Comparison of clinical presentation and out-comes of Chikungunya and Dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan

Shahid, Uzma; Farooqi, Joveria; Barr, Kelli L.; Mahmood, Syed Mohammad; Jamil, Bushra; Imitaz, Kehkashan; Azizullah, Zahida; Malik, Faisal; Prakoso, Dhani; Long, Maureen T.; Khan, Erum

doi:10.1371/journal.pntd.0008086

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…In a cross-sectional study of arbovirus infections in Pakistan, thrombocytopenia was observed in 18% of CHIKV infections, compared to 74% in DENV. Furthermore, thrombocytosis was significantly associated with CHIKV infection (OR 2.2) [ 83 ].…”

Section: Resultsmentioning

confidence: 99%

Thrombocytopenia in Virus Infections

Raadsen

Toit

Langerak

et al. 2021

JCM

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Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.

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Section: Resultsmentioning

confidence: 99%

Thrombocytopenia in Virus Infections

Raadsen

Toit

Langerak

et al. 2021

JCM

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“…However, 33.3% of arthralgia was noted in CHIKV-seropositive patients and 66.6% in combined CHIKV- and DENV-seropositive patients, but not in DENV-only cases. Arthralgia and rash have been identified as some of the typical clinical features of CHIKV although, in some cases, the infection can progress to debilitating polyarthritis that can last for months and years [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

Evidence of Chikungunya virus seroprevalence in Myanmar among dengue-suspected patients and healthy volunteers in 2013, 2015, and 2018

et al. 2021

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Introduction Chikungunya virus (CHIKV) is a mosquito-borne virus known to cause acute febrile illness associated with debilitating polyarthritis. In 2019, several institutions in Myanmar reported a CHIKV outbreak. There are no official reports of CHIKV cases between 2011 and 2018. Therefore, this study sought to determine the seroprevalence of CHIKV infection before the 2019 outbreak. Methods A total of 1,544 serum samples were collected from healthy volunteers and patients with febrile illnesses in Yangon, Mandalay, and the Myeik district in 2013, 2015, and 2018. Participants ranged from one month to 65 years of age. Antibody screening was performed with in-house anti-CHIKV IgG and IgM ELISA. A neutralization assay was used as a confirmatory test. Results The seroprevalence of anti-CHIKV IgM and anti-CHIKV IgG was 8.9% and 28.6%, respectively, with an overall seropositivity rate of 34.5%. A focus reduction neutralization assay confirmed 32.5% seroprevalence of CHIKV in the study population. Age, health status, and region were significantly associated with neutralizing antibodies (NAbs) and CHIKV seropositivity (p < 0.05), while gender was not (p = 0.9). Seroprevalence in 2013, 2015, and 2018 was 32.1%, 28.8%, and 37.3%, respectively. Of the clinical symptoms observed in participants with fevers, arthralgia was mainly noted in CHIKV-seropositive patients. Conclusion The findings in this study reveal the circulation of CHIKV in Myanmar’s Mandalay, Yangon, and Myeik regions before the 2019 CHIKV outbreak. As no treatment or vaccine for CHIKV exists, the virus must be monitored through systematic surveillance in Myanmar.

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“…Whilst clinicians use IgM ELISA to screen for infection, the plaque reduction neutralization test (PRNT) with ZIKV alongside DENV and other endemic flaviviruses is recommended by the Centers for Disease Control and Prevention (CDC) to confirm diagnosis in RT-PCR negative and IgM ELISA positive cases (15). However, PRNT has been shown to be challenging for diagnosis with over half of patients exhibiting significant neutralization of ZIKV, DENV, and other flaviviruses co-circulating in that region (28).…”

Section: Discussionmentioning

confidence: 99%

Zika Virus looming epidemic in Pakistan: seroprevalence findings by plaque reduction neutralization test in the Sindh Region of Pakistan

Imtiaz

Farooqui

Barr

et al. 2023

Preprint

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Background Zika virus (ZIKV) has emerged as a cause of febrile illness in children and adults globally. West Asian and Middle Eastern countries have not yet experienced the widespread emergence of ZIKV. In Pakistan, detection of ZIKV antibodies have been reported. However, the validity of this data is questionable given the current understanding of flaviviral antigenic cross-reactivity. In order to determine if ZIKV is circulating in the Sindh region of Pakistan, patients presenting to healthcare centers with an acute febrile dengue-like illness were evaluated for ZIKV infection. Methods Dengue virus (DENV) screening in patients was performed using a commercial ELISA Rapid Test NS1 antigen capture test. All DENV negative samples were tested for Zika virus, using a commercial IgM capture ELISA kit. Additionally, a plaque reduction neutralization test (PRNT) was performed to measure neutralizing antibodies. Singleplex, two-step Real-time PCR using general primers and probes was performed for the detection of Zika virus nucleic acid. Results Patients with acute dengue-like illness (DLI) presenting at healthcare centers in different sites throughout the Sindh region of Pakistan were recruited. A total of 745 patient samples were tested for ZIKV via IgM ELISA and RT-PCR. Thirty-seven samples (4.9%) tested positive for ZIKV IgM without any cross-reactivity to other flaviviruses tested simultaneously. These were considered as presumptive positive for ZIKV, selected presumptive positive samples (n=20) were confirmed using PRNT50 using Vero cells. All 20 samples showed ZIKV neutralization at PRNT50. Conclusions Our study provides evidence that ZIKV is circulating in the Sindh region of Pakistan and is a probable cause of clinical dengue-like illness (DLI) cases that are seen seasonally in Pakistan.

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Comparison of clinical presentation and out-comes of Chikungunya and Dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan

Cited by 6 publications

References 27 publications

Thrombocytopenia in Virus Infections

Thrombocytopenia in Virus Infections

Evidence of Chikungunya virus seroprevalence in Myanmar among dengue-suspected patients and healthy volunteers in 2013, 2015, and 2018

Zika Virus looming epidemic in Pakistan: seroprevalence findings by plaque reduction neutralization test in the Sindh Region of Pakistan

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