Atypical Clinical Presentations of Acute Phase Chikungunya Virus Infection in Older Adults

Godaert, Lidvine; Najioullah, Fatiha; Bartholet, Seendy; Colas, Sébastien; Yactayo, Sergio; Cabie, André; Fanon, Jean Luc; Césaire, Raymond; Dramé, Moustapha

doi:10.1111/jgs.15004

Cited by 41 publications

(55 citation statements)

References 29 publications

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“…In the current study population, underdiagnosis was more frequent than overdiagnosis in older adults and that underdiagnosis was significantly more frequent in older (21.6%) than in younger (2.8%) adults (p<.001). This is consistent with the more frequent atypical presentation in older adults and the fact that fever and arthralgia are often absent (in > 40% of older adults) . CVI does not require any specific treatment, and management mainly consists of painkillers and antipyretics.…”

Section: Discussionsupporting

confidence: 78%

“…Other authors have previously studied the rate of diagnostic errors in the ED in individuals with pulmonary tuberculosis and identified atypical presentation and unresponsiveness as factors associated with greater rate of misdiagnosis. It was previously reported that there is a higher rate of atypical presentations of CVI in individuals aged 65 and older . In the current study population, underdiagnosis was more frequent than overdiagnosis in older adults and that underdiagnosis was significantly more frequent in older (21.6%) than in younger (2.8%) adults (p<.001).…”

Section: Discussionsupporting

confidence: 41%

“…Furthermore, in atypical or severe cases, a range of other clinical signs accompany the illness and may mask CVI . Atypical presentations are more frequently observed in older adults, which may explain why there is a higher rate of misdiagnosis in this age group. Physician use of scales to predict the likelihood of CVI that are not adapted to older adults may be a further explanation for the higher rate of misdiagnosis in this population.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we included individuals who were assessed within 3 days of onset of symptoms. As previously stated, this time limit was chosen to reduce the risk that signs or symptoms observed were a consequence of the CVI. In elderly adults, the longer the time between onset of disease and diagnosis, the greater the likelihood that complications of the disease may mask the initial infection .…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Misdiagnosis of Chikungunya Virus Infection: Comparison of Old and Younger Adults

Godaert

Bartholet²,

Gazeuse

et al. 2018

J American Geriatrics Society

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Misdiagnosis of Chikungunya Virus Infection: Comparison of Old and Younger Adults

Godaert

Bartholet²,

Gazeuse

et al. 2018

J American Geriatrics Society

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“…We previously showed that elderly patients who develop unclassifiable CVI have more comorbidities than those with typical or atypical presentation. The comorbidities alone do not explain the frailty of elderly subjects , but they do account for a large part of it.…”

Section: Discussionmentioning

confidence: 99%

Long‐term survival and clinical forms in the acute phase of Chikungunya virus infection in older Caribbeans

Godaert

Bartholet

Najioullah

et al. 2019

Tropical Med Int Health

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Objective To investigate whether the long‐term survival in elderly patients with prior Chikungunya virus infection (CVI) is associated with the clinical form presented in the acute phase, as defined by the WHO classification. Methods Retrospective cohort study performed in Martinique University Hospitals. Patients who attended the emergency department for suspected CVI, and who had a positive biological diagnosis of CVI by reverse transcription‐polymerase chain reaction on a plasma sample between 10 January and 31 December 2014 were eligible for inclusion. Time‐to‐death was the primary outcome. The independent relationship between clinical forms and time‐to‐death was analysed using a Cox model. Results In total, 268 patients were included. Mean age was 80 ± 8 years, 53% were women. Median length of follow‐up was 28 months (range: 0–39). During follow‐up, 53 (19.8%) patients died. Median survival time was 13.2 months (range: 0–33.6). At the end of follow‐up, death rates were 4.6% for acute clinical cases, 19.0% for atypical cases, 19.2% for severe acute cases and 23.5% for unclassifiable cases. By multivariable analysis, the clinical form of CVI at admission was found to be independently associated with long‐term survival (atypical form: HR = 2.38; 95% CI = 2.15–2.62; severe acute form: HR = 2.40; 95% CI = 2.17–2.64; unclassifiable form: HR = 2.28; 95% CI = 2.06–2.51). Conclusion The clinical form at presentation with CVI has a significant impact on long‐term survival. Management of CVI patients should be tailored according to their clinical form at admission.

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The relationship between chikungunya virus and the kidneys: A scoping review

Costa

Gouveia

Silva

et al. 2022

Reviews in Medical Virology

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Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality.Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.

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Atypical Clinical Presentations of Acute Phase Chikungunya Virus Infection in Older Adults

Abstract: Only 8.2% of the older adults presenting in the acute phase of CHIKV have typical forms, suggesting that the most-frequent clinical presentation of CHIKV in older adults differs from that in younger individuals.

Cited by 41 publications

References 29 publications

Misdiagnosis of Chikungunya Virus Infection: Comparison of Old and Younger Adults

Misdiagnosis of Chikungunya Virus Infection: Comparison of Old and Younger Adults

Long‐term survival and clinical forms in the acute phase of Chikungunya virus infection in older Caribbeans

The relationship between chikungunya virus and the kidneys: A scoping review

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