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

Abstract

Chikungunya virus is a re-emerging mosquito-borne alphavirus. Outbreaks are unpredictable and explosive in nature. Fever, arthralgia, and rash are common symptoms during the acute phase. Diagnostic tests are required to differentiate chikungunya virus from other co-circulating arboviruses, as symptoms can overlap, causing a dilemma for clinicians. Arthritis is observed during the sub-acute and chronic phases, which can flare up, resulting in increased morbidity that adversely affects activities of daily living. During the 2019 chikungunya epidemic in Thailand, cases surged in Bangkok in the last quarter of the year. Here, we demonstrate the chronic sequelae of post-chikungunya arthritis in one of our patients 1 year after the initial infection. An inflammatory process involving edema, erythema, and tenderness to palpation of her fingers' flexor surfaces was observed, with positive chikungunya IgG and negative IgM tests and antigen. The condition produced stiffness in the patient’s fingers and limited their range of motion, adversely affecting daily living activities. Resolution of symptoms was observed with a short course of an anti-inflammatory agent. More research is required to determine whether sanctuaries enable chikungunya virus to evade the host immune response and remain latent, flaring up months later and triggering an inflammatory response that causes post-chikungunya arthritis.

Clinical Features of Acute Chikungunya Virus Infection in Children and Adults during an Outbreak in the Maldives

“…The cutaneous involvement in CHIKV infection has been well described, and some rashes that occur in other conditions, such as hyperpigmentation, scar phenomenon, and erysipelas of the pinnae (Milians ear sign), have been reported in CHIKV infection. 13,45,46 Half of the cases in the present study developed rash, commonly a maculopapular rash, which was associated with pruritus, and one patient exhibited the Milians ear sign and scar phenomenon.…”

“…9 Arthralgia and arthritis are reportedly the most debilitating symptoms, which can occur in 87% of adults and in 30-50% of children. [10][11][12][13] Although individuals of all ages are susceptible to the virus, the arthritogenic manifestations of arthralgia are less prominent in children, whereas females appear to be at higher risk of developing incapacitating symptoms. 14 Severe forms of infection-associated neuro-invasive disease can occur in children, and other atypical manifestations or fatality can occur in individuals with underlying comorbidities.…”