Chikungunya virus infection in Aruba: Diagnosis, clinical features and predictors of post-chikungunya chronic polyarthralgia

Abstract

BackgroundChikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year.MethodologyPatient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18–24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 ‘American College of Rheumatology/ European League Against Rheumatism’ criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression.Principal findingsAcute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0–59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1–19.6]); high ACR-score (7.4, [2.7–23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4–34.1].ConclusionsWe identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014–2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.

Beyond Fever and Pain: Diagnostic Methods for Chikungunya Virus

“…With the exception of joint pain, the symptoms of acute chikungunya typically resolve over a few days to 1 week (1,68). Approximately 50% of patients have chronic arthralgia and/or arthritis at 3 to 6 months, and over 25% of patients may still have symptoms at 12 months, which negatively impacts quality of life during recovery (68,(176)(177)(178)(179)(180). Although significant heterogeneity regarding the rate of chronic joint pain following chikungunya exists in the literature, older age (Ͼ35 to 60 years) and preexisting joint disease have been consistently associated with this outcome (176,177).…”

Socio-demographic, Clinical and Laboratory Characteristics of a Chikungunya Cohort from the 2017 Dhaka Outbreak of Bangladesh

“…9,16 Features were comparable with other chikungunya cohorts in literature as well. 17 Lymph adenopathy was common in nondiabetic patients in our series, while neurological and cardiovascular complications were less common. But we found acute kidney injury in one-tenth of our cases.…”

Clinical profile and factors associated with hospitalization during a Chikungunya epidemic in Ceará, Brazil

“…Regarding the laboratory findings, leukopenia showed a strong association with hospital admission due to CHIKV infection. A study carried out on a Caribbean island showed that none of the patients infected with CHIKV were hospitalized and no infection-related mortality was recorded 12 . This confirms that the disease has low lethality providing the patients do not have comorbidities and factors associated with death 11 .…”

“…This confirms that the disease has low lethality providing the patients do not have comorbidities and factors associated with death 11 . The infection cases are usually referred by family physicians for laboratory confirmation of suspected acute infection, and most cases are treated in primary care facilities 12 .…”

“…A study carried out to assess risk factors associated with disease severity in atypical cases of CHIKV infection in adults showed that hypertension and underlying respiratory or cardiac conditions were independent risk factors for disease severity and identified risk factors associated with the chronic phase of the disease. Severe clinical forms of CHIKV infection are associated with the presence of several pre-existing, underlying medical conditions in approximately 90% of cases 12 .…”