Prospective Study of Chikungunya Virus Acute Infection in the Island of La Réunion during the 2005–2006 Outbreak

Abstract

BackgroundChikungunya virus (CHIKV) is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean and India, and extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa and America. Our objective was to determine the clinical and biological features of patients at the acute phase of CHIKV infection.Methods and FindingsA prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March and May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR), one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM and negative IgG), and one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM and IgG). Bivariate analyses of clinical and biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5%) affecting the lower (98%) and small joints (74.8%), as well as asthenia (88.6%), headache (70%), digestive trouble (63.3%), myalgia (59%), exanthems (47.8%), conjunctival hyperhemia (23%) and adenopathy (8.9%). Vertigo, cutaneous dysesthesia, pharyngitis and haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%), entesopathies (1.6%), talalgia (14%) were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001), whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001). Others biological abnormalities included leukopenia (38.3%), thrombocytopenia (37.3%), increased ASAT and ALAT blood levels (31.6 and 7.3%, respectively) and hypocalcemia (38.7%). Lymphopenia <1,000/mm3 was very closely associated with viremic patients (Yule coefficient 0.82, positive predictive value 92.3%). Age under 65 was associated with a benign course, as no patients younger than 65 had to be hospitalized (Yule coefficient 0.78).ConclusionsThe diagnosis of CHIKV infection in acute phase is based on commonly accepted clinical criteria (fever and arthralgia), however clinical and biological diffrences exist in acute phase depending on whether or not the patient is within the viremic phase of the infection.

Chikungunya and Dengue Fever among Hospitalized Febrile Patients in Northern Tanzania

“…30 The age distribution of CHIKV cases observed is in marked contrast to the preponderance of cases among older patients observed during recent outbreaks among non-immune populations outside of Africa. 31,32 CHIKV infection was inevitably misdiagnosed as another infection, usually malaria. However, CHIKV infection was [27 and 28].…”

Arthrogenic Alphaviruses and Inflammatory Myopathies

“…Human CHIKV infection has been clinically well documented (Chow et al, 2011;Pialoux et al, 2007;Powers & Logue, 2007;Simon et al, 2007;Sissoko et al, 2010;Taubitz et al, 2007). The serology profile during the course of infection has been documented by numerous studies, showing that viraemia lasts 5-7 days (acute infection), with a subsequent IgM+/IgG-sub-acute infection progressing for a further week until IgG antibodies are detected and in some cases IgM was still detectable (Staikowsky et al, 2009). Interestingly, it has been reported that levels of IgM have remained high for months and even years in many cases of alphavirus infection (Chopra et al, 2008;Kurkela et al, 2005;Niklasson et al, 1988).…”

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

“…In contrast, lesions as nephritis are more likely to be caused by the virus. Additionally, in this third stage, a constrictive syndrome has also been described, with extensive compromise and pericarditis, but it is indeed less common 24 .…”

“…The location of the arthralgias tends to vary between individuals. There are rare descriptions in the literature of pain in the costochondral, hip and temporomandibular articulations 24 , so it may not be advisable to dismiss a CHIKV diagnosis if these pains are present. Palmo-plantar pruritus, photophobia, edema in the face and extremities and adenopathies have been also described, and benign and self-limited hemorrhagic manifestations are relatively common in children.…”

“…A common denominator of the 0.5% of patients who develop these systemic atypical patterns of disease is having some kind of predisposing condition, disease, or advanced age 9, 16, 24 . In retrospective records of severe cases reported by Economopolou A., et al from La Réunion, 89% had previous medical conditions, 78% took medication before the disease (14% NSAIDS) and 14% were alcoholic 11, 23 .…”