Classification of chikungunya cases: a proposal

Abstract

Since 2005, chikungunya virus (CHIKV) has caused large outbreaks, with reports of more than 10 million cases worldwide over the course of a decade. Since 2013, almost three million cases have been reported in the Americas. Although musculoskeletal involvement is the most prevalent symptom in the disease spectrum, systemic manifestations with involvement of important organs have also been described. Currently, case classifications of chikungunya based on the intensity and duration of articular symptoms have been used to guide the clinical management of the joint manifestations, with little or no emphasis on the severe clinical forms associated with systemic disease and target organ involvement. Thus, these classifications have failed to aid health professionals in the detection and early management of severe cases, which can lead to fatal outcomes and sequelae. Based on data from international literature and the opinions of clinical professionals, epidemiologists, and arbovirologists with extensive experience gained from the Brazilian chikungunya outbreak, a group of specialists proposed a revised classification for chikungunya cases. In this proposed classification, the specialists highlight the different patterns of the disease, including systemic manifestations, with the aim of sensitizing health professionals for the prompt detection and early management of severe conditions, which can contribute to reducing fatal outcomes.

Increased Indoleamine 2,3-Dioxygenase 1 (IDO-1) Activity and Inflammatory Responses during Chikungunya Virus Infection

“…The patients were categorized into groups according to the duration of symptoms: acute (up 14 days, n = 78), post-acute (14-90 days, n = 12), and chronic (91-124 days, n = 10) [25], and they were classified according to the Ministry of Health's guidelines [24]. All plasma samples from acute patients had detectable CHIKV viral RNA.…”

“…The cohort of CHIKV patients included those with varying clinical symptoms/signs and chronicity of symptoms. Eighty-eight CHIKV positive patients (88/353; 24.9%) were included in the study, and they were categorized into three phases: acute phase (up to 14 days after disease onset), a post-acute phase (15 to 90 days), and a chronic phase (after 90 days) [25]. Blood samples from 10 healthy donors (HD) were collected and used as controls in the analyses.…”

Antiviral, Cytoprotective, and Anti-Inflammatory Effect of Ampelozizyphus amazonicus Ducke Ethanolic Wood Extract on Chikungunya Virus Infection

“…mosquitos, CHIKV is widespread across the globe due to the presence of its vectors in both tropical and temperate zones [1]. It is estimated that more than 10 million cases of CHIKV infection occurred in the last decade [2], and this number is supposed to increase in the next years. Infection by CHIKV results in a very debilitating disease, named Chikungunya fever (CHIKF), characterized by a high fever of sudden onset and an intense arthralgia that impairs individual regular activities such as cooking, housecleaning, and others, resulting in a significant social and economic impact [3][4][5].…”