Post–Chikungunya Virus Infection Musculoskeletal Disorders: Syndromic Sequelae after an Outbreak

Abstract

The Chikungunya virus is a re-emerging mosquito-borne alphavirus. Outbreaks are unpredictable and explosive in nature. Fever, arthralgia, and rash are common symptoms during the acute phase. Diagnostic tests are required to differentiate chikungunya virus from other co-circulating arboviruses, as symptoms can overlap, causing a dilemma for clinicians. Arthritis is observed during the sub-acute and chronic phases, which can flare up, resulting in increased morbidity that adversely affects the activities of daily living. During the 2019 chikungunya epidemic in Thailand, cases surged in Bangkok in the last quarter of the year. Here, we demonstrate the chronic sequelae of post-chikungunya arthritis in one of our patients one year after the initial infection. An inflammatory process involving edema, erythema, and tenderness to palpation of her fingers’ flexor surfaces was observed, with positive chikungunya IgG and negative IgM tests and antigen. The condition produced stiffness in the patient’s fingers and limited their range of motion, adversely affecting daily living activities. Resolution of symptoms was observed with a short course of an anti-inflammatory agent. More research is required to determine whether sanctuaries enable chikungunya virus to evade the host immune response and remain latent, flaring up months later and triggering an inflammatory response that causes post-chikungunya arthritis.

Spread of a Novel Indian Ocean Lineage Carrying E1-K211E/E2-V264A of Chikungunya Virus East/Central/South African Genotype across the Indian Subcontinent, Southeast Asia, and Eastern Africa

“…Sixteen existing, previously published CHIKV real-time RT-PCR-positive sera were obtained from Indira Gandhi Memorial Hospital, the Maldives in 2019 [14,15] and 10 newly collected, also CHIKV real-time RT-PCR-positive sera in the Bangkok Hospital for Tropical Diseases in 2020 were used. The study was conducted according to the Declaration of Helsinki, and ethical approval was obtained from the National Health Research Committee in the Maldives.…”

Clinical Features of Acute Chikungunya Virus Infection in Children and Adults during an Outbreak in the Maldives

“…The cutaneous involvement in CHIKV infection has been well described, and some rashes that occur in other conditions, such as hyperpigmentation, scar phenomenon, and erysipelas of the pinnae (Milians ear sign), have been reported in CHIKV infection. 13 , 45 , 46 Half of the cases in the present study developed rash, commonly a maculopapular rash, which was associated with pruritus, and one patient exhibited the Milians ear sign and scar phenomenon.…”

“… 9 Arthralgia and arthritis are reportedly the most debilitating symptoms, which can occur in 87% of adults and in 30–50% of children. 10 – 13 Although individuals of all ages are susceptible to the virus, the arthritogenic manifestations of arthralgia are less prominent in children, whereas females appear to be at higher risk of developing incapacitating symptoms. 14 Severe forms of infection-associated neuro-invasive disease can occur in children, and other atypical manifestations or fatality can occur in individuals with underlying comorbidities.…”

A Case Report of Secondary Syphilis Co-Infected with Measles: A Diagnostic Dilemma with Fever and Rash

“…The hospital runs numerous specialized clinics, such as the Fever Clinic, which functions round the clock, 7 days a week, as a public service [ 43 ]. Patients diagnosed with tropical diseases are frequently referred from other hospitals and individuals suffering from acute febrile illness may opt to walk into the clinic or present as described in this report [ 44 , 45 ].…”

“…Hence, other viral etiologies, such as rubella and parvovirus B19 infections, may also manifest with similar clinical findings to the presented case [ 49 , 50 ]. However, the classical manifestation of rubella in adults includes arthralgias, similar to the symptoms caused by arthritogenic viral infections [ 44 , 51 , 52 , 53 ]. Similarly, parvovirus B19 infection in adults may manifest with arthralgia, including enanthemic eruptions of Koplik’s spots [ 54 ].…”