Chikungunya Infection

Abstract

A large chikungunya virus (CHIKV) outbreak emerged in 2005-2006 in the Indian Ocean islands, including Comoros, Mayotte, Mauritius, the Seychelles, and particularly in Reunion Island where 35% of 770,000 inhabitants were infected in 6 months. More recently, circulation of the virus has been documented in Madagascar and in India where CHIKV is spreading rapidly. CHIKV-infected visitors have returned home to nonendemic regions from these islands. We conducted a 14-month prospective observational study on the clinical aspects of CHIKV infection imported to Marseilles, France, in travelers returning from the Indian Ocean islands. A total of 47 patients have been diagnosed with imported CHIKV infection confirmed by serology, reverse transcription-polymerase chain reaction, and/or viral culture. At the early stage of the disease (within 10 days of the disease onset), fever was present in 45 of 47 patients. A rash was present in the first week in 25 cases. All patients suffered with arthritis. The most frequently affected joints were fingers, wrists, toes, and ankles. Eight patients were hospitalized during the acute stage, including 2 severe life-threatening cases. A total of 38 patients remained symptomatic after the tenth day with chronic peripheral rheumatism, characterized by severe joint pain and multiple tenosynovitis, with a dramatically limited ability to ambulate and carry out activities in daily life. Three patients were hospitalized at this stage for severe persistent handicap. Follow-up demonstrated slow improvement in joint pain and stiffness despite symptomatic treatment, mainly antiinflammatory and analgesic drugs. In the current series we describe 2 stages of the disease, an initial severe febrile and eruptive polyarthritis, followed by disabling peripheral rheumatism that can persist for months. We point out the possibility of transitory peripheral vascular disorders during the second stage and the occasional benefit of short-term corticosteroids. As CHIKV could spread throughout the world, all physicians should be prepared to encounter this arboviral infection.

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

“…Chikungunya virus (CHIKV) is an RNA-type arbovirus species that according to the International Committee on Taxonomy of Viruses (ICTV) belongs to the Family Togaviridae, the Genus Alphavirus (currently not assigned to an Order), along with more than 30 other pathogens for vertebrates and humans, causing a very broad spectrum of disease 1, 2 . The word “Chikungunya” means “which contorts or bends up” in Makonde language from Tanzania and Mozambique, referring accurately to the difficulty in deambulation or walking of those affected 1, 2 .…”

“…The word “Chikungunya” means “which contorts or bends up” in Makonde language from Tanzania and Mozambique, referring accurately to the difficulty in deambulation or walking of those affected 1, 2 . Despite CHIKV first being documented in 1954 in Tanzania, Africa and subsequently Asia 1, 3, 4 , it was not until 2006 that CHIKV first alarmed the world for being a major public health concern. After an explosive epidemic outbreak in French island La Réunion, where 35% of the total population was infected over six months, CHIKV arrived to central France and extended to Germany, Italy, Norway, and Switzerland 1 .…”

“…Despite CHIKV first being documented in 1954 in Tanzania, Africa and subsequently Asia 1, 3, 4 , it was not until 2006 that CHIKV first alarmed the world for being a major public health concern. After an explosive epidemic outbreak in French island La Réunion, where 35% of the total population was infected over six months, CHIKV arrived to central France and extended to Germany, Italy, Norway, and Switzerland 1 . Later on, the virus hit North, Central and South America and brought with it the concept of a “self-limited febrile illness”, a more benign type of infection with predominantly articular symptomatology 1, 3– 5 .…”

“…“Old World” viruses such as CHIKV are known for their articular tropism and exanthematous febrile syndrome; and the “New World” viruses such as the western equine encephalitis and Venezuelan equine encephalitis viruses 1– 3 have preference for nervous system stromal cells. CHIKV infection pathway in humans is shared with Dengue fever, and is caused by the biting of borne-arthropods from the Aedes mosquito family, Aedes aegypti and most recently Aedes albopictus 1 , the last one being essential to the wide geographic colonization process ever since a new mutation (A226V) in CHIKV has conferred the virus a better ability to replicate in this species. Ae.…”

“…The transmission cycle, although originally merely sylvatic between primates and forest mosquitoes, has developed an alternate urban cycle involving humans 1, 6 . Aedes as vectors are capable of spreading the virus after biting a viremic human, after which CHIKV replicates in salivary glands of the female mosquito and then a new bite of a healthy host takes place 6, 7 .…”