Abstract
.From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30–50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.
Highlights
Chikungunya fever is a viral illness caused by a singlestranded RNA virus belonging to the Alphavirus family.[1]
Male preponderance was higher than the findings from the same countries except for Colombia
The similar male predominance was found in Singapore.[23]. This is probably because males usually get involved with more outdoor activities compared with females in developing countries such as Bangladesh, Sri Lanka, India, and others.[24]
Summary
Chikungunya fever is a viral illness caused by a singlestranded RNA virus belonging to the Alphavirus family.[1] The virus is transmitted between humans through the bites of infected female, Aedes mosquitoes.[2] The first documented case of chikungunya virus (CHIKV) infection in humans was in 1952–1953 at Tanganyika, East Africa, and the first outbreak occurred in Bangkok, Thailand, in 1958.3,4 It was followed by a decade-long epidemic in India from 1963 to 1973 and the largest documented outbreak from 2004 to 2007 in the Indian Ocean islands.[5,6] In December 2008, the first chikungunya outbreak was confirmed in the Rajshahi and Chapai Nawabganj districts of Bangladesh.[7] In 2011, another outbreak occurred in the Dohar subdistrict of Dhaka where several hundred patients were exposed.[7] Since it has been determined to be a potential cause of acute febrile illness in adults in Bangladesh based on anecdote and case reports.[7,8,9,10,11,12] The classical clinical manifestation of chikungunya fever is high-grade fever, maculopapular rash, and joint pain or arthralgia.[13] The patient can experience varied rheumatological manifestations mainly chronic and disabling arthritis of varying joints.[1,14] Other systemic manifestations such as gastrointestinal (diarrhea, vomiting, and abdominal pain), ocular (conjunctivitis, optic neuritis, iridocyclitis, episcleritis, retinitis, and uveitis), and neurological involvement (encephalitis, myelitis, Guillain-Barre syndrome [GBS], and others) can occur.[10,15,16,17]
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