Post-chikungunya chronic arthralgia: Results from a retrospective follow-up study of 131 cases in Tolima, Colombia

Rodríguez‐Morales, Alfonso J.; Calvache-Benavides, Carlos Enrique; Gómez, Jennifer Giraldo; Hurtado-Hurtado, Natalia; Yepes-Echeverri, María Camila; García-Loaiza, Carlos Julian; Patiño-Barbosa, Andrés Mauricio; Sabogal-Roman, Juan Alejandro; Patiño-Valencia, Sarita; Hidalgo-Zambrano, Diana Meliza; Vásquez-Serna, Heriberto; Jiménez-Cañizales, Carlos Eduardo

doi:10.1016/j.tmaid.2015.09.001

Cited by 53 publications

(40 citation statements)

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“…Similarly high costs are well documented through India, where medical expenses are out-of-pocket and thus present a significant financial challenge to affected families [30–32]. In Tolima, Colombia, 44.3% of patients with laboratory-confirmed CHIKV infection continued to suffer from polyarthralgia 7 months after their initial diagnosis, indicating that New World CHIKV infection may also result in chronic joint symptoms [33]. Although our study includes potential sources of bias, most importantly an interview bias inherent to the retrospective nature of the medical chart review, the results provide useful preliminary data for evaluating the clinical phenotype of Asian CHIKV genotypes circulating in the Americas.…”

Section: Discussionmentioning

confidence: 99%

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

et al. 2016

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Since emerging in Saint Martin in 2013, chikungunya virus (CHIKV), an alphavirus transmitted by the Aedes aegypti mosquito, has infected approximately two million individuals in the Americas, with over 500,000 reported cases in the Dominican Republic (DR). CHIKV-infected patients typically present with a febrile syndrome including polyarthritis/polyarthralgia, and a macropapular rash, similar to those infected with dengue and Zika viruses, and malaria. Nevertheless, many Dominican cases are unconfirmed due to the unavailability and high cost of laboratory testing and the absence of specific treatment for CHIKV infection. To obtain a more accurate representation of chikungunya fever (CHIKF) clinical signs and symptoms, and confirm the viral lineage responsible for the DR CHIKV outbreak, we tested 194 serum samples for CHIKV RNA and IgM antibodies from patients seen in a hospital in La Romana, DR using quantitative RT-PCR and IgM capture ELISA, and performed retrospective chart reviews. RNA and antibodies were detected in 49% and 24.7% of participants, respectively. Sequencing revealed that the CHIKV strain responsible for the La Romana outbreak belonged to the Asian/American lineage and grouped phylogenetically with recent Mexican and Trinidadian isolates. Our study shows that, while CHIKV-infected individuals were infrequently diagnosed with CHIKF, uninfected patients were never falsely diagnosed with CHIKF. Participants testing positive for CHIKV RNA were more likely to present with arthralgia, although it was reported in just 20.0% of CHIKF+ individuals. High percentages of respiratory (19.6%) signs and symptoms, especially among children, were noted, though it was not possible to determine whether individuals infected with CHIKV were co-infected with other pathogens. These results suggest that CHIKV may have been underdiagnosed during this outbreak, and that CHIKF should be included in differential diagnoses of diverse undifferentiated febrile syndromes in the Americas.

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Section: Discussionmentioning

confidence: 99%

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

et al. 2016

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“…55,56 Nevertheless, the Colombian burden of CHIKF in terms of disability-adjusted life years and the cost of treatment should be estimated along with studies throughout the Americas to determine if the Asian CHIKV lineage differs from the IOL in virulence. [57][58][59][60] Infections in Colombia with CHIKV could also be influenced by the presence of other pathogens. The alphaviruses MAYV and CHIKV, closely related in the Semliki Forest complex, could cross-protect to some degree.…”

Section: Discussionmentioning

confidence: 99%

Genetic Characterization of Northwestern Colombian Chikungunya Virus Strains from the 2014–2015 Epidemic

Rodas

Kautz²,

Camacho

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Chikungunya fever, an acute and often chronic arthralgic disease caused by the mosquito-borne alphavirus, chikungunya virus (CHIKV), spread into the Americas in late 2013. Since then it has caused epidemics in nearly all New World countries, the second largest being Colombia with over 450,000 suspected cases beginning in September, 2014, and focused in Bolivar Department in the north. We examined 32 human sera from suspected cases, including diverse age groups and both genders, and sequenced the CHIKV envelope glycoprotein genes, known determinants of vector host range. As expected for Asian lineage CHIKV strains, these isolates lacked known Aedes albopictus-adaptive mutations. All the Colombian strains were closely related to those from the Virgin Islands, Saint Lucia, Mexico, Puerto Rico, and Brazil, consistent with a single, point-source introduction from the southeast Asia/Pacific region. Two substitutions in the E2 and E1 envelope glycoprotein genes were found in the Colombian strains, especially E1-K211E involving a residue shown previously to affect epistatically the penetrance of the E1-A226V A. albopictus-adaptive substitution. We also identified two amino acid substitutions unique to all American CHIKV sequences: E2-V368A and 6K-L20M. Only one codon, 6K-47, had a high nonsynonymous substitution rate suggesting positive selection.

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“…This was assessed via phone calls made by trained authors of this study. A structured questionnaire, previously employed in other studies 6, 7 was used (see Dataset 1, which includes all the variables assessed in these patients).…”

Section: Methodsmentioning

confidence: 99%

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

et al. 2016

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Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).

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Post-chikungunya chronic arthralgia: Results from a retrospective follow-up study of 131 cases in Tolima, Colombia

Cited by 53 publications

References 5 publications

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

Genetic Characterization of Northwestern Colombian Chikungunya Virus Strains from the 2014–2015 Epidemic

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

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