Clinical Forms of Chikungunya Virus Infection: The Challenge and Utility of a Consensus Definition

Dramé, Moustapha; Kanagaratnam, Lukshe; Hentzien, Maxime; Fanon, Jean-Luc; Bartholet, Seendy; Godaert, Lidvine

doi:10.4269/ajtmh.18-0468a

Cited by 2 publications

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“…In 2015, a Pan American Health organization-WHo expert consultation group provided a definition of a typical confirmed case of chikungunya. This definition can be summarized as "fever and joint pain with acute onset" and either "residing or visiting areas with local transmission of chikungunya" or "laboratory confirmation by immunoglobulin or RT-PCR" 212 . However, the primary symptoms of acute chikungunya (TABle 1) are often shared with other co-circulating (and occasionally co-infecting) arboviruses such as Zika virus (ZIKv) or dengue virus (DeNv), which can complicate the clinical diagnosis 213 .…”

Section: Box 1 | Diagnosis Of Chikungunyamentioning

confidence: 99%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Suhrbier

2019

Nat Rev Rheumatol

145

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Chikungunya virus (CHIKV) is a member of a group of globally distributed, mosquito-transmitted arthritogenic alphaviruses that cause sporadic outbreaks of primarily rheumatic disease every 2-50 years 1-4. The largest epidemic of CHIKV disease (hereafter simply referred to as chikungunya) ever recorded began on Lamu Island, Kenya, in 2004 (Fig. 1). The epidemic expanded across four continents, with cases still being reported in 2019 (Fig. 1; Supplementary Table 1). Three major genotypes of CHIKV are now recognized-the Asian, the West African and the Asian and East-Central South African (ECSA) genotypes 5-but a new lineage, the Indian Ocean Lineage (IOL), also emerged from the ECSA genotype during the 2004-2019 epidemic 6. The epidemic reached >100 countries (Supplementary Table 1), caused >10 million cases (Supplementary Table 2), and might arguably be called a pandemic. An estimated 1.3 billion people are at risk of chikungunya 7. Climate change modelling suggests that many more areas of the world (including parts of China, sub-Saharan Africa, South America and the United States) might become able to accommodate transmission of CHIKV in the future 8,9. Chikungunya was previously often viewed as (and for many patients remains) a relatively benign and selflimiting rheumatic disease. However, a considerably more complex spectrum of less common atypical and severe manifestations is now recognized in subgroups of patients, with chikungunya often complicated by comorbidities and co-infections. Hospitalization rates for chikun gunya range from 0.6% to 13% 10-14 and estimates of chikungunya-related mortality range from 0.024% to 0.7% 10,12,15-17. In addition, many patients develop protracted rheumatic disease lasting many months, occasionally years, with a number of sequelae now also recognized 18-22. Estimates for the total economic costs (direct and indirect) of chikungunya have ranged from a median of US$67 for adults and $258 for children in Columbia 23 , to a mean of $150 per outpatient and $3,300 per inpatient in 2006 in Réunion Island 11. In a large study of a chikungunya outbreak in Bangladesh in 2017, >10 days of productivity were lost in ~30% of patients with chikung unya because of severe arthropathy 24. Such costs might be viewed as relatively modest by Western standards; however, the occasionally high attack rate of chikungunya, with up to 30-75% of a given population affected by chikungunya disease at any one time 1,25 , can result in a substantial economic burden, especially in resource-poor communities that are often affected by the disease 26. Considerable research in patients and animal models has now provided extensive insights into the complex Pandemic An epidemic of disease that has spread across a large region; for instance, multiple continents, or even worldwide. Attack rate The total number of new cases of a disease divided by the total population (that is, the percentage of a defined population that is affected by a disease).

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Section: Box 1 | Diagnosis Of Chikungunyamentioning

confidence: 99%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Suhrbier

2019

Nat Rev Rheumatol

145

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“…From the beginning of the outbreak, physicians and authors reported that the definition of the clinical forms of CVI was not applicable to infants and the elderly [ 55 ]. Pediatric and geriatric specificities were hence studied during the epidemics.…”

Section: Specific Populationsmentioning

confidence: 99%

Contribution of Research in the West Indies and Northeast Amazonia to Knowledge of the 2014–2015 Chikungunya Epidemic in the Americas

et al. 2021

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Purpose of Review Although the chikungunya virus was discovered more than 60 years ago, it has only really been studied since the outbreak in La Reunion in 2005–2006. Ten years later, between 2014 and 2015, the chikungunya virus spread throughout the Americas, affecting millions of people. The objective of this review is to describe the contributions of research on chikungunya virus infection gained from epidemic in the West Indies and the Guiana Shield. Recent Findings Prevalence data were similar to those found in the Indian Ocean or Asia during epidemics. Clinically, there is now a better understanding of the typical, atypical, and severe forms. Several studies have insisted on the presence of neurological forms of chikungunya infection, such as encephalitis or Guillain–Barré syndrome. Cases of septic shock due to chikungunya virus as well as thrombotic thrombocytopenic purpura were described for the first time. Given the magnitude of the epidemic and the large number of people affected, this has led to a better description and new classifications of chikungunya virus infections in specific populations such as pregnant women, the elderly, and children. Several studies also described the behavior of populations faced with an emerging disease. Summary Current epidemiological data from tropical regions highlights the risk of spreading emerging diseases at higher latitudes, especially concerning arboviruses, since the vector Aedes albopictus is already established in many parts of northern countries. A better understanding of the disease and its epidemic dynamics will foster better management, the crucial importance of which was demonstrated during the COVID-19 epidemic.

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Clinical Forms of Chikungunya Virus Infection: The Challenge and Utility of a Consensus Definition

Cited by 2 publications

References 7 publications

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Rheumatic manifestations of chikungunya: emerging concepts and interventions

Contribution of Research in the West Indies and Northeast Amazonia to Knowledge of the 2014–2015 Chikungunya Epidemic in the Americas

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