Abstract
Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.
Highlights
Chronic fatiguing illnesses following well-documented infections and acute ‘infectious-like’ illnesses of uncertain cause have been reported for many decades [1]
Chikungunya virus (CHIKV) infection is clinically and virologically reminiscent of epidemic polyarthritis caused by the River virus (RRV) in Australia, or by Sindbis virus-related diseases in Scandinavia [13]
The hallmark of CHIKV infection relies on its ability to cause prolonged manifestations such as long-lasting incapacitating rheumatic musculoskeletal pain (LRMSP), mostly arthralgia or even arthritis that the experts define as post-chikungunya rheumatic disorder [14,15,16,17,18,19,20]
Summary
Chronic fatiguing illnesses following well-documented infections and acute ‘infectious-like’ illnesses of uncertain cause have been reported for many decades [1]. Ross River virus (RRV), an alphavirus belonging to the arthritogenic Semliki forest virus (SFV) serocomplex, can trigger a postinfective CFS [4]. CHIKV infection is clinically and virologically reminiscent of epidemic polyarthritis caused by the RRV in Australia, or by Sindbis virus-related diseases (referred as Pogosta, Ockelbo or Karelian fever) in Scandinavia (this latter alphavirus belongs to the Western Equine Encephalitis serocomplex) [13]. CHIKV can trigger or even reveal definitive inflammatory rheumatic diseases (IRD) [21,22,23]. Beyond this classical picture, CHIKV is associated with a broad spectrum of other early-onset
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