Chikungunya Manifestations and Viremia in Patients Who Presented to the Fever Clinic at Bangkok Hospital for Tropical Diseases During the 2019 Outbreak in Thailand

Abstract

Chikungunya virus is an Alphavirus belonging to the family Togaviridae that is transmitted to humans by an infected Aedes mosquito. Patients develop fever, inflammatory arthritis, and rash during the acute stage of infection. Although the illness is self-limiting, atypical and severe cases are not uncommon, and 60% may develop chronic symptoms that persist for months or even for longer durations. Having a distinct periodical epidemiologic outbreak pattern, chikungunya virus reappeared in Thailand in December 2018. Here, we describe a cohort of acute chikungunya patients who had presented to the Bangkok Hospital for Tropical Diseases during October 2019. Infection was confirmed by real-time RT-PCR using serum collected at presentation to the Fever Clinic. Other possible acute febrile illnesses such as influenza, dengue, and malaria were excluded. We explored the sequence of clinical manifestations at presentation during the acute phase and associated the viral load with the clinical findings. Most of the patients were healthy individuals in their forties. Fever and arthralgia were the predominant clinical manifestations found in this patient cohort, with a small proportion of patients with systemic symptoms. Higher viral loads were associated with arthralgia, and arthralgia with the involvement of the large joints was more common in female patients

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

“…We previously demonstrated that arthralgia and a decrease in lymphocyte count are associated with higher viremia. 49 In the present study, we also observed a lower number of circulating lymphocytes in patients with arthritis, along with a lower cycle threshold value and other signs of systemic involvement and inflammation. The elevated serum creatinine levels in adults could have been due to worsening kidney function associated with pre-existing comorbidities.…”

“…50 We took this opportunity to compare the clinical and laboratory profiles of patients in the present and previous CHIKV infection studies with our dengue patient cohort. 34,49 Early in the onset of illness, dengue cases exhibited an increased frequency of headaches compared with both CHIKV patient cohorts. Decreases in the number of circulating leukocytes, neutrophils, lymphocytes, and platelets were more common in dengue cases than in CHIKV infection cases in the present study.…”