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 detected by a novel antigen kit and subsequently 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.

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

“…Furthermore, the East Central South African (ECSA) lineage and Asian lineage reportedly cause long-lasting musculoskeletal disorders [ 24 ]. Similarly, post-CHIKV arthritis can occur during infection with the ECSA Indian Ocean sub-lineage, as observed in the present case [ 3 ]. Inflammatory polyarthritis is the most common long-term sequelae to occur with chikungunya infection [ 12 , 25 , 26 ].…”

“…The patient was a participant of one of our previous studies conducted at the Bangkok Hospital for Tropical Diseases during the CHIKV outbreak in 2019 [ 3 ]. After becoming symptomatic again in 2020, the patient returned to the Fever Clinic.…”

“…The co-existence of these pathogens in endemic regions poses a conundrum in clinical practice [ 2 ]. Due to similarities in their presentation, these viruses can be easily misidentified [ 3 ]. The use of definite laboratory diagnostics, either molecular techniques or serology, is therefore crucial in narrowing down the differential diagnosis of acute febrile illnesses or, more precisely, acute undifferentiated febrile illnesses.…”

“…The use of definite laboratory diagnostics, either molecular techniques or serology, is therefore crucial in narrowing down the differential diagnosis of acute febrile illnesses or, more precisely, acute undifferentiated febrile illnesses. Infections involving the majority of arboviral etiologic agents such as the dengue viruses, Zika, and chikungunya virus (CHIKV), frequently manifest as an abrupt-onset illness with non-localizing signs and symptoms; the infections are self-limited, and patients typically recuperate without the use of any particular therapeutics [ 3 , 4 , 5 ]. Conversely, of the three sympatric pathogens described, CHIKV causes more morbidity and arthritis during chronic infection.…”

Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

“…Several tropical diseases are endemic to the Maldives, and clinicians use point-of-care test kits since many tropical diseases are indistinguishable upon presentation and can overlap with symptoms of MIS-A [ 36 , 37 , 38 ]. In the present case, the patient had a positive diagnosis of dengue IgM from ELISA, but this finding had to be carefully interpreted as false-positive dengue serology had been described in COVID-19 patients [ 39 ].…”