Chikungunya Pathogenesis: From the Clinics to the Bench

Abstract

Chikungunya alphavirus has caused large epidemics worldwide and leads to acute incapacitating polyarthralgia. The inflammatory reaction over several days will drive robust innate and humoral responses essential to control the infection. Critically, fatal cases and mother-to-child transmission have also been described. Chikungunya can give rise to chronic musculoskeletal diseases, which can last for months to years, particularly in elderly individuals, and occasionally leads to seronegative rheumatoid arthritis-like pathologies. Histopathological studies of patient biopsy specimens and animal models have revealed that chikungunya virus can hide in tissue sanctuaries, and ongoing research should help to decipher the inflammatory mechanisms of tissue injuries.

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

“…In older adults, two phenomena could result in poor efficiency of the immune response in CHIKV infection: lymphopenia and age‐related changes in T‐cell immunity. Experimental models have documented the capacity of CHIKV to infect fibroblasts of the connective tissue, which activates the innate immune system with production of type 1 interferon (INF) . Higher levels of type 1 INF induce cell death in lymphocytes .…”

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever

“…In a small percentage of patients, a condition that resembles rheumatoid arthritis (RA) may develop, possibly caused by the presence of the HLA‐DRB1 gene (associated with the development of RA) in these patients. However, unlike classic RA, high levels of rheumatoid factor and anticyclic citrullinated peptide are not detected . Estimates of the percentage of patients who develop CIR vary .…”

“…The fibroblasts affected by CHIKV express high levels of prostaglandins that stimulate nociceptors and increase sensitivity to pain. Another secondary effect is increased osteoclastic activity of the macrophages, which leads to bone erosion …”

“…Another secondary effect is increased osteoclastic activity of the macrophages, which leads to bone erosion. 11,12 After 10 days, most patients improve, and the rest develop subacute and chronic forms of the disease. The subacute phase lasts between 11 days and 3 months.…”

Point of sampling detection of Zika virus within a multiplexed kit capable of detecting dengue and chikungunya

“…In other cases, illness is clinically mild with symptoms lasting from several days to a week, including fever, rash, joint pain, conjunctivitis, myalgia, and headache. Serious illnesses associated with Zika virus include Guillain-Barré syndrome in adults, microcephaly in neonates, and chronic musculoskeletal diseases that may last months to years [7]. Two cases are reported from New Caledonia having co-infection of Zika and dengue; Colombia reports one patient co-infected with Zika, chikungunya and dengue.…”