Clinical profile and long-term sequelae of Chikungunya fever

Abstract

Objectives 1. Primary objective: To study the clinical profile of acute Chikungunya fever. 2. Secondary objectives: To study the clinical profile of chronic sequelae and response of these patients to treatment. Methods One hundred and fifty adult patients who presented with a triad of fever arthralgia and rash during the period of June-December 2007 to the outpatient department of Medical College Calicut were considered for the study. They were followed up for 18 months or till symptoms subsided by direct examination as well as telephone interviews. There were no drop outs. Further follow-up of those in whom symptoms persisted was done, Exclusion of other rheumatologic disorders was done clinically and by relevant investigations Data was analyzed using SPSS statistical package. Results One hundred and thrity-four patients had typical clinical features of Chikungunya and 122 tested positive for IgM chik V capture ELISA. Hundred of them who were traceable were included in follow-up group with an age range of 20–60 years; 60% of them were females. A biphasic pattern was noted for the disease with first surge during July-September (60% of cases) and second surge during December (15% of cases). Fever was present in 96% Arthralgia was present in 100% of the patients and arthritis in 78%. Acute arthritis resolved within seven days in most of the patients. Ankle and small joints of hand were the joints most commonly affected. Ninty percent of the patients had symptoms beyond three months. In 14% of patients arthralgia persisted for 3–6 months, in 32% for 6–9 months, in 22% for 9–12 months, and in 22% for more than 1 year. Antimalarials were effective in decreasing the duration of disease; 5% of chronic Chikungunya arthritis evolved into rheumatoid arthritis. Conclusions In our study causes arthralgia was present in 100% of Chikungunya patients, arthritis in 78%, skin rash in 68%, and 22% had persistent symptoms. Antimalarials and short courses of steroids may be useful in a subset of them. Chikungunya arthritis evolved into rheumatoid arthritis in 5% of our patients.