test was applied for categorical variables. The significance was set at α=0.05. The disease duration was 19.5±13.1 months. We found no differences between groups for peak force (PCAA:23.6±7.4kgf; HC: 24.5±6.2kgf; p=0.676). The results showed a significant difference between groups regarding range of motion (PCCA: 63.5±17.3o; HC: 77.2±9.6o), level of hand pain (PCCA: 5.8±2.2; HC: 0.4±1.5), and upper limbs functional levels (PCCA: 44.5±17.4; HC: 16.2±20.5). Participants related severe difficulty or inability to perform tasks such as opening a jar (78.4%), placing objects above head height (48.7%), doing heavy household chores (56.8%), and gardening (51.4%). Impairment in the upper limb physical function in daily, work, and leisure activities shows the higher prevalence in the long-term.
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17
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Simon F, Bossy R, Federico D, Dezaunay J, Demoux AL, Rugard N, Calusi G, Nizzardo A, Watson H, Gane-Troplent F. Determinants of Health-Related Quality of Life in Chronic Chikungunya Disease in Guadeloupe. Pathogens 2022; 11:pathogens11090989. [PMID: 36145421 PMCID: PMC9504273 DOI: 10.3390/pathogens11090989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic chikungunya disease is associated with a poor quality of life and a variety of symptoms, not restricted to the musculoskeletal system. Patients with chronic chikungunya disease in Guadeloupe were evaluated in order to identify the main factors determining the quality of life. Patients were followed up at a mean of 36 months after chikungunya infection, undergoing detailed clinical examination for musculoskeletal involvement, with assessment of subjective symptoms and the impact on mood, physical activity, and quality of life (SF12). Patients had extensive musculoskeletal involvement shown by tenderness in 9 ± 4 joints and stiffness in 5 ± 4 joints. SF12 physical and mental component scores showed a poor health-related quality of life. Measures of joint pain, stiffness, and inflammation contributed to impaired quality of life scores. In addition, fatigue and interrupted sleep appeared to be important predictors for physical aspects of quality of life. The emergence of anxiodepressive syndromes post-chikungunya infection was associated with both physical and mental component scores of SF12. These data confirm that musculoskeletal symptoms are not the only determinants of quality of life in chronic chikungunya disease. Follow-up of patients should include assessment and management of fatigue, poor sleep quality, and anxiodepressive syndromes.
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Affiliation(s)
- Fabrice Simon
- Emerging Virus Unit, University of Aix-Marseille, 13284 Marseille, France
| | - Rémi Bossy
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Denise Federico
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Julien Dezaunay
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | | | - Nadia Rugard
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Giulia Calusi
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Andrea Nizzardo
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Hugh Watson
- Antiviral Research Unit, Evotec ID, 69007 Lyon, France
- Correspondence: ; Tel.: +33-(0)6-71-87-86-19
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18
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Filippatos F, Tatsi EB, Michos A. Post‑COVID‑19 syndrome in children (Review). Exp Ther Med 2022; 24:609. [PMID: 36160884 PMCID: PMC9468832 DOI: 10.3892/etm.2022.11547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
The persistence of symptoms for a long time after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is now familiar as post-COVID syndrome (PCS). To the best of our knowledge, the risk of long-term clinical outcomes in children after SARS-CoV-2 infection is still unclear. Unlike in adults, current evidence suggests a lower prevalence of persistent symptoms in children. However, since several studies are characterized by great heterogeneity, it is difficult to accurately estimate the exact incidence of PCS in children. The presence and course of recovery depend on risk factors that are more common in adults than children. Proposed pathophysiological mechanisms in PCS in children include age-dependent immune responses, angiotensin-converting enzyme 2 expression, blood-brain barrier development or social issues affecting children behavior, such as school closure and social isolation. However, further longitudinal studies are required for unanswered issues to be clarified. The aim of the present review is to describe the long-term symptoms per biological system in children, potential risk factors and the role of the immune system in the presence of PCS.
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Affiliation(s)
- Filippos Filippatos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
| | - Elizabeth-Barbara Tatsi
- University Research Institute for Maternal and Child Health and Precision Medicine, 11527 Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
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19
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Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med 2022; 28:911-923. [PMID: 35585196 DOI: 10.1038/s41591-022-01810-6] [Citation(s) in RCA: 203] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 is not unique in its ability to cause post-acute sequelae; certain acute infections have long been associated with an unexplained chronic disability in a minority of patients. These post-acute infection syndromes (PAISs) represent a substantial healthcare burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine. The relatively similar symptom profiles of individual PAISs, irrespective of the infectious agent, as well as the overlap of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggest the potential involvement of a common etiopathogenesis. In this Review, we summarize what is known about unexplained PAISs, provide context for post-acute sequelae of SARS-CoV-2 infection (PASC), and delineate the need for basic biomedical research into the underlying mechanisms behind this group of enigmatic chronic illnesses.
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Affiliation(s)
- Jan Choutka
- Department of Chemistry of Natural Compounds, University of Chemistry and Technology, Prague, Czech Republic.
| | - Viraj Jansari
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, USA.
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20
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Lu Y, Liu BP, Tan CT, Pan F, Larbi A, Ng TP. Lifetime pathogen burden, inflammatory markers, and depression in community-dwelling older adults. Brain Behav Immun 2022; 102:124-134. [PMID: 35202734 DOI: 10.1016/j.bbi.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023] Open
Abstract
The link between pathogen exposure and mental health has long been hypothesized, but evidence remains limited. We investigated the association of seropositivity to common pathogens and total pathogen burden with depression and mental health and explored the role of mediating inflammatory cytokines. We profiled in 884 participants in the Singapore Longitudinal Ageing Studies, mean (SD) age: 67.9 (8.1) years, their seropositivities for 11 pathogens (CMV, HSV 1, HSV 2, HHV-6, EBV, VZV, RSV, Dengue, Chikungunya, H. Pylori and Plasmodium) and pathogen burden, Geriatric Depression Scale (GDS) score at baseline and 3-4 and 6-8 years follow-up, and baseline Mental Component Score (MCS) of 12-Item Short Form Survey (SF-12). Inflammatory markers included CRP, TNF-α, IL-6, MIP-1α, sgp130, sTNF-RI, sTNF-RII, C3a, and MCP-2. Controlling for age, sex, ethnicity, education, marital status, living alone, and smoking status, high pathogen burden (7 + cumulative infections) compared to low pathogen burden (1-5 cumulative infections) was significantly associated with period prevalence (the highest GDS score from baseline and follow-up measurements) of depressive symptoms (OR = 2.36, 95% CI = 1.05-5.33) and impaired mental health (OR = 2.25, 95% CI = 1.18-4.30). CMV seropositivity and HSV1 seropositivity, which are highly prevalent and most widely studied, were associated with estimated 2-fold increased odds of depression, but only HSV1 seropositivity was significantly associated with depression after adjusting for confounders. Notably, adjusted for confounders, RSV, H. pylori and Plasmodium seropositivity were significantly associated with increased odds, and Dengue seropositivity was associated with unexpectedly deceased odds of depressive symptoms and impaired mental health. The association of pathogen exposure with depression and mental health were at least in parts explained by inflammatory markers. Adding certain inflammatory markers to the models attenuated or weakened the association. Bootstrap method showed that MIP-1α significantly mediated the association between pathogen burden and mental health. In conclusion, lifelong pathogen burden and specific infections are associated with depression and impaired mental health in older adults.
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Affiliation(s)
- Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, China.
| | - Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Crystal Ty Tan
- Biology of Aging Laboratory, Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fang Pan
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, China
| | - Anis Larbi
- Geriatrics Division, Department of Medicine, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canaa
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Geriatric Education and Research Institute, Ministry of Health, Singapore.
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Tanaka A, Suzuki Y. Genome-Wide Approaches to Unravel the Host Factors Involved in Chikungunya Virus Replication. Front Microbiol 2022; 13:866271. [PMID: 35401487 PMCID: PMC8988064 DOI: 10.3389/fmicb.2022.866271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 01/05/2023] Open
Abstract
Chikungunya virus (CHIKV), the causative agent of Chikungunya fever (CHIKVF) that is often characterized by fever, headache, rash, and arthralgia, is transmitted to humans by Aedes mosquito bites. Although the mortality rate associated with CHIKV infection is not very high, CHIKVF has been confirmed in more than 40 countries, not only in tropical but also in temperate areas. Therefore, CHIKV is a growing major threat to the public health of the world. However, a specific drug is not available for CHIKV infection. As demonstrated by many studies, the processes completing the replication of CHIKV are assisted by many host factors, whereas it has become clear that the host cell possesses some factors limiting the virus replication. This evidence will provide us with an important clue for the development of pharmacological treatment against CHIKVF. In this review, we briefly summarize cellular molecules participating in the CHIKV infection, particularly focusing on introducing recent genome-wide screen studies that enabled illuminating the virus-host interactions.
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Affiliation(s)
- Atsushi Tanaka
- Division of Research Animal Laboratory and Translational Medicine, Research and Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- *Correspondence: Atsushi Tanaka,
| | - Youichi Suzuki
- Department of Microbiology and Infection Control, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Youichi Suzuki,
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22
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Doran C, Elsinga J, Fokkema A, Berenschot K, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Bailey A, Tami A. Long-term Chikungunya sequelae and quality of life 2.5 years post-acute disease in a prospective cohort in Curaçao. PLoS Negl Trop Dis 2022; 16:e0010142. [PMID: 35231033 PMCID: PMC8887759 DOI: 10.1371/journal.pntd.0010142] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the persistence and impact of non-rheumatic symptoms after acute chikungunya disease. We have studied the clinical presentation and long-term impact of rheumatic and non-rheumatic symptoms on health related quality of life (QoL) 2.5 years after disease onset. Additionally, the validity of the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying disease severity over time was evaluated. Methodology/Principal findings This prospective cohort study followed 248 chikungunya patients. Symptoms and SF-36 QoL were evaluated during baseline and follow-up at 2.5 years using questionnaires. Chikungunya disease status was classified using the CLTCS-score. At 2.5 years after disease onset patients were classified as being recovered (43%), mildly (35%) or highly (22%) affected. In comparison to mildly affected, highly affected patients reported the highest prevalence of ongoing rheumatic and non-rheumatic/psychological symptoms, with increased prevalence of arthralgia in the lower extremities (p = .01) and fatigue (p = .049) over time, and higher pain intensity (p < .001). Compared to mildly affected, being highly affected was associated with weakness in the lower extremities (OR: 1.90; CI: 1.29–2.80, p = .001) and worsened physical and mental QoL impairment. Conclusions Patients are both physically and psychologically affected by rheumatic and non-rheumatic symptoms of long-term chikungunya disease. The CLTCS-score is an easy to use instrument for classifying long-term chikungunya disease severity and impact and can facilitate health care providers in identifying highly affected patients who are prone to develop severe QoL impairment. Highly affected patients are recommended to be treated in a multidisciplinary setting to improve physical and psychological functioning, and QoL. Chikungunya disease manifestation is characterized by a sudden onset of non-rheumatic flu-like symptoms and debilitating rheumatic symptoms in the acute phase. Little is known about the persistence of non-rheumatic symptoms after acute disease. In this prospective cohort study we investigated the clinical manifestations and persistence of baseline rheumatic and non-rheumatic/psychological symptoms and their impact on health related quality of life (QoL) 2.5 years after disease onset. Moreover, we investigated the performance of the classification instrument the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying chikungunya disease severity over time. We found that 57% of the patients were still affected 2.5 years after disease onset. An increase of mainly recurrent rheumatic and non-rheumatic/psychological symptoms including fatigue, insomnia, sombreness, and loss of vitality were reported, with a significantly higher symptom recurrence and pain intensity reported by highly affected patients. In addition, QoL assessment indicates that the disease burden impaired the physiological well-being of these patients. We also showed that the CLTCS-score can be used to easily identify highly affected patients. This study demonstrates that disease severity increases non-rheumatic symptoms and subsequent physiological impairments and suggests a multidisciplinary treatment approach to treat the psychological effects of long-term chikungunya disease.
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Affiliation(s)
- Churnalisa Doran
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- * E-mail:
| | - Jelte Elsinga
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Ante Fokkema
- University of Groningen, Groningen, The Netherlands
| | | | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Red Cross Blood Bank Foundation, Willemstad, Curaçao
| | - Norediz Lourents
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Yaskara Halabi
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Johannes Burgerhof
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
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Leung AKL, Griffin DE, Bosch J, Fehr AR. The Conserved Macrodomain Is a Potential Therapeutic Target for Coronaviruses and Alphaviruses. Pathogens 2022; 11:pathogens11010094. [PMID: 35056042 PMCID: PMC8780475 DOI: 10.3390/pathogens11010094] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Emerging and re-emerging viral diseases pose continuous public health threats, and effective control requires a combination of non-pharmacologic interventions, treatment with antivirals, and prevention with vaccines. The COVID-19 pandemic has demonstrated that the world was least prepared to provide effective treatments. This lack of preparedness has been due, in large part, to a lack of investment in developing a diverse portfolio of antiviral agents, particularly those ready to combat viruses of pandemic potential. Here, we focus on a drug target called macrodomain that is critical for the replication and pathogenesis of alphaviruses and coronaviruses. Some mutations in alphavirus and coronaviral macrodomains are not tolerated for virus replication. In addition, the coronavirus macrodomain suppresses host interferon responses. Therefore, macrodomain inhibitors have the potential to block virus replication and restore the host’s protective interferon response. Viral macrodomains offer an attractive antiviral target for developing direct acting antivirals because they are highly conserved and have a structurally well-defined (druggable) binding pocket. Given that this target is distinct from the existing RNA polymerase and protease targets, a macrodomain inhibitor may complement current approaches, pre-empt the threat of resistance and offer opportunities to develop combination therapies for combating COVID-19 and future viral threats.
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Affiliation(s)
- Anthony K. L. Leung
- Department of Biochemistry and Molecular Biology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- McKusick-Nathans Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Molecular Biology and Genetics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence: (A.K.L.L.); (D.E.G.); (A.R.F.); Tel.: +1-(410)-5028939 (A.K.L.L.); +1-(410)-955-3459 (D.E.G.); +1-(785)-864-6626 (A.R.F.)
| | - Diane E. Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence: (A.K.L.L.); (D.E.G.); (A.R.F.); Tel.: +1-(410)-5028939 (A.K.L.L.); +1-(410)-955-3459 (D.E.G.); +1-(785)-864-6626 (A.R.F.)
| | - Jürgen Bosch
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH 44106, USA;
- InterRayBio, LLC, Cleveland, OH 44106, USA
| | - Anthony R. Fehr
- Department of Molecular Biosciences, University of Kansas, Lawrence, KS 66045, USA
- Correspondence: (A.K.L.L.); (D.E.G.); (A.R.F.); Tel.: +1-(410)-5028939 (A.K.L.L.); +1-(410)-955-3459 (D.E.G.); +1-(785)-864-6626 (A.R.F.)
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Abstract
El virus de chikunguña (CHIKV) es un Alfavirus perteneciente al grupo denominado del Viejo Mundo; estos son virus artritogénicos que causan una enfermedad febril caracterizada por artralgias y mialgias. Aunque la muerte por CHIKV es poco frecuente, la enfermedad puede llegar a ser incapacitante y generar un amplio espectro de manifestaciones atípicas, como complicaciones cardiovasculares, respiratorias, oculares, renales y dérmicas, entre otras. Cuando el dolor articular persiste por tres o más meses, da lugar a la forma crónica de la enfermedad denominada reumatismo inflamatorio crónico poschikunguña, el cual es la principal secuela de la enfermedad. Se considera que este virus no es neurotrópico, sin embargo, puede afectar el sistema nervioso central y generar secuelas graves y permanentes, principalmente, en niños y ancianos. En África, Asia y Europa se habían reportado anteriormente brotes epidémicos por CHIKV, pero solo hasta finales del 2013 se documentó la introducción del virus a las Américas; desde entonces, el virus se ha propagado a 45 países o territorios del continente y el número de casos acumulados ascendió a cerca de dos millones en dos años. Esta revisión describe de manera general la biología molecular del virus, sus manifestaciones clínicas, su patogénesis y las principales complicaciones posteriores a la infección. Además, reúne la información de la epidemia en Colombia y el continente americano publicada entre el 2014 y el 2020.
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"Kankasha" in Kassala: A prospective observational cohort study of the clinical characteristics, epidemiology, genetic origin, and chronic impact of the 2018 epidemic of Chikungunya virus infection in Kassala, Sudan. PLoS Negl Trop Dis 2021; 15:e0009387. [PMID: 33930028 PMCID: PMC8115788 DOI: 10.1371/journal.pntd.0009387] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/12/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The public health impact of Chikungunya virus (CHIKV) is often underestimated. Usually considered a mild condition of short duration, recent outbreaks have reported greater incidence of severe illness, fatality, and longer-term disability. In 2018/19, Eastern Sudan experienced the largest epidemic of CHIKV in Africa to date, affecting an estimated 487,600 people. Known locally as Kankasha, this study examines clinical characteristics, risk factors, and phylogenetics of the epidemic in Kassala City. Methodology/Principal findings A prospective cohort of 102 adults and 40 children presenting with chikungunya-like illness were enrolled at Kassala Teaching Hospital in October 2018. Clinical information, socio-demographic data, and sera samples were analysed to confirm diagnosis, characterise illness, and identify viral strain. CHIKV infection was confirmed by real-time reverse transcription-PCR in 84.5% (120/142) of participants. Nine (7.5%) CHIKV-positive participants had concurrent Dengue virus (DENV) infection; 34/118 participants (28.8%) had a positive Rapid Diagnostic Test for Plasmodium falciparum; six (5.0%) had haemorrhagic symptoms including two children with life-threatening bleeding. One CHIKV-positive participant died with acute renal injury. Age was not associated with severity of illness although CHIKV-infected participants were younger (p = 0.003). Two to four months post-illness, 63% of adults available for follow-up (30) were still experiencing arthralgia in one or more joints, and 11% remained moderately disabled on Rapid3 assessment. Phylogenetic analysis showed all CHIKV sequences from this study belonged to a single clade within the Indian Ocean Lineage (IOL) of the East/Central/South African (ECSA) genotype. History of contact with an infected person was the only factor associated with infection (p = 0.01), and likely related to being in the same vector environment. Conclusions/Significance Vulnerability to CHIKV remains in Kassala and elsewhere in Sudan due to widespread Aedes aegypti presence and mosquito-fostering household water storage methods. This study highlights the importance of increasing awareness of the severity and impact of CHIKV outbreaks, and the need for urgent actions to reduce transmission risk in households. Chikungunya is an arboviral disease transmitted to humans by infected mosquitoes and characterised by fever and arthralgia. Although it is generally considered a short self-limiting infection, long term sequelae and severe disease are increasingly recognised. In 2018/19, Eastern Sudan experienced the largest epidemic of Chikungunya in Africa to date, affecting approximately 500,000 people. We undertook a prospective hospital-based cohort study of patients presenting with undifferentiated febrile illness in Kassala city, Sudan, supported by next-generation sequencing. We confirmed that CHIKV was the dominant pathogen, with positive CHIKV RT-PCR in 85% of patients presenting during the 7-day study period. Dengue virus was also circulating with nine CHIKV RT-PCR-positive patients co-infected, and we identified high rates of Plasmodium falciparum infection and CHIKV/P.falciparum co-infection. Genetic sequencing confirmed Indian Ocean Lineage of the East/Central/South African CHIKV genotype. A quarter of participants available for follow-up (16/60, 26.6%) reported being admitted to hospital including two children with haemorrhage, reflecting the severe phenotype linked to this genotype. Increased understanding of the health and economic burden of Chikungunya is needed, and recognition that severe and occasionally fatal infection exists. With widespread presence of Ae. aegypti and household water storage practices that encourage mosquito breeding, timely actions will be essential to prevent further large outbreaks.
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26
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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.
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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.
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Lentscher AJ, McCarthy MK, May NA, Davenport BJ, Montgomery SA, Raghunathan K, McAllister N, Silva LA, Morrison TE, Dermody TS. Chikungunya virus replication in skeletal muscle cells is required for disease development. J Clin Invest 2020; 130:1466-1478. [PMID: 31794434 DOI: 10.1172/jci129893] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
Chikungunya virus (CHIKV) is an arbovirus capable of causing a severe and often debilitating rheumatic syndrome in humans. CHIKV replicates in a wide variety of cell types in mammals, which has made attributing pathologic outcomes to replication at specific sites difficult. To assess the contribution of CHIKV replication in skeletal muscle cells to pathogenesis, we engineered a CHIKV strain exhibiting restricted replication in these cells via incorporation of target sequences for skeletal muscle cell-specific miR-206. This virus, which we term SKE, displayed diminished replication in skeletal muscle cells in a mouse model of CHIKV disease. Mice infected with SKE developed less severe disease signs, including diminished swelling in the inoculated foot and less necrosis and inflammation in the interosseous muscles. SKE infection was associated with diminished infiltration of T cells into the interosseous muscle as well as decreased production of Il1b, Il6, Ip10, and Tnfa transcripts. Importantly, blockade of the IL-6 receptor led to diminished swelling of a control CHIKV strain capable of replication in skeletal muscle, reducing swelling to levels observed in mice infected with SKE. These data implicate replication in skeletal muscle cells and release of IL-6 as important mediators of CHIKV disease.
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Affiliation(s)
- Anthony J Lentscher
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary K McCarthy
- Department of Immunology and Microbiology, 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
| | - Bennett J Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie A Montgomery
- Department of Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Krishnan Raghunathan
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nicole McAllister
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurie A Silva
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas E Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Terence S Dermody
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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28
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Waechter R, Ingraham E, Evans R, Cudjoe N, Krystosik A, Isaac R, Watts A, Noël T, Landon B, Fernandes M, Mapp-Alexander V, Suresh P, Mitchell G, Macpherson C, Gérardin P, LaBeaud AD. Pre and postnatal exposure to Chikungunya virus does not affect child neurodevelopmental outcomes at two years of age. PLoS Negl Trop Dis 2020; 14:e0008546. [PMID: 33017393 PMCID: PMC7535067 DOI: 10.1371/journal.pntd.0008546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The 2005-06 chikungunya virus (CHIKV) outbreak in La Réunion suggested that mothers could transmit CHIKV to their neonates while viremic during the intrapartum period, and more than half of the infected neonates showed impaired neurodevelopment at two years of age. However, data sparsity precluded an overview of the developmental impact of vertical infection within the whole prenatal period. OBJECTIVE & METHODS The current study assessed two-year old children born to mothers who were infected during the 2014 CHIKV outbreak in Grenada to determine the neurodevelopmental impact of perinatal CHIKV infection throughout gestation. Mother and child infection status were confirmed by serologic testing (IgG and IgM) for CHIKV. Cognitive, fine motor, gross motor, language and behavioral outcomes were assessed at two years of age on the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA). RESULTS No differences in neurodevelopmental outcomes were observed between two-year-old children born to mothers infected with CHIKV during gestation (n = 149) and those born to mothers not infected with CHIKV (n = 161). No differences were found in INTER-NDA scores between children infected with CHIKV (n = 47) and children not infected with CHIKV (n = 592). Likewise, there were no differences between children infected with CHIKV post-partum (n = 19) versus children not infected with CHIKV (n = 592). CONCLUSION Our findings suggest that children exposed and/or infected with CHIKV outside of the intrapartum period experience no significant neurodevelopmental delay at two years of age, as measured by the INTER-NDA, compared to their unexposed and/or uninfected peers. These results complement those of previous studies which showed a neurodevelopmental risk only for children infected during the intrapartum period, while the mother was highly viremic. These results might be reassuring for women of childbearing age and public health officials in CHIKV-endemic regions.
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Affiliation(s)
- Randall Waechter
- Department of Neuroscience and Physiology and Behavioral Sciences, School of Medicine, St. George’s University, St. George’s, Grenada, West Indies
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Erinique Ingraham
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Amy Krystosik
- Stanford University, School of Medicine, Department of Pediatrics, Division of Infectious Disease, California, United States of America
| | - Rashida Isaac
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Ashlee Watts
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
- Office of Research, St. George’s University, St. George’s, Grenada, West Indies
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
- Psychological Services Center, St. George’s University, St. George’s, Grenada, West Indies
| | - Michelle Fernandes
- Faculty of Medicine, Department of Paediatrics, University Hospitals Southampton, University of Southampton, Southampton, United Kingdom
- Nuffield Department of Women’s & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Veronica Mapp-Alexander
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
- School of Veterinary Medicine, St. George’s University, St. George’s, Grenada, West Indies
| | - Priyanka Suresh
- Stanford University, School of Medicine, Department of Pediatrics, Division of Infectious Disease, California, United States of America
| | - George Mitchell
- Office of Chief Medical Officer, Ministry of Health, St, George’s, Grenada, West Indies
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St. George’s, Grenada, West Indies
- Office of Research, St. George’s University, St. George’s, Grenada, West Indies
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion / Unité Mixte 134 PIMIT (Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249), Sainte Clotilde, Réunion
| | - A. Desiree LaBeaud
- Stanford University, School of Medicine, Department of Pediatrics, Division of Infectious Disease, California, United States of America
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Tritsch SR, Encinales L, Pacheco N, Cadena A, Cure C, McMahon E, Watson H, Porras Ramirez A, Mendoza AR, Li G, Khurana K, Jaller-Raad JJ, Castillo SM, Barrios Taborda O, Jaller-Char A, Echavez LA, Jiménez D, Gonzalez Coba A, Alarcon Gomez M, Ariza Orozco D, Bravo E, Martinez V, Guerra B, Simon G, Firestein GS, Chang AY. Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms. J Rheumatol 2020; 47:1267-1274. [PMID: 31263071 PMCID: PMC7938419 DOI: 10.3899/jrheum.190162] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. METHODS A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. RESULTS Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. CONCLUSION To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.
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Affiliation(s)
- Sarah R Tritsch
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Liliana Encinales
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Nelly Pacheco
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Andres Cadena
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Carlos Cure
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Elizabeth McMahon
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Hugh Watson
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alexandra Porras Ramirez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alejandro Rico Mendoza
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Guangzhao Li
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Kunal Khurana
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Juan Jose Jaller-Raad
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Stella Mejia Castillo
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Onaldo Barrios Taborda
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Alejandro Jaller-Char
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Lil Avendaño Echavez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Dennys Jiménez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Andres Gonzalez Coba
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Magda Alarcon Gomez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Dores Ariza Orozco
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Eyda Bravo
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Victor Martinez
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Brenda Guerra
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Gary Simon
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Gary S Firestein
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University
| | - Aileen Y Chang
- From George Washington University; George Mason University, Washington, DC; University of California, San Diego, San Diego, California, USA; Allied Research Society LLC; Clinica de La Costa Ltda.; Biomelab; Centro de Reumatología y Ortopedia; Universidad Simón Bolívar, Barranquilla, Atlántico; Universidad El Bosque, Bogotá, Colombia; Evotec ID, Lyon, France.
- S.R. Tritsch, MS, George Washington University; L. Encinales, MD, Allied Research Society LLC; N. Pacheco, Allied Research Society LLC; A. Cadena, MD, Clinica de La Costa Ltda.; C. Cure, MD, Biomelab; E. McMahon, George Washington University; H. Watson, PhD, Evotec ID; A. Porras Ramirez, PhD, Universidad El Bosque; A.R. Mendoza, PhD, Universidad El Bosque; G. Li, MS, George Washington University; K. Khurana, George Mason University; J.J. Jaller-Raad, MD, Centro de Reumatología y Ortopedia; S. Mejia Castillo, MD, Universidad Simón Bolívar; O. Barrios Taborda, MD, Universidad Simón Bolívar; J.J. Jaller-Char, MD, Centro de Reumatología y Ortopedia; L. Avendaño Echavez, MD, Universidad Simón Bolívar; D. Jiménez, MD, Clinica de La Costa Ltda.; A. Gonzalez Coba, MD, Clinica de La Costa Ltda.; M. Alarcon Gomez, MD, Universidad Simón Bolívar; D. Ariza Orozco, Allied Research Society LLC; E. Bravo, Allied Research Society LLC; V. Martinez, Clinica de La Costa Ltda.; B. Guerra, Clinica de La Costa Ltda.; G. Simon, MD, PhD, George Washington University; G.S. Firestein, MD, ScD, University of California, San Diego; A.Y. Chang, MD, MSPH, George Washington University.
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Anwar S, Mourosi JT, Khan MF, Hosen MJ. Prediction of Epitope-Based Peptide Vaccine Against the Chikungunya Virus by Immuno-informatics Approach. Curr Pharm Biotechnol 2020; 21:325-340. [PMID: 31721709 DOI: 10.2174/1389201020666191112161743] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/16/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chikungunya is an arthropod-borne viral disease characterized by abrupt onset of fever frequently accompanied by joint pain, which has been identified in over 60 countries in Africa, the Americas, Asia, and Europe. METHODS Regardless of the availability of molecular knowledge of this virus, no definite vaccine or other remedial agents have been developed yet. In the present study, a combination of B-cell and T-cell epitope predictions, followed by molecular docking simulation approach has been carried out to design a potential epitope-based peptide vaccine, which can trigger a critical immune response against the viral infections. RESULTS A total of 52 sequences of E1 glycoprotein from the previously reported isolates of Chikungunya outbreaks were retrieved and examined through in silico methods to identify a potential B-cell and T-cell epitope. From the two separate epitope prediction servers, five potential B-cell epitopes were selected, among them "NTQLSEAHVEKS" was found highly conserved across strains and manifests high antigenicity with surface accessibility, flexibility, and hydrophilicity. Similarly, two highly conserved, non-allergenic, non-cytotoxic putative T-cell epitopes having maximum population coverage were screened to bind with the HLA-C 12*03 molecule. Molecular docking simulation revealed potential T-cell based epitope "KTEFASAYR" as a vaccine candidate for this virus. CONCLUSION A combination of these B-cell and T-cell epitope-based vaccine can open up a new skyline with broader therapeutic application against Chikungunya virus with further experimental and clinical investigation.
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Affiliation(s)
- Saeed Anwar
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.,Maternal and Child Health Program, Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Edmonton, AB T6G 2R7, Canada
| | - Jarin T Mourosi
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.,Microbial and Cellular Biology Program, Department of Biology, The Catholic University of America, 620 Michigan Ave. NE, Washington, DC, 20064, United States
| | - Md Fahim Khan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Mohammad J Hosen
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
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Bertolotti A, Thioune M, Abel S, Belrose G, Calmont I, Césaire R, Cervantes M, Fagour L, Javelle É, Lebris C, Najioullah F, Pierre-François S, Rozé B, Vigan M, Laouénan C, Cabié A. Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique): A prospective cohort study. PLoS Negl Trop Dis 2020; 14:e0007327. [PMID: 32163420 PMCID: PMC7100975 DOI: 10.1371/journal.pntd.0007327] [Citation(s) in RCA: 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).
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Affiliation(s)
- Antoine Bertolotti
- INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France
- CHU de la Réunion, service de maladies infectieuses-médecine interne-dermatologie, Saint Pierre, France
| | - Marême Thioune
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Sylvie Abel
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
| | - Gilda Belrose
- CHU de Martinique, Centre de ressource biologique de la Martinique, Fort-de-France, France
| | | | - Raymond Césaire
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Minerva Cervantes
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
| | - Laurence Fagour
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | - Émilie Javelle
- Hôpital d’instruction des Armées Laveran, service de pathologie infectieuse et tropicale, Marseille, France; Aix Marseille Université, Institut de Recherche pour le Développement (IRD); Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME); Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Catherine Lebris
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Fatiha Najioullah
- Université des Antilles, EA 4537, Fort-de-France, France
- CHU de Martinique, laboratoire de virologie, Fort-de-France, France
| | | | - Benoît Rozé
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
| | - Marie Vigan
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Cédric Laouénan
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - André Cabié
- CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France
- Université des Antilles, EA 4537, Fort-de-France, France
- INSERM, CIC1424, CHU de Martinique, Fort-de-France, France
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Ninla-Aesong P, Mitarnun W, Noipha K. Long-Term Persistence of Chikungunya Virus-Associated Manifestations and Anti-Chikungunya Virus Antibody in Southern Thailand: 5 Years After an Outbreak in 2008-2009. Viral Immunol 2020; 33:86-93. [PMID: 31976828 DOI: 10.1089/vim.2019.0168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chikungunya fever, a disease caused by chikungunya virus (CHIKV), reemerged and affected over 52,000 people in southern Thailand in 2008 and 2009. The CHIKV strain involved in this outbreak was the East Central South African (ECSA) strain with the E1-A226V mutation. The prevalence of CHIKV-associated chronic discomfort varied by virus lineage. This retrospective cohort study aims to describe the CHIKV-related symptoms persisting in CHIKV-affected patients, related factors, and the presence of anti-CHIKV immunoglobulin G (IgG) antibodies 5 years after the onset of disease. From 5,344 of the study population screened, a total of 89 affected patients reported persistent arthralgia 5 years after the disease onset (nonrecovery rate = 1.7%). Of the 141 affected patients enrolled, 122 cases (86.5%; 77 cases with persistent arthralgia and 45 cases of fully recovered) still had detectable levels of anti-CHIKV IgG antibodies. Long-term persistence of chronic joint symptoms is associated with the severity of the disease during the initial phase of the infection, but not gender, age, or comorbidities. The common manifestations were arthralgia (75.3%), morning joint stiffness (39.0%), muscle pain (19.5%), and occasional joint swelling (16.9%). Chronic joint symptoms could occur in either a fluctuating or a persistent manner and usually caused moderate pain. The joints affected were mainly fingers (71.4%), wrists (51.9%), and knees (50.6%). Most patients had polyarthralgia with symmetrical joint involvement. In some cases with persistent arthralgia, atypical manifestations, including severe depression with suicide attempts, severe weight loss, and severe hair loss, were found, and some patients still experienced severe joint pain.
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Affiliation(s)
| | - Winyou Mitarnun
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Kusumarn Noipha
- Faculty of Health and Sports Science, Thaksin University, Paphayom, Thailand
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Sengupta S, Mukherjee S, Haldar SK, Bhattacharya N, Tripathi A. Re-emergence of Chikungunya virus infection in Eastern India. Braz J Microbiol 2020; 51:177-182. [PMID: 31898249 DOI: 10.1007/s42770-019-00212-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022] Open
Abstract
Chikungunya fever is a major public health issue in India. Re-emergence of chikungunya virus (CHIKV) in West Bengal was detected after 32 years in 2006. After 2010, this infection was in apparent decline, but in 2016 a massive outbreak affected the country. Present study was carried out to understand CHIKV infection dynamics during recent outbreaks in West Bengal, Eastern India and its implication on disease manifestations. Blood was collected from 641 symptomatic patients. Patients' sera were serologically diagnosed to detect presence of anti-chikungunya-IgM antibodies. Viral RNA was extracted; presence of CHIKV genome and its respective viral load was determined by real time quantitative reverse transcription-PCR (real-time qRT-PCR). Statistical analysis was performed using EPI INFO software. CHIKV infection was detected in 24.64% of symptomatic patients. Middle-aged patients (31-40 years) were predominantly affected; clinically, both arthralgia and joint-swelling were significantly prevalent among CHIKV-infected patients. Myalgia, joint-swelling, and arthralgic manifestation were found in significantly higher frequency among patients with high chikungunya viral load (> 10,000 copies/ml). Thus, this study clearly indicated the re-emergence of CHIKV in Eastern India. Significant presence of myalgia, joint swelling, and arthralgia among chikungunya patients with high viral load implied association of disease severity with viral load; requiring vigilance for proper management of infected patients as this disease is highly morbid in nature. However, in addition to chikungunya virus, other viral, bacterial, and protozoal infections also occur during post-monsoon season in India, having overlapping symptoms. Hence, continuous monitoring of these infections is required for better clinical management of patients.
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Affiliation(s)
- Siddhartha Sengupta
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata, West Bengal, 700073, India
| | - Saikat Mukherjee
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata, West Bengal, 700073, India
| | - Surja Kumar Haldar
- Department of Microbiology, Virus Unit, Calcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata, West Bengal, 700073, India
| | - Nemai Bhattacharya
- Department of Microbiology, Virus Unit, Calcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata, West Bengal, 700073, India
| | - Anusri Tripathi
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata, West Bengal, 700073, India.
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Prow NA, Hirata TDC, Tang B, Larcher T, Mukhopadhyay P, Alves TL, Le TT, Gardner J, Poo YS, Nakayama E, Lutzky VP, Nakaya HI, Suhrbier A. Exacerbation of Chikungunya Virus Rheumatic Immunopathology by a High Fiber Diet and Butyrate. Front Immunol 2019; 10:2736. [PMID: 31849947 PMCID: PMC6888101 DOI: 10.3389/fimmu.2019.02736] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
Chikungunya virus (CHIKV) is a mosquito transmitted alphavirus associated with a robust systemic infection and an acute inflammatory rheumatic disease. A high fiber diet has been widely promoted for its ability to ameliorate inflammatory diseases. Fiber is fermented in the gut into short chain fatty acids such as acetate, propionate, and butyrate, which enter the circulation providing systemic anti-inflammatory activities. Herein we show that mice fed a high fiber diet show a clear exacerbation of CHIKV arthropathy, with increased edema and neutrophil infiltrates. RNA-Seq analyses illustrated that a high fiber diet, in this setting, promoted a range of pro-neutrophil responses including Th17/IL-17. Gene Set Enrichment Analyses demonstrated significant similarities with mouse models of inflammatory psoriasis and significant depression of macrophage resolution phase signatures in the CHIKV arthritic lesions from mice fed a high fiber diet. Supplementation of the drinking water with butyrate also increased edema after CHIKV infection. However, the mechanisms involved were different, with modulation of AP-1 and NF-κB responses identified, potentially implicating deoptimization of endothelial barrier repair. Thus, neither fiber nor short chain fatty acids provided benefits in this acute infectious disease setting, which is characterized by widespread viral cytopathic effects and a need for tissue repair.
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Affiliation(s)
- Natalie A Prow
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Thiago D C Hirata
- Computational Systems Biology Laboratory, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bing Tang
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Thibaut Larcher
- Institut National de Recherche Agronomique, Unité Mixte de Recherche 703, Oniris, Nantes, France
| | - Pamela Mukhopadhyay
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Tiago Lubiana Alves
- Computational Systems Biology Laboratory, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Thuy T Le
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Joy Gardner
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Yee Suan Poo
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Eri Nakayama
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Viviana P Lutzky
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Helder I Nakaya
- Computational Systems Biology Laboratory, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Andreas Suhrbier
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Australian Infectious Disease Research Centre, University of Queensland, Brisbane, QLD, Australia
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Ninla-Aesong P, Mitarnun W, Noipha K. Proinflammatory Cytokines and Chemokines as Biomarkers of Persistent Arthralgia and Severe Disease After Chikungunya Virus Infection: A 5-Year Follow-Up Study in Southern Thailand. Viral Immunol 2019; 32:442-452. [PMID: 31718485 DOI: 10.1089/vim.2019.0064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chikungunya fever is a re-emerging viral disease caused by chikungunya virus (CHIKV). The disease is generally self-limiting, but chronic arthralgia/arthritis may persist for months or years. We evaluated the expression of 12 cytokines/chemokines and matrix metalloproteinases (MMP)-1 and MMP-3 using enzyme-linked immunosorbent assays (ELISAs) and compared among patients who still had arthralgia (persistent arthralgia), patients who had fully recovered, and healthy controls. There was a significant increase in interleukin (IL)-1β, IL-6, IL-8, monocyte chemotactic protein-1 (MCP-1), MMP-1, and MMP-3 levels in patients with persistent arthralgia in comparison to healthy controls (p < 0.05) and a significant increase in tumor necrosis factor-alpha (TNF-α), MMP-1, and MMP-3 levels in patients with persistent arthralgia in comparison to patients who had fully recovered (p < 0.05). Interferon (IFN)-γ, IL-6, and transforming growth factor beta (TGF-β) levels tended to be increased in patients with chronic CHIKV-induced arthritis compared with fully recovered. TNF-α, IL-12, and MCP-1 levels were elevated (p < 0.05), whereas regulated on activation, normal T cell expressed and secreted (RANTES) levels were decreased in patients with severe pain compared with patients with nonsevere pain (p < 0.05). IFN-γ, IL-1β, IL-6, and IL-8 levels tended to be elevated in patients with severe pain compared with patients with nonsevere pain. We proposed a role played by TNF-α, IL-6, IL-8, and MCP-1 in persistent arthralgia or chronic disease through the activation of MMP-1 and MMP-3. The increase in TNF-α, IL-12, and MCP-1 levels (and the tendency toward an increase in IFN-γ, IL-1β, IL-6, and IL-8 levels) in patients with severe pain compared with patients with nonsevere pain suggests the role of these inflammatory markers in chronic disease and severity of the disease.
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Affiliation(s)
| | - Winyou Mitarnun
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Kusumarn Noipha
- Faculty of Health and Sports Science, Thaksin University, Paphayom, Phatthalung, Thailand
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The surveillance of four mosquito-borne diseases in international travelers arriving at Guangzhou Baiyun International Airport, China, 2016–2017. Travel Med Infect Dis 2019; 32:101513. [PMID: 31712181 DOI: 10.1016/j.tmaid.2019.101513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Little comprehensive analysis combining epidemiological and clinical data has been done with mosquito-borne diseases imported into Guangzhou by air travelers. METHODS We screened international travelers (body temperature >36.5 °C) arriving at Guangzhou Baiyun International Airport, and recorded their epidemiological and clinical information. Whole-blood samples were collected for laboratory diagnosis of dengue virus (DENV), chikungunya virus (CHIKV), zika virus (ZIKV) infections and malaria. RESULTS Between March 1, 2016 and December 31, 2017, 155 (6.6%) cases (100 of DENV, 21 of CHIKV, 1 of ZIKV, 34 of malaria, including one co-infection of DENV and CHIKV) were identified among 2350 febrile travelers. DENV (90.0%) and CHIKV (100.0%) cases mainly came from Southern and Southeast Asia. Malaria cases (91.2%) mainly came from sub-Saharan Africa. Traveling abroad (28/74, 37.8%) and living/working abroad (11/22, 50.0%) were the most common causes of DENV infection and malaria for Chinese, respectively. Cases with these four mosquito-borne diseases were more likely to have nervous, musculoskeletal and skin symptoms and signs than other febrile diseases (P < 0.001). CONCLUSIONS It is important to strengthen the surveillance of mosquito-borne diseases among tourists and workers returning from Southeast Asia, Southern Asia and sub-Saharan Africa, especially those with nervous, musculoskeletal and skin symptoms and signs.
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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.
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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
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Feldstein LR, Ellis EM, Rowhani-Rahbar A, Hennessey MJ, Staples JE, Halloran ME, Weaver MR. Estimating the cost of illness and burden of disease associated with the 2014-2015 chikungunya outbreak in the U.S. Virgin Islands. PLoS Negl Trop Dis 2019; 13:e0007563. [PMID: 31323020 PMCID: PMC6668848 DOI: 10.1371/journal.pntd.0007563] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/31/2019] [Accepted: 06/19/2019] [Indexed: 12/29/2022] Open
Abstract
Chikungunya virus (CHIKV), an alphavirus that causes fever and severe polyarthralgia, swept through the Americas in 2014 with almost 2 million suspected or confirmed cases reported by April 2016. In this study, we estimate the direct medical costs, cost of lost wages due to absenteeism, and years lived with disability (YLD) associated with the 2014–2015 CHIKV outbreak in the U.S. Virgin Islands (USVI). For this analysis, we used surveillance data from the USVI Department of Health, medical cost data from three public hospitals in USVI, and data from two studies of laboratory-positive cases up to 12 months post illness. On average, employed case-patients missed 9 days of work in the 12 months following their disease onset, which resulted in an estimated cost of $15.5 million. Estimated direct healthcare costs were $2.9 million for the first 2 months and $0.6 million for 3–12 months following the outbreak. The total estimated cost associated with the outbreak ranged from $14.8 to $33.4 million (approximately 1% of gross domestic product), depending on the proportion of the population infected with symptomatic disease, degree of underreporting, and proportion of cases who were employed. The estimated YLDs associated with long-term sequelae from the CHIKV outbreak in the USVI ranged from 599–1,322. These findings highlight the significant economic burden of the recent CHIKV outbreak in the USVI and will aid policy-makers in making informed decisions about prevention and control measures for inevitable, future CHIKV outbreaks. Chikungunya, a virus carried and transmitted by mosquitoes, causes fever, headache, and severe joint pain in humans that often resolves within 7–10 days. However, a proportion of cases, up to 79% in some outbreaks, report persistent joint pain and chronic inflammatory rheumatism, resulting in decreased quality of life for months to years following initial infection. In 2014, chikungunya virus swept through the Americas, resulting in almost 2 million suspected or confirmed cases reported by April 2016. Previous studies have noted the large resource burden from chikungunya outbreaks, including high healthcare costs, lost wages due to absenteeism, and decreased quality of life for months following infection. Our work aimed to estimate the direct medical costs, cost of lost productivity due to absenteeism, and years lived with disability associated with the chikungunya outbreak in the U.S. Virgin Islands. This information may aid policy-makers in making informed decisions about prevention and control measures for inevitable, future chikungunya outbreaks.
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Affiliation(s)
- Leora R. Feldstein
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - Esther M. Ellis
- U.S. Virgin Islands Department of Health, Saint Croix, United States Virgin Islands, United States of America
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Morgan J. Hennessey
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - J. Erin Staples
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Center for Inference and Dynamics of Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Marcia R. Weaver
- Departments of Health Metrics Sciences and Global Health, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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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.
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Amaral JK, Bilsborrow JB, Schoen RT. Brief report: the disability of chronic chikungunya arthritis. Clin Rheumatol 2019; 38:2011-2014. [PMID: 30963336 DOI: 10.1007/s10067-019-04529-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/18/2019] [Accepted: 03/20/2019] [Indexed: 01/18/2023]
Abstract
In 50% of patients, chikungunya fever (CHIKF) is followed by arthritic pain that is often chronic, painful, and disabling. To better define the spectrum of pain and disability in chronic CHIK arthritis (CCA), we evaluated 35 consecutive CCA patients seen in a Brazilian rheumatology clinic, using a pain Visual Analog Scale and the Health Assessment Questionnaire Disability Index. In our patients, pain and disability levels were of the same magnitude as are seen in other serious rheumatic diseases. The mean score for 19 patients with moderate disability was 1.42± 0.20 (median 1.37). The median HAQ-DI score for the entire group was 1.25. These findings underscore the morbidity imposed by CCA and the urgent need for improvements in management.
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Affiliation(s)
- J Kennedy Amaral
- Department of Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joshua B Bilsborrow
- Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT, USA
| | - Robert T Schoen
- Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT, USA.
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Jain J, Narayanan V, Chaturvedi S, Pai S, Sunil S. In Vivo Evaluation of Withania somnifera-Based Indian Traditional Formulation ( Amukkara Choornam), Against Chikungunya Virus-Induced Morbidity and Arthralgia. J Evid Based Integr Med 2019; 23:2156587218757661. [PMID: 29484895 PMCID: PMC5871050 DOI: 10.1177/2156587218757661] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chikungunya viral fever results in extreme morbidity and arthralgia in affected individuals. Currently, modern medicines providing symptomatic relief for the acute febrile phase and the chronic arthritic phase are only options available. Traditional Indian medical system, however, uses specific formulations for treatment of this infection; one such polyherbal formulation used to treat the postpyretic phase of chikungunya is amukkara choornam. The current study was undertaken to study the efficacy of amukkara choornam in the treatment of chikungunya in C57BL/6J mice. The formulation when administered to chikungunya-infected mice relieved morbidity and joint swelling. Analysis of virus clearance in brain and joint tissues on formulation treatment revealed a direct correlation of viral load in brain to morbidity during infection; likewise, joint swelling receded prior to complete viral clearance explaining possible immunomodulatory effect of amukkara choornam. This study provides insight into the possible mode of action of amukkara choornam during chikungunya.
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Affiliation(s)
- Jaspreet Jain
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Vimal Narayanan
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Shivam Chaturvedi
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Somnath Pai
- Amity University, Noida, Uttar Pradesh, India
| | - Sujatha Sunil
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- Sujatha Sunil, Vector Borne Diseases Group, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi 110067, India.
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Haque F, Rahman M, Banu NN, Sharif AR, Jubayer S, Shamsuzzaman AKM, Alamgir ASM, Erasmus JH, Guzman H, Forrester N, Luby SP, Gurley ES. An epidemic of chikungunya in northwestern Bangladesh in 2011. PLoS One 2019; 14:e0212218. [PMID: 30856200 PMCID: PMC6411100 DOI: 10.1371/journal.pone.0212218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In November 2011, a government hospital physician in Shibganj sub-district of Bangladesh reported a cluster of patients with fever and joint pain or rash. A multi-disciplinary team investigated to characterize the outbreak; confirm the cause; and recommend control and prevention measures. METHODS Shibganj's residents with new onset of fever and joint pain or rash between 1 September and 15 December 2011 were defined as chikungunya fever (CHIKF) suspect cases. To estimate the attack rate, we identified 16 outpatient clinics in 16 selected wards across 16 unions in Shibganj and searched for suspect cases in the 80 households nearest to each outpatient clinic. One suspect case from the first 30 households in each ward was invited to visit the nearest outpatient clinic for clinical assessment and to provide a blood sample for laboratory testing and analyses. RESULTS We identified 1,769 CHIKF suspect cases from among 5,902 residents surveyed (30%). Their median age was 28 (IQR:15-42) years. The average attack rate in the sub-district was 30% (95% CI: 27%-33%). The lowest attack rate was found in children <5 years (15%). Anti-CHIKV IgM antibodies were detected by ELISA in 78% (264) of the 338 case samples tested. In addition to fever, predominant symptoms of serologically-confirmed cases included joint pain (97%), weakness (54%), myalgia (47%), rash (42%), itching (37%) and malaise (31%). Among the sero-positive patients, 79% (209/264) sought healthcare from outpatient clinics. CHIKV was isolated from two cases and phylogenetic analyses of full genome sequences placed these viruses within the Indian Ocean Lineage (IOL). Molecular analysis identified mutations in E2 and E1 glycoproteins and contained the E1 A226V point mutation. CONCLUSION The consistently high attack rate by age groups suggested recent introduction of chikungunya in this community. Mosquito control efforts should be enhanced to reduce the risk of continued transmission and to improve global health security.
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Affiliation(s)
- Farhana Haque
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Nuzhat Nasreen Banu
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Ahmad Raihan Sharif
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Shamim Jubayer
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - AKM Shamsuzzaman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - ASM Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Jesse H. Erasmus
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Hilda Guzman
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Naomi Forrester
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Stephen P. Luby
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Emily S. Gurley
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
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Neglected Tropical Diseases and Mental Health: Progress, Partnerships, and Integration. Trends Parasitol 2018; 35:23-31. [PMID: 30578149 DOI: 10.1016/j.pt.2018.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/01/2023]
Abstract
Neglected tropical diseases (NTDs) are increasingly recognised as major drivers of psychosocial morbidity in affected individuals and their caregivers. Nevertheless, there has remained a lack of prioritisation at the policy level of some of the most stigmatising and chronic NTDs, with subsequent under-representation within NTD programmes. In response, the Neglected Tropical Disease/Non-Governmental Organization/Network (NNN) has established a Mental Wellbeing and Stigma Task Group (MWS) to address these issues through a comprehensive research agenda. In our article, we highlight the progress in understanding the scope of the mental health impact of NTDs and the innovative practice emerging in this area. Finally, we examine opportunities for integration of mental and physical health for individuals with NTDs.
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Abstract
The emergence of novel arboviruses of zoonotic potential in South Africa (SA) threatens human health and animal welfare, and affects economic growth and development. These viruses cause severe infections in animals and humans, including neurological diseases, such as encephalitis, resulting in high morbidities, mortalities and economic losses. With increasing reports of Middelburg, Shuni, Sindbis, West Nile and Wesselsbron virus infections in animals and humans in SA, this article reviews and discusses known and currently emerging arboviruses in the country. These reports underscore the need for increased surveillance, vector control management, public health preparedness, focused research, community awareness programs, and the development of rapid and sensitive diagnostic approaches. Furthermore, appropriate medical personnel training and strengthening initiatives for a one-health approach are required to understand and mitigate the emerging arboviral threat to public health.
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Affiliation(s)
- Eric Mensah
- Virology and Microbiology Research Group, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4000, South Africa
| | - Mohamed E El Zowalaty
- Virology and Microbiology Research Group, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4000, South Africa
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Tanabe ISB, Tanabe ELL, Santos EC, Martins WV, Araújo IMTC, Cavalcante MCA, Lima ARV, Câmara NOS, Anderson L, Yunusov D, Bassi ÊJ. Cellular and Molecular Immune Response to Chikungunya Virus Infection. Front Cell Infect Microbiol 2018; 8:345. [PMID: 30364124 PMCID: PMC6191487 DOI: 10.3389/fcimb.2018.00345] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/11/2018] [Indexed: 11/13/2022] Open
Abstract
Chikungunya virus (CHIKV) is a re-emergent arthropod-borne virus (arbovirus) that causes a disease characterized primarily by fever, rash and severe persistent polyarthralgia. In the last decade, CHIKV has become a serious public health problem causing several outbreaks around the world. Despite the fact that CHIKV has been around since 1952, our knowledge about immunopathology, innate and adaptive immune response involved in this infectious disease is incomplete. In this review, we provide an updated summary of the current knowledge about immune response to CHIKV and about soluble immunological markers associated with the morbidity, prognosis and chronicity of this arbovirus disease. In addition, we discuss the progress in the research of new vaccines for preventing CHIKV infection and the use of monoclonal antibodies as a promising therapeutic strategy.
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Affiliation(s)
- Ithallo S B Tanabe
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Eloiza L L Tanabe
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Elane C Santos
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Wanessa V Martins
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Isadora M T C Araújo
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Maria C A Cavalcante
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Ana R V Lima
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
| | - Niels O S Câmara
- Laboratório de Imunobiologia dos Transplantes, Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Leticia Anderson
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil.,Centro Universitário CESMAC, Maceió, Brazil
| | - Dinar Yunusov
- Cold Spring Harbor Laboratory, Genome Research Center, Woodbury, NY, United States
| | - Ênio J Bassi
- IMUNOREG-Grupo de Pesquisa em Regulação da Resposta Imune, Laboratório de Pesquisas em Virologia e Imunologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil
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Edington F, Varjão D, Melo P. Incidence of articular pain and arthritis after chikungunya fever in the Americas: A systematic review of the literature and meta-analysis. Joint Bone Spine 2018; 85:669-678. [PMID: 30053609 DOI: 10.1016/j.jbspin.2018.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/21/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the incidence of chronic articular symptoms after chikungunya virus infection of patients from the American continent. METHODS We performed a systematic review of the literature using the MEDLINE, Web of Science and Scopus databases. We included only cohort studies conducted in the American continent reporting the incidence of chronic articular symptoms after chikungunya virus acute infection. The quality of the selected studies was evaluated through the Newcastle-Ottawa Scale for non-randomized studies and relevant data were extracted. The pooled incidence of post-chikungunya chronic symptoms was estimated using a random-effect model meta-analysis. Heterogeneity was assessed by Q of Cochrane and its P-value, Tau2 and I2. Subgroup analysis was performed, and studies were stratified by quality, sample size, region, country, period of follow-up and study design. RESULTS Up to February 24, 2018, a total of 1115 potentially relevant studies were identified through our search strategy. After exclusion of 226 duplicates and 845 irrelevant studies, we retrieved 41 articles for full-text appreciation, from which 18 studies met our inclusion criteria and were included in this systematic review. Our meta-analysis suggests that 52% of the patients infected with the chikungunya virus will present chronic articular symptoms, although a high heterogeneity between studies was also found (I2 = 94%). CONCLUSION Fifty-two percent of chikungunya infected patients in the American continent are expected to develop the chronic stage of the disease. Chikungunya fever needs to be dealt as a major world health problem.
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Affiliation(s)
- Fernando Edington
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Rodovia Jorge Amado, Km 16, Bairro Salobrinho, CEP 45662-900, Ilhéus-Bahia, Brazil.
| | - Douglas Varjão
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Rodovia Jorge Amado, Km 16, Bairro Salobrinho, CEP 45662-900, Ilhéus-Bahia, Brazil
| | - Paulo Melo
- Universidade Estadual de Santa Cruz, Campus Soane Nazaré de Andrade, Rodovia Jorge Amado, Km 16, Bairro Salobrinho, CEP 45662-900, Ilhéus-Bahia, Brazil
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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.
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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
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48
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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.
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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
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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.
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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
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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.
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