Virological, Serological and Clinical Analysis of Chikungunya Virus Infection in Thai Patients
Yin May TunPrakaykaew CharunwatthanaChatnapa DuangdeeJantawan SatayarakSarocha SuthisawatOranit LikhitDivya LakhotiaNathamon KosoltanapiwatPassanesh SukphopetchKobporn Boonnak
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From 2018 to 2020, the Chikungunya virus (CHIKV) outbreak re-emerged in Thailand with a record of more than 10,000 cases up until the end of 2020. Here, we studied acute CHIKV-infected patients who had presented to the Bangkok Hospital for Tropical Diseases from 2019 to 2020 by assessing the relationship between viral load, clinical features, and serological profile. The results from our study showed that viral load was significantly high in patients with fever, headache, and arthritis. We also determined the neutralizing antibody titer in response to the viral load in patients, and our data support the evidence that an effective neutralizing antibody response against the virus is important for control of the viral load. Moreover, the phylogenetic analysis revealed that the CHIKV strains we studied belonged to the East, Central, and Southern African (ECSA) genotype, of the Indian ocean lineage (IOL), and possessed E1-K211E and E1-I317V mutations. Thus, this study provides insight for a better understanding of CHIKV pathogenesis in acute infection, along with the genomic diversity of the current CHIKV strains circulating in Thailand.The local public health authorities reported nine cases of chikungunya in Mexico in 2019, none of which occurred in Guerrero, a coastal state in the southwest. To test the hypothesis that chikungunya is grossly underreported in Mexico, acute sera were collected from 639 febrile patients from low-income households in Guerrero in 2019 and serologically assayed for chikungunya virus (CHIKV). Analysis of the sera by plaque reduction neutralization test revealed that 181 (28.3%) patients were seropositive for CHIKV. To identify patients with acute CHIKV infections, a subset of serum samples were tested for CHIKV-specific IgM by ELISA. Serum samples from 21 of 189 (11.1%) patients were positive. These patients met the chikungunya case definition established by the WHO. In conclusion, we provide evidence that CHIKV remains an important public health problem in Mexico and that the true number of cases is severely underestimated.
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A case of dengue virus and chikungunya viruse co-infection is reported here. The patient had fever, severe generalized bodyache, arthritis as well as drowsiness. Laboratory investigations showed dengue-chikungunya co-infection. The objective of our report is to emphasize the co-existence of dengue and chikungunya in a clinical case and to aware the clinicians about chikungunya and dengue co-infection.Birdem Med J 2018; 8(1): 72-74
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A serological study of coronaviruses with the OC 43 agent (HI-test) was undertaken in 1000 sera from the population of Hamburg. 32,7% of the sera showed HI=titers between 1 : 8 and 1 : 128. The geometric mean titer (GMT) for the whole group was 1 : 16. The frequency of seropositive reactions was highest in 244 individuals 15 to 24 years old (52,8% positive reactions, GMT 1 : 19) whilst in the older age groups (25-59 years and over 60 years old) the precentage of positive reactors was markedly lower (14,4% and 16,8%, respectively, GMT 1 : 12). Among 131 twelve to 17 years old youngsters, a seroconversion was demonstrated in paired sera in 6,8% with a 4- to 8-fold rise in HI-titer within 8 weeks.
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Chikungunya is a mosquito-borne viral disease caused by the chikungunya virus (CHIKV). CHIKV is expanding at an alarming rate, potentially spreading and establishing endemicity in new areas where competent vectors are present. The dramatic spread of CHIKV in recent years highlights the urgent need to take precautionary measures and investigate options for control. It is crucial in developing nations where diagnostic tools are limited, and symptoms are similar to other prevalent diseases such as malaria and dengue. The most reliable method for diagnosing chikungunya virus is viral gene detection by RT-PCR. Alternative methods like detecting human antibody and viral antigen can also be used, especially in areas where resources are limited. In this review, we summarize the limited data on antigen detection immunoassays. We further explain the essential structural elements of the virus to help comprehend the scientific concepts underlying the testing methods, as well as future methods and diagnostic approaches under investigation.
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In 2013, the first autochthonous cases of the chikungunya virus (CHIKV) were reported on the Caribbean island of Saint Martin. The chikungunya virus has since become endemic in the Caribbean due to autochthonous transmission. In the presence of fever and joint symptoms in any traveller returning from the Caribbean, CHIKV should be considered. Although symptoms resemble those of dengue fever, the course of chikungunya is milder. Chikungunya much more commonly causes chronic joint pain. Laboratory tests for the chikungunya virus may give false positive results due to cross reactions with closely related viruses, so taking a full disease and travel history from the patient is necessary in order to interpret these test results correctly. There is no specific treatment for the chikungunya virus. A correct diagnosis can prevent unnecessary additional tests and unjustified treatment. The chikungunya virus can be prevented by the use of insect-repelling substances, nets and air-conditioning.
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Arboviral diseases, such as chikungunya, dengue and now zika represent a public health problem, especially in tropical countries. Epidemiology of chikungunya and dengue is well known, including its social and climatic factors associated, but only few data and reports of chikungunya are available from North India. The clinical differentiation of chikungunya from dengue is no doubt challenging since both diseases can share clinical signs and symptoms leading to potential misdiagnosis of chikungunya in areas where dengue is endemic. The aim of this study was to know the seroprevalence, seasonal trends, clinical presentations of chikungunya and its co-infection with dengue virus.This was a prospective study conducted in Varanasi, from January to December 2016. All serum samples were tested for both chikungunya and dengue IgM antibodies by MAC ELISA test.Total of 186 samples, out of which 108 (58%) samples were total seropositive, 23 (12.37%) samples positive for chikungunya IgM antibodies, 57 (30.65%) samples positive for dengue and 28 (15.05%) samples positive for both chikungunya and dengue. The most affected age group was 20-30 years and males were more affected than females. A seasonal peak for chikungunya and its co-infection with dengue were seen in November.In India, the seroprevalence of chikungunya is increasing. India is a rapidly developing country where adequate sanitation is required. More aggressive intervention and vigilance by health authorities is needed to decrease vector born diseases.
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Chikungunya is a viral disease. This disease is caused by the chikungunya virus. This virus is transmitted through the bites of infected mosquitoes. The most significant symptoms of chikungunya virus infection are fever and joint pain, which are usually debilitating1. The duration for which pain occurs varies among individuals. Headache, muscle pain, nausea, rashes, and joint pain are some of the other symptoms associated with this viral infection1. These symptoms of chikungunya infection are similar to those of dengue and Zika infections; thus, these similar infections are frequently confused in areas where these diseases coexist. Chikungunya infection is rarely severe and does not result in death1. However, the current surge in chikungunya cases amid the spread of the dengue virus is alarming. In Paraguay, both diseases with similar patterns, dengue and chikungunya, are on the rise. An increasing number of both dengue and chikungunya cases was reported in 2022. So far, 1839 cases of dengue have been reported in 20222. The total number of cases of chikungunya was reported in 2022, although less than that of dengue, has reached 531 as of 1 December 20222. Paraguay is a landlocked country. It is situated in the center of South America. Paraguay is bordered by Brazil, Argentina, and Bolivia. The first reported case of chikungunya fever in Paraguay dates back to 2014. In 2014, all the reported cases were imported to Paraguay. The first outbreak of chikungunya in Paraguay occurred in 2015. A similar epidemic occurred in 2016 as well. The outbreak of chikungunya in Paraguay that occurred in 2017 was milder than that which occurred in 2016. This can be explained by improvements in vector control interventions after the previous outbreaks. Every year since its introduction into Paraguay, a seasonal outbreak of chikungunya has occurred until 2018. All these outbreaks were accompanied by a rising number of cases of dengue infections3. Thus, both of these diseases have been occurring at the same time. Paraguay has faced a big burden from coronavirus disease 2019 (COVID-19) infections, with the total number of reported cases being 778 000 and the total number of deaths being 19 6304. Currently, the incidence of chikungunya infections has been on the rise in Paraguay. This increase in the number of chikungunya infections should be investigated by screening programs and surveillance, but due to the current COVID-19 pandemic, all the efforts are to control COVID-19 infections. Moreover, the staff that was supposed to be appointed to provide healthcare facilities related to other public health issues is directed to control COVID-19 infections5. Moreover, there is a diversion of funds to control the COVID-19 pandemic. Previously, these funds were to be used to provide public healthcare facilities5. Thus, the COVID-19 pandemic has led to a lack of healthcare facilities by reducing the number of available healthcare staff and reducing the provision of medical facilities. Climate change plays an important role in the spread of chikungunya infections6. Since this disease is caused by a virus that is transmitted via the bite of an infected mosquito, climate change is very important for the growth of mosquitoes and the spread of the Chikungunya virus by these mosquitoes. Another factor responsible for the spread of chikungunya is the nonavailability of the vaccine against it6. Thus, all the above-mentioned factors are responsible for the increase in the number of chikungunya cases in Paraguay. Chikungunya viruses have had a significant negative impact in Paraguay, such as on public health and economic adversities7. Effective measures are therefore needed to manage existing cases and prevent further ones. One of the factors causing the increased spread of the Chikungunya virus in Paraguay is the lack of important details on the season of the illness and the genetic diversity of the spreading viral lineages7. Thus, there should be a proper study of the arbovirus. This is essential for supporting healthcare organizations with readiness because it provides important details about the periodicity of illnesses and variations of circulating viral lineages. Where resources allow, this monitoring can also include genome monitoring using portable sequencing technologies. It was effectively utilized to research the Chikungunya virus outbreaks in numerous Brazilian provinces8, the resurgence of yellow fever in Brazil9, and the Zika virus outbreak in the Americas10. Furthermore, immigrants should be tested for the Chikungunya virus before entering Paraguay to prevent them from spreading the virus to other uninfected people if they are infected. Also, there should be an adequate number of professionals and facilities for the proper testing of individuals. Preventative measures should be taken to curb the spread of the Chikungunya virus in Paraguay. There should be public enlightenment on the importance of protecting oneself from mosquito bites using efficient methods such as the use of insect repellants, wearing long-sleeved shirts and pants, treating clothes, using mosquito nets properly, and taking other steps to control mosquitoes indoors and outdoors10. Finally, further research should be done on chikungunya in Paraguay to develop better means of its management there. Ethical approval Not applicable. Sources of funding Not applicable. Author contribution A.N.: conceptualization and project administration; A.N., S.C.E., S.R.S., M.J.M., F.S., and A.N.: original manuscript writing; S.C.E.: second draft and writing – review, editing, and final draft. All authors were involved in the final approval of the manuscript. Conflicts of interest disclosure There were no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Name: Abubakar Nazir; Affiliation: Oli Health Magazine and Organization, Kigali, Rwanda; E-mail: [email protected]; ORCID ID: 0000-0002-6650-6982.
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"Doctor, I will never normally work and live again; joint pain prevents me that." This was expressed by a patient in La Virginia, Colombia, three years after having been infected with chikungunya virus (CHIKV). After more than five decades of obscurity, probably due to lack of studies, many clinical consequences of CHIKV began to be reported, particularly rheumatic ones, after the outbreaks in Réunion Island and India (Javelle et al., 2015Javelle E. Ribera A. Degasne I. Gauzere B.A. Marimoutou C. Simon F. Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006–2012.PLoS Negl Trop Dis. 2015; 9e0003603Crossref PubMed Scopus (139) Google Scholar) during the epidemic wave that crossed over the Indian Ocean in 2005–2010, and later with the emergence in the Americas since 2014. Through the first three weeks of disease, CHIKV can manifest intensely with fever, myalgia, rash and particularly polyarthralgia, polyarthritis or both. However, miscellaneous rheumatic manifestations can persist for months or even years (Javelle et al., 2015Javelle E. Ribera A. Degasne I. Gauzere B.A. Marimoutou C. Simon F. Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006–2012.PLoS Negl Trop Dis. 2015; 9e0003603Crossref PubMed Scopus (139) Google Scholar) for a variable and non-negligible part of the CHIKV-infected adults (Bouquillard et al., 2018Bouquillard E. Fianu A. Bangil M. Charlette N. Ribera A. Michault A. et al.Rheumatic manifestations associated with chikungunya virus infection: a study of 307 patients with 32-month follow-up (RHUMATOCHIK study).Joint Bone Spine. 2018; 85: 207-210Crossref PubMed Scopus (37) Google Scholar; Dupuis-Maguiraga et al., 2012Dupuis-Maguiraga L. Noret M. Brun S. Le Grand R. Gras G. Roques P. Chikungunya disease: infection-associated markers from the acute to the chronic phase of arbovirus-induced arthralgia.PLoS Negl Trop Dis. 2012; 6e1446Crossref PubMed Scopus (170) Google Scholar). Over the recent era of CHIKV clinical research, studies have reported that after three months of infection - the current time criteria to define chronic disease due to CHIKV infection- the prevalence of patients with such clinical persistence is ranging from less than 15% up to more than 90% (Dupuis-Maguiraga et al., 2012Dupuis-Maguiraga L. Noret M. Brun S. Le Grand R. Gras G. Roques P. Chikungunya disease: infection-associated markers from the acute to the chronic phase of arbovirus-induced arthralgia.PLoS Negl Trop Dis. 2012; 6e1446Crossref PubMed Scopus (170) Google Scholar; Rodriguez-Morales et al., 2015Rodriguez-Morales A.J. Cardona-Ospina J.A. Villamil-Gomez W. Paniz-Mondolfi A.E. How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?.Rheumatol Int. 2015; 35: 2091-2094Crossref PubMed Scopus (51) Google Scholar). Nevertheless, most of those studies only have followed-up patients until 32 months after infection (Bouquillard et al., 2018Bouquillard E. Fianu A. Bangil M. Charlette N. Ribera A. Michault A. et al.Rheumatic manifestations associated with chikungunya virus infection: a study of 307 patients with 32-month follow-up (RHUMATOCHIK study).Joint Bone Spine. 2018; 85: 207-210Crossref PubMed Scopus (37) Google Scholar; Rodriguez-Morales et al., 2016Rodriguez-Morales A.J. Cardona-Ospina J.A. Fernanda Urbano-Garzon S. Sebastian Hurtado-Zapata J. Prevalence of post-chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis.Arthritis Care Res (Hoboken). 2016; 68: 1849-1858Crossref PubMed Scopus (105) Google Scholar). In a study having compared CHIKV-infected and uninfected adults 6 years after disease onset in Reunion island, the infected group reported higher rheumatic morbidity (joint pain, stiffness, swelling) and surprisingly, a higher prevalence of headache, fatigue, depressive mood and social disabilities, a significant impairment of the quality of life and greater health care consumption (Marimoutou et al., 2015Marimoutou C. Ferraro J. Javelle E. Deparis X. Simon F. Chikungunya infection: self-reported rheumatic morbidity and impaired quality of life persist 6 years later.Clin Microbiol Infect. 2015; 21: 688-693Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar). While the majority of the patients with post-CHIK status suffer from cumulative mechanical musculoskeletal disorders, a low percentage of people develop a de novo chronic inflammatory rheumatism such as rheumatoid arthritis that should be treated according to the appropriate guidelines (Javelle et al., 2015Javelle E. Ribera A. Degasne I. Gauzere B.A. Marimoutou C. Simon F. Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006–2012.PLoS Negl Trop Dis. 2015; 9e0003603Crossref PubMed Scopus (139) Google Scholar). Most studies converge to conclude that the long-term clinical impact of CHIKV occurs in not less than 14% of the initially infected patients (Dupuis-Maguiraga et al., 2012Dupuis-Maguiraga L. Noret M. Brun S. Le Grand R. Gras G. Roques P. Chikungunya disease: infection-associated markers from the acute to the chronic phase of arbovirus-induced arthralgia.PLoS Negl Trop Dis. 2012; 6e1446Crossref PubMed Scopus (170) Google Scholar; Rodriguez-Morales et al., 2015Rodriguez-Morales A.J. Cardona-Ospina J.A. Villamil-Gomez W. Paniz-Mondolfi A.E. How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?.Rheumatol Int. 2015; 35: 2091-2094Crossref PubMed Scopus (51) Google Scholar). However, the mechanisms and predicting factors for the development of post-CHIKV chronic disorders remain to be better identified. Studies like the one published by Murillo-Zamora et al. in the current issue of IJID should be stimulated. Such clinical scores or index that could early predict the outcome toward post-CHIKV chronic disorders (Murillo-Zamora et al., 2019Murillo-Zamora E. Cano O.M. Trujillo-Hernandez B. Guzman-Esquivel J. Lugo-Radillo A. Higareda-Almaraz M.A. et al.Development of a concise clinical index for predicting chronic chikungunya arthritis.Int J Infect Dis. 2019; Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar) would be useful to sort out the patients and identify those who should benefit from a specific clinical management to mitigate an unfavorable evolution and its long-term burden in daily life. The score proposed by Murillo-Zamora et al. (CCAS-4) showed high sensitivity and specificity to predict the persistence of chronic chikungunya arthralgia at 12 months after acute disease. Nevertheless, retrospective validation of such scores on different cohorts and on uninfected populations are necessary to improve these tools. Unfortunately, numerous questions remain unanswered for patients, physicians, and researchers to date. What processes induce the lasting consequences: host autoimmunity, the possible presence of the virus or its antigens at the synovial cavity promoting local inflammation, cytokines disorders? How to detect early the patients who are developing a chronic and potentially destructive inflammatory rheumatism? For how long will the post-CHIKV chronic clinical disorders persist? Would any early or very early treatment significantly benefit patients, and even avoid the progression to chronic disease? Which should be the most appropriate treatment to manage these patients specifically? How much is CHIKV emergence weighing the global burden of rheumatic diseases? Such points are still to be answered (McHugh, 2018McHugh J. Acute inflammatory arthritis: long-term effects of chikungunya.Nat Rev Rheumatol. 2018; 14: 62Crossref PubMed Scopus (3) Google Scholar), necessary to fully understand basic and clinical aspects of the viral pathogenesis and the chronic consequences of CHIKV. There is a real need to standardize the nosological frame of the cases and the clinical endpoints in the studies to improve the treatment strategy of these long-lasting persisting symptoms. To date, there is no magic bullet and the treatment must be personalized and based upon good clinical assessment, control of the pain and inflammation, physiotherapy and self-rehabilitation, and identification of the rare cases that should be treated specifically by disease-modifying antirheumatic drugs (Simon and Demoux, 2018Simon F. Demoux A.L. Chikungunya in U.S. travelers: a double challenge.Am J Trop Med Hyg. 2018; 99: 239Crossref PubMed Scopus (1) Google Scholar). There is still a long way until all patients with a post-CHIK disorder benefit from optimal, efficient and not deleterious, evidence-based treatment. Given the current trends of international human flows, the general practitioners, rheumatologists and specialists on infectious diseases should all be aware of the worldwide multifocal emergence of CHIKV and its related challenges in individual and public health. Still more, it is not unlikely to expect in a non-distant future, new epidemics of CHIKV in tropical and subtropical areas of the world, which again lead to acute but also chronic consequences for significant proportions of affected populations. None. Both authors declare having served as consultants for Sanofi-Aventis R&D and Fabrice Simon serves as consultant for Valneva. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. AJRM conceived the idea of the Editorial and perform a review of the literature on the topic related; all authors read the study that is being editorialized; AJRM developed the first draft of the manuscript; all authors contributed consequently with newer versions; all authors approved the final submitted version. None.
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Since its first isolation in Calcutta, in 1963, there have been many reports about epidemis of chikungunya virus infection in different parts of India. Calcutta experienced a concurrent epidemic of dengue and chikungunya between 1963 and 1965. But after that there is no report about any chikungunya infection in Calcutta. During routine investigations it is found that chikungunya antibody is on the wane. The present survey for chikungunya antibody showed only 4.37% (n = 17) seropositivity out of 389 sera tested. The highest (12.5%) seropositivity was observed in the age group of 51-55 years and no chikungunya antibody was detected in young and young adults. The findings suggest that chikungunya virus is disappearing from the Calcutta population.
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