Abstract
BackgroundChikungunya virus (CHIKV) is responsible for acute febrile polyarthralgia and, in a proportion of cases, severe complications including chronic arthritis. CHIKV has spread recently in East Africa, South-West Indian Ocean, South-Asia and autochthonous cases have been reported in Europe. Although almost all patients are outpatients, medical investigations mainly focused on hospitalised patients.Methodology/Principal FindingsHere, we detail clinico-biological characteristics of Chikungunya (CHIK) outpatients in Reunion Island (2006). 76 outpatients with febrile arthralgia diagnosed within less than 48 hours were included by general practitioners during the CuraChik clinical trial. CHIK was confirmed in 54 patients and excluded in 22. A detailed clinical and biological follow-up was organised, that included analysis of viral intrahost diversity and telephone survey until day 300. The evolution of acute CHIK included 2 stages: the ‘viral stage’ (day 1–day 4) was associated with rapid decrease of viraemia and improvement of clinical presentation; the ‘convalescent stage’ (day 5–day 14) was associated with no detectable viraemia but a slower clinical improvement. Women and elderly had a significantly higher number of arthralgia at inclusion and at day 300. Based on the study clinico-biological dataset, scores for CHIK diagnosis in patients with recent febrile acute polyarthralgia were elaborated using arthralgia on hands and wrists, a minor or absent myalgia and the presence of lymphopenia (<1G/L) as major orientation criteria. Finally, we observed that CHIKV intra-host genetic diversity increased over time and that a higher viral amino-acid complexity at the acute stage was associated with increased number of arthralgia and intensity of sequelae at day 300.Conclusions/SignificanceThis study provided a detailed picture of clinico-biological CHIK evolution at the acute phase of the disease, allowed the elaboration of scores to assist CHIK diagnosis and investigated for the first time the impact of viral intra-host genetic diversity on the disease course.
Highlights
Chikungunya virus (CHIKV) is an arbovirus, transmitted by the bite of infected mosquitoes (Aedes aegypti = Stegomya aegypti and Aedes albopictus = Stegomya albopicta), that causes Chikungunya fever (CHIK), an acute febrile illness characterized by severe and often debilitating arthralgia [1]
The mosquito-transmitted chikungunya virus is responsible for acute febrile polyarthralgia and, in a proportion of cases, complications including chronic arthritis
Woman and elderly patients were found at risk for more symptomatic forms of the disease at both the acute and late stages and we observed that the viral intra-host genetic diversity increased over time and that a higher viral amino-acid complexity at the acute stage was associated with more symptomatic illness at the late stage of the disease
Summary
Chikungunya virus (CHIKV) is an arbovirus (genus Alphavirus, family Togaviridae), transmitted by the bite of infected mosquitoes (Aedes aegypti = Stegomya aegypti and Aedes albopictus = Stegomya albopicta), that causes Chikungunya fever (CHIK), an acute febrile illness characterized by severe and often debilitating arthralgia [1]. Since 2005, CHIK outbreaks of unprecedented magnitude have occurred in South-Asia and the Indian Ocean islands, including Reunion Island with an estimated 266,000 cases, accounting for roughly one third of the population [5]. Chikungunya virus (CHIKV) is responsible for acute febrile polyarthralgia and, in a proportion of cases, severe complications including chronic arthritis. CHIKV has spread recently in East Africa, South-West Indian Ocean, South-Asia and autochthonous cases have been reported in Europe. Almost all patients are outpatients, medical investigations mainly focused on hospitalised patients
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