Clinical Features and Molecular Diagnosis of Chikungunya Fever from South India

Abstract

An epidemic of Chikungunya fever of unprecedented magnitude occurred in many parts of India in early 2006 after an interval of 33 years, and there has been a resurgence in some parts of South India since June 2007. The article highlights clinical manifestations of infection and various molecular tests that were used for diagnoses of Chikungunya virus infection. Of particular interest is the real-time loop-mediated isothermal amplification (RT LAMP) assay, which is rapid and cost-effective and can be adopted at ill-equipped laboratories. Clinical symptoms were characterized by a triad of fever, rash, and severe rheumatic manifestations. RT LAMP identified 20 additional Chikungunya virus-positive cases, compared with reverse-transcriptase polymerase chain reaction. Chikungunya virus was isolated from 20 randomly selected samples. Genotyping of the virus isolates revealed that the East Central South African genotype of Chikungunya virus was the etiologic agent of this epidemic. Molecular diagnosis is an important tool to identify such new vectorborne viral illnesses.

Persistent Chronic Inflammation and Infection by Chikungunya Arthritogenic Alphavirus in Spite of a Robust Host Immune Response

“…Paresthesia (numbness and tingling) in the skin covering affected joints has also been described, although the joints are often swollen there are usually no other signs of inflammation (11,12). The other symptoms include myalgia, headache, edema of the extremities, and gastrointestinal complaints (11)(12)(13). The incubation period for CHIKV ranges from 3 to 7 d, in agreement with data from other alphaviruses (14), and as few as 5% of asymptomatic CHIKVD cases were generally reported.…”

Rapid Identification of Chikungunya and Dengue Virus by a Real-Time Reverse Transcription-Loop-Mediated Isothermal Amplification Method

“…11,25 Emergence or reemergence of severe mosquito-borne viruses, such as CHIK virus and DEN virus, have been frequently reported worldwide and have caused a significant economic loss. 6,11 There have been a few adaptive mutations of CHIK virus or a shift in viral genotypes; its epidemiologic characteristics or host-specific barriers have changed to distribute into new geographic ranges. It is now considered a real threat to temperate areas, such as Europe and the Americas, that are colonized by Aedes spp.…”

“…The two kinds of infections have similar characteristics of geographical distribution and seasonal correlation, 10,11 because they share the same vectors of transmission, Aedes albopictus and Aedes aegypti mosquitoes. Some factors such as population migration and transportation could also promote the spread of the diseases.…”

Emerging Viral Diseases

“…Atypical dermatologic manifestations include bullous skin lesions (most often in children) and hyperpigmentation. 13 Cervical lymphadenopathy may occur in10-40% of patients, mostly in children or young adults. 14 Few patients may present or develop complications like severe sepsis or septic shock, meningoencephalitis, Guillian-Barre syndrome (GBS), myocarditis, decomposition of cardiovascular diseases, fulminant hepatitis in patients with chronic liver disease (CLD), pancreatitis, extensive epidermolysis, kidney failure, respiratory failure.…”