Was It Chikungunya? Laboratorial and Clinical Investigations of Cases Occurred during a Triple Arboviruses’ Outbreak in Rio de Janeiro, Brazil

Abstract

The co-circulation of chikungunya virus (CHIKV), dengue virus (DENV) and Zika virus (ZIKV) in Rio de Janeiro (RJ), Brazil, caused a challenging triple epidemic, as they share similar clinical signs and symptoms and geographical distribution. Here, we aimed to investigate the clinical and laboratorial aspects of chikungunya suspected cases assisted in RJ during the 2018 outbreak, focusing on the differential diagnosis with dengue and zika. All suspected cases were submitted to molecular and/or serological differential diagnostic approaches to arboviruses. A total of 242 cases suspected of arbovirus infection were investigated and 73.6% (178/242) were molecular and/or serologically confirmed as chikungunya. In RT-qPCR confirmed cases, cycle threshold (Ct) values ranged from 15.46 to 35.13, with acute cases presenting lower values. Chikungunya cases were mainly in females (64%) and the most frequently affected age group was adults between 46 to 59 years old (27%). Polyarthralgia affected 89% of patients, especially in hands and feet. No dengue virus (DENV) and Zika virus (ZIKV) infections were confirmed by molecular diagnosis, but 9.5% (23/242) had serological evidence of DENV exposure by the detection of specific anti-DENV IgM or NS1, and 42.7% (76/178) of chikungunya positive cases also presented recent DENV exposure reflected by a positive anti-DENV IgM or NS1 result. A significantly higher frequency of arthritis (p = 0.023) and limb edema (p < 0.001) was found on patients with CHIKV monoinfection compared to dengue patients and patients exposed to both viruses. Lastly, phylogenetic analysis showed that the chikungunya cases were caused by the ECSA genotype. Despite the triple arboviruses’ epidemic in the state of RJ, most patients with fever and arthralgia investigated here were diagnosed as chikungunya cases, and the incidence of CHIKV/DENV co-detection was higher than that reported in other studies.

Antiviral and Virucidal Activities of Uncaria tomentosa (Cat’s Claw) against the Chikungunya Virus

“…Chikungunya fever is an acute febrile illness that causes fever, myalgia, headache, and other unspecific symptoms, but it is characterized mostly by its intense joint pain [ 15 , 16 ]. Post-chikungunya arthritis is the most common clinical manifestation after infection, and it is estimated that 40 to 60% of cases have significantly impaired long-term quality of life after infection.…”

“…The disease tends to be self-limiting, evolving to cure in approximately two weeks; however, in 48 to 80% of arthritogenic patients, the symptoms persist for months or years, evolving into a chronic phase. Outbreaks from different regions showed a similar clinical outcome, compromising the joints in the long term [ 5 , 13 , 14 , 15 , 16 ]. Atypical manifestations such as skin pigmentation, ulcers, chest pain, and ocular and neurological symptoms are described during the acute phase [ 17 , 18 , 19 ], and lethal complications such as myocarditis, hepatitis, and encephalitis have also been reported [ 20 , 21 ].…”

“…Viruses 2024, 16, 369 2 of 17 About 80 to 90% of CHIKV infections are symptomatic [9,10], although recent studies indicate that the percentage of asymptomatic patients may be higher [11]. Chikungunya fever is an acute illness with a sudden onset.…”

Oropouche Virus Exposure in Febrile Patients during Chikungunya Virus Introduction in the State of Amapá, Amazon Region, Brazil

“…Ever since, CHIKV has caused several outbreaks all over the country, registering 1.5 million cases by 2022 [ 10 ]. Clinical manifestations in typical acute CHIKV infection are fever, arthralgia, myalgia, nausea, and vomiting, among others [ 11 , 12 ]. Arthralgia is the most common and prominent symptom reported by patients with chikungunya fever [ 11 , 12 ].…”

“…Clinical manifestations in typical acute CHIKV infection are fever, arthralgia, myalgia, nausea, and vomiting, among others [ 11 , 12 ]. Arthralgia is the most common and prominent symptom reported by patients with chikungunya fever [ 11 , 12 ]. CHIKV clinical infection can also have atypical manifestations, affecting cardiological, neurological, and respiratory systems, and may result in death [ 13 , 14 ].…”