Clinical characterization of acute and convalescent illness of confirmed chikungunya cases from Chiapas, S. Mexico: A cross sectional study

Abstract

BackgroundThe emerging chikungunya virus (CHIKV), is an arbovirus causing intense outbreaks in North America. The situation in Mexico is alarming, and CHIKV threatens to spread further throughout North America. Clinical and biological features of CHIKF outbreaks in Mexico have not been well described; thus, we conducted a cross sectional study of a CHIKV outbreak in Chiapas, Southern Mexico to further characterize these features.Methodology/Principal findingsWe collected blood samples from patients suspected of having chikungunya fever (CHIKF) who presented to Clinical Hospital ISSSTE Dr. Roberto Nettel in Tapachula, Chiapas, Mexico. In addition to the clinical examination, real-time polymerase chain reaction (PCR) standardized for the Asian Chikungunya lineage and/or enzyme-linked immunosorbent assay for immunoglobulin M (IgM) were used to confirm CHIKV diagnosis. Of a total of 850 patients who presented with probably CHIKV at Hospital “Dr. Roberto Nettel”, 112 probable CHIKF cases were enrolled in this study from November 2014- June 2015, of which 95 patients (84.8%) were CHIKV positive and 17 were negative (15.2%). Of these 95 CHIKV positive patients, 62 were positive by real-time reverse transcriptase PCR (+qRT-PCR); and 33 were seropositive to +IgM with a negative qRT-PCR. The most frequent symptoms reported were fever (100%), headache (82.3%), polyarthralgia (72.1%), and exanthem (82.3%). Biological abnormalities observed during CHIKV infection were lymphopenia (41.1%), leukopenia (51.6%), elevated transaminases (30.5%-46.3%) and high LDH (46.3%) and CRP (60.0%).ConclusionClinical and biological data obtained from this study is providing more useful information for benchmarking purposes with outbreaks from different parts of the world and would be helpful for better patient care and treatment.

Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014–2015

“…As noted above, our clinical staff was convinced that the AFI peak seen in October and November 2014 ( Figure 2) reflected a "recurrence" of CHIKV; in actuality, it built on a DENV1 case cluster, with some ZIKV mixed in at the end, and a still unidentified presumptive pathogen responsible for the majority of cases. Although we recognize the difficulties inherent in making clinical arboviral diagnoses, our data reinforce the frequency with which arthralgias are seen in CHIKV cases (with knees, wrists, and ankles most commonly affected, in keeping with findings in studies in other locales [9,30]).…”

“…As has been noted in multiple studies [8,22,23,[30][31][32], it can be difficult, particularly in endemic regions, to identify an infecting arbovirus based solely on clinical presentation. The current study made use of a school cohort, and consequently ages were concentrated between 3 years and 20 years, reflecting attendance in prekindergarten through "grade 13" (an additional year of school generally taken as part of the secondary education cycle).…”

Chikungunya in Colombia: a description of an epidemic within the framework of a COPCORD study

“…Like other studies, we found symmetrical arthralgia to be a frequent symptom in patients with suspicion of CHIKV infection [30,33,60–62]. Knees, hands and ankles the most affected joints [30,33,60,62–64]. However only arthritis was statistically significant in true positive patients when compared to the other three groups (false positives, false negatives and true negatives).…”

“…Other studies found similar percentages of fever ranging from 90 to 100%, however we have to remember that it is an obligatory symptom for WHO CHIKV infection criteria, increasing selection bias [30,33,75,49,53,54,63,64,72–74]. Another point to consider is that in regions where Zika, Dengue or CHIKV infections can co-exist at the same time, the use of non-specific symptoms like fever in the diagnostic criteria, increases sensibility but decreases specificity reducing the ability to discern which infection is responsible, leading to over or underdiagnosis.…”

A scoping review of Chikungunya virus infection: epidemiology, clinical characteristics, viral co-circulation complications, and control

“…Moreover, the C-reactive protein is generally elevated in the acute phase illness (Table 2) (Venugopalan et al, 2014;Brito and Cordeiro, 2016;PAHO, 2017). Elevation of hepatic enzymes, as well as elevated creatinine and creatine phosphokinase levels, have also been reported (Danis-Lozano et al, 2017). The different laboratory patterns observed during CHIKV, DENV and ZIKV infections, added to clinical findings, may be incorporated to support a correct diagnosis (Tables 1 and 2).…”