Chikungunya IgM Research Articles

Prevalence of Chikungunya Virus IgG and IgM Antibodies among Febrile Patients Presumptively Diagnosed with Malaria in Ogun State, Nigeria

Prevalence of Chikungunya Virus IgG and IgM Antibodies among Febrile Patients Presumptively Diagnosed with Malaria in Ogun State, Nigeria

Comparison of rapid dengue NS1, qualitative ELISA, and quantitative ELISA result

Background: Non-structural glycoprotein-1 (NS1) is a useful biomarker for early diagnosis of dengue fever. NS-1 antigen ELISA can be used for the early diagnosis of dengue fever in the acute stage. Quantitative methods are better for epidemic settings due to high false negative rates in qualitative ELISA. Methods: The study was initiated after approval from the institutional ethics council (IEC/DISS/17118). Study examined 280 patients with dengue symptoms who presented to the hospital's OPDs and IPDs. Patients were tested using qualitative ELISA, and those with Leptospira antibody, malaria, or Chikungunya IgM antibody were excluded. Age, gender, symptoms, comorbidities, total leucocyte count, platelet count, and risk category were all patient-related parameters. Patient-related parameters were recorded, and data was collected using Microsoft excel and analysed statistically. Results: Most patients aged 2-40 with male predominance had fever, chills, and body aches, 243 (86.8%) tested positive for ELISA NS1. Quantitative ELISA test showed a statistically significant correlation with rapid antigen NS1 result (p=0.015). Its AUC was 0.883 (p=0.0001), and its cut-off was (>109.1) with 96.9% sensitivity and 13.64% specificity. The AUC of quantitative ELISA NS1 against qualitative ELISA NS1 was 0.853 which was statistically significant (p<0.0001). At the cut-off >74.34, the test's sensitivity was 92.59% and specificity was 75.68%. Conclusions: Qualitative ELISA NS1 test is better than rapid antigen test for screening due to its higher specificity and similar sensitivity.

Seroprevalence of Dengue, Chikungunya, and Zika viruses antibodies in a cohort of asymptomatic pregnant women in a low-income region of Minas Gerais, Brazil, 2018-2019.

Dengue, Chikungunya, and Zika viruses are arthropod-borne viruses (arboviruses) that infect millions of individuals in tropical and subtropical regions. In the Americas, arboviruses represent a major public health problem, especially among vulnerable groups such as the elderly, children, and pregnant women. In this study, the seroprevalence of IgM or IgG against these arboviruses in pregnant, young women in the city of Diamantina, Minas Gerais, Brazil, and the influence of sociodemographic factors on the incidence/prevalence of infection in this group were investigated. A cross-sectional investigation was conducted on a total of 135 pregnant women for Dengue and Chikungunya IgM and 88 pregnant women for Zika IgG. Dengue IgM was found on the serum of twenty participants (14.8%) and only one woman (0.7%) tested positive for Chikungunya IgM. Zika IgG was found in three (3.4%) participants and 2 women who tested positive for Zika virus were also positive for Dengue virus IgM. Although the arboviruses seroprevalence was higher frequency among young (20-25years old), brown and high school women, with a monthly income of 1-3 minimum wages, no association between these sociodemographic factors and arboviruses seroprevalence was found.

CHIKUNGUNYA, SCRUB TYPHUS MONO, AND CO-INFECTION AMONG PATIENTS WITH UNDIFFERENTIATED FEBRILE ILLNESS: A HOSPITAL-BASED STUDY

Objectives: Chikungunya virus is a common arthropod-related acute febrile disease and it is transmitted by Aedes aegypti or Aedes albopictus species. On the other hand, the bacterium Orientia tsutsugamushi causes scrub typhus, which is also an acute febrile illness with multiple organ involvement. Coinfection of chikungunya and scrub typhus may lead to severe manifestation including severe respiratory and central nervous system (CNS) complications. Coinfection of chikungunya and scrub typhus may lead to severe manifestation including severe respiratory and CNS complications. Therefore, the proper diagnosis can prevent the clinical complications. The aim and objective of our study is to find the seroprevalence of chikungunya and scrub typhus and coinfection of both through medical assessment and serological research of these patients presented with acute febrile infection at Diamond Harbour Government Medical College and Hospital. Methods: A prospective study was conducted from August 2022 to January 2023 at VRDL, Department of Microbiology, Diamond Harbour Government Medical College and Hospital. Serum was collected for IgM antibody enzyme-linked immunosorbent assay (ELISA) for scrub typhus (In bios kit) and Chikungunya (NIV Chikungunya IgM Capture ELISA Kit) test. Four hundred and eighty-seven samples were tested for IgM antibody by chikungunya and scrub typhus ELISA kit. Result: The present study demonstrated that, from the month of August 2022 to January 2023, 67% of chikungunya cases, 25% cases with only scrub typhus, and 8% cases with both chikungunya and scrub typhus presented positive. A present study shows that chikungunya is slightly more prevalent in males as compared to females, where scrub typhus is equally positive in both male and female patients. Conclusion: Laboratory testing of both of the diseases can prevent the complication of other suspected disease in coinfected patients.

Facility-Based Cross-Sectional Survey on Aedes-Borne Diseases and Associated Symptoms among Febrile Patients During the 2019 Dengue Outbreak in Moshi Rural District, Tanzania

Background: Diseases caused by Aedes-borne viruses, such as; dengue, chikungunya, and Zika are emerging and re- emerging in different parts of the world. Tanzania has experienced several dengue outbreaks since 2010. The present study aims to determine the seroprevalence and associated symptoms of dengue and chikungunya fever in the Moshi rural district during the 2019 dengue outbreak. Methodology: A facility-based cross-sectional survey was conducted in 15 health facilities in the Moshi Rural district. A total of 397 participants with malaria-like symptoms were enrolled. Participants were screened for seropositivity towards dengue and chikungunya Immunoglobulin G and M (IgG and IgM) using ELISA-based kits. Results: Out of 397 participants, 28 (7.1 %) and 8 (2.0%) were dengue IgM and IgG positive respectively. Chikungunya IgM positives were 34 (8.6%). The most commonly reported symptoms were; headache 189 (27.7%), joint pains 132 (19.4%) and muscle pain 106 (15.5%). Factors such as being a farmer and history of travelling to outside regions was associated with dengue IgM seropositivity (p<.05). Conclusion: Aedes-borne illnesses appear to be endemic in the area, with IgG antibodies against the Chikungunya virus being more prevalent among study participants. These results provide an understanding of arboviral diseases as well as provide an early warning signal on the risk of transmission in north Tanzania. The results inform the allocation of local and national public health intervention to prevent future outbreaks.

Prevalence of Chikungunya and Scrub Typhus Coinfection among Dengue Negative Patients in Kolkata, India-A Newly Emerging Public Health Hazard

The chikungunya virus (CHIKV) and scrub typhus infection has scattered worldwide creating human health hazards in India and Asia specific region. We aimed to identify chikungunya, scrub typhus, and their co-infection in dengue-negative samples having undifferentiated febrile illnesses. Enzyme linked immunosorbent assay (ELISA) methods were used to detect the chikungunya and scrub typhus specific IgM antibody by using chikungunya IgM capture ELISA kit and scrub typhus IgM Microlisa ELISA kit, respectively. OD value was measured with the help of BeneSphera (India) ELISA microplate reader. Among 490 suspected patients, 57 (11.63%) samples were tested positive for chikungunya IgM antibodies, while 43 (8.77%) came positive for scrub typhus IgM antibodies, but all samples tested negative for dengue IgM antibodies. Additionally, 5% of the total positive cases were positive for both chikungunya and scrub typhus infection. Our study offers a hypothesis regarding one of the possible causes of the decline in the frequency of scrub typhus and chikungunya cases reported in Kolkata and other districts of West Bengal. As an outcome, physicians treating undifferentiated febrile patients in endemic locations should look for chikungunya, scrub typhus, and existing coinfection between them to avoid delayed diagnosis and provide proper treatment against these infections.

CO-INFECTION OF DENGUE AND CHIKUNGUNYA VIRUSES: A SEROLOGICAL STUDY IN A TERTIARY CARE HOSPITAL IN WARANGAL, TELANGANA, INDIA

Background: All around India, Dengue and Сhikungunya (CHIK) diseases seem to be rising. Aedes aegypti mosquitoes frequently transmit the CHIK virus and Dengue virus (DENV). Both viruses can spread together in regions where they cocirculate. Objectives: The objective of the current investigation is to determine the seroprevalence of coinfection with Dengue and Сhikungunya. Methods: The present study was conducted at the Virus Research and Diagnostic Laboratory, Kakatiya Medical College, Warangal, Telangana, India, from January to December 2022. The district health authority and the admitted cases provided the samples. The patients had symptoms typical of CHIK and DEN infections, including high fever (>39°C), chills, rashes, joint pain, joint swelling, nausea, and headache, myalgia, and pain behind the eyes. Results: Between January 2022 and December 2022, a total of 4892, 3344, and 2103 hospitalised patients underwent serological testing for the Dengue virus (DENV), the Сhikungunya virus (CHIKV), and both Dengue and Сhikungunya virus for co-infection, respectively. IgM Capture ELISA was used for all tests. 153 (7.8%) of the cases had both Dengue virus (DENV) and Сhikungunya virus IgM positivity. (CHIKV). Dengue virus (DENV) monoinfection, or 703 (14.3%), denotes the presence of Dengue virus. 313 (9.3%) individuals tested positive for the Сhikungunya virus, or mono-infected with the virus (CHIKV). Chikungunya IgM, Dengue IgM, and Co-infection Conclusion: Dengue and Chikungunya virus co-infections are clinically more serious than a single infection. However, in endemic regions, particularly during the monsoon season, clinically suspected cases should be tested for both viruses. To determine the severity and clinical result of co-infection, more thorough investigations are needed to analyse the pathophysiology and complications of co-infection.

Assessment of Dengue and Chikungunya Infections among Febrile Patients Visiting Four Healthcare Centres in Yaoundé and Dizangué, Cameroon.

Dengue and chikungunya are now widely distributed in Cameroon, but there is still not enough information on their prevalence in different epidemiological settings. This study was undertaken to assess the prevalence of dengue and chikungunya in both urban and rural settings in Cameroon using three diagnostic tools. From December 2019 to September 2021, willing febrile (temperature >38 °C) outpatients visiting four healthcare facilities in the cities of Yaoundé and Dizangué were screened for dengue, and chikungunya. Clinical features of patient were recorded in a form, and their blood samples were analysed using real-time reverse transcriptase-polymerase chain reaction (rtRT-PCR), rapid diagnostic tests (RDTs) and enzyme-linked immuno-sorbent assays (ELISA). Odds ratios were used to determine the level of association between socio-demographic factors, clinical features, and infection status. The Kappa coefficient permitted to assess the level of agreement between RDTs and ELISA. Overall, 301 febrile patients were recruited in the study: 198 in Yaoundé and 103 in Dizangué. The prevalence of infection varied with the diagnostic tool used. For dengue diagnostics, 110 patients were positive to rtRT-PCR: 90 (45.45%) in Yaoundé, and 20 (19.42%) in Dizangué. The prevalence of dengue IgM using ELISA varied from 22.3% in Dizangué to 30.8% in Yaoundé. Dengue IgM rate using RDTs was 7.6% in Yaoundé and 3.9% in Dizangué. For chikungunya, one (0.5%) patient (Yaoundé, suburb) was positive to rtRT-PCR. The prevalence of chikungunya IgM according to ELISA varied from 18.4% in Dizangué to 21.7% in Yaoundé, while it was 4.5% in Yaoundé and 12.6% in Dizangué with RDTs. Only abdominal and retro-orbital pains were significantly associated with acute dengue infection. All four dengue serotypes were recorded, with a predominance of DENV-3 (35.45%) and DENV-4 (25.45%). Rapid Diagnostic Tests for either chikungunya or dengue displayed very poor sensitivity. This study further confirms the high endemicity of both dengue and chikungunya in Yaoundé and Dizangué. These data stress the need for active surveillance and the implementation of vector control measures to prevent the occurrence of outbreaks across the country.

Potential impact of SARS COV-2 infection on the performance of serological assays used to diagnose arboviral diseases

BackgroundThe COVID-19 pandemic caused by SARS-CoV-2 was first described in December 2019, in China. In addition, there has also been an increase in arboviral infections in recent years. As both infections have similar symptoms, misdiagnosis may occur if both outbreaks occur at the same time. ObjectiveOur objective was to assess the potential impact of SARS-CoV-2 infection on diagnostic assays used for arboviral diseases. Materials and methodsWe conducted this study by testing samples obtained during the precovid phase (before November 2019) and during the covid period (after February 2020). Samples were further grouped as those with acute febrile illness (AFI) and those without. All samples were tested for anti SARS-CoV-2 Ab, Chikungunya and Dengue specific IgM antibodies to evaluate potential serological cross-reactions between COVID-19 and Arbovirus specific antibodies. ResultsOne sample from the 62 cases of AFI during the pre-covid phase showed seropositivity for SARS-CoV-2 antibodies. Also, in asymptomatic individuals, arboviral seropositivity was significantly higher in the COVID period samples (22%) compared to pre-COVID samples (3%). ConclusionDue to similar clinical symptoms and cross reactions in both infections, relying solely on serological testing for arboviral diagnosis may be less sensitive; other clinical and laboratory parameters may be required.

Seroprevalence of Chikungunya Virus Infection in an Urban Slum Population of Bangladesh: A Cross-Sectional Study

Background: Chikungunya virus is common in Bangladesh. Objective: The aim of the study was to estimate the post-outbreak seroprevalence of chikungunya virus infection in a Bangladeshi urban slum population. Methodology: From April to May 2018, a cross-sectional study was conducted in Bauniabadh, an underprivileged slum area in Mirpur Thana (subdistrict), Dhaka, Bangladesh. Randomly selected residents of this area were interviewed and screened for chikungunya IgM and IgG antibodies in sera using the immunochromatographic process. Results: Randomly selected 403 residents were recruited of which 200 cases were male and 203 cases were female. Chikungunya seroprevalence was 4.7% cases with males being more vulnerable than females (6.5% vs. 3.0% ). People over the age of 60 years were found to be infected at a higher rate (7.2%) than people between the ages of 18 and 59 years (5.5%) and those in the pediatric age group (1%). During the outbreak, 22% of patients with joint pain and 17% with fever were diagnosed as having chikungunya. Conclusion Urban slum people, especially the elderly, are affected by chikungunya outbreak in Bangladesh characterized by fever and joint pain. Journal of Current and Advance Medical Research, January 2022;9(1):3-8

Emerging co-infections in dengue

Background: Infection with two agents might cause overlapping symptoms, confusing the treating physician. This study aims to determine the current coinfections rates in dengue patients in a tertiary care Govt. General Hospital, Anathapuramu. Method: From July 2021 to November 2021, an observational study was conducted at the Government Medical College & Hospital in Ananthapuramu. A total of 100 clinically suspected Dengue patients were included in this research. Blood samples from 100 patients who visited the General Medicine and Pediatrics OPD were taken and sent to the lab for the diagnosis of Dengue and other co-infections. Result: In our study, Out of 100 samples, 32 samples tested positive for Dengue by RTPCR. Out of 32 samples tested positive by RTPCR, two samples were positive for DENV-1, 26 samples were positive for DENV-2, and four samples were positive for DENV-3, according to RTPCR results. Dengue with co-infection was detected in 21 individuals, with 1 (3.125%) being MP-ICT positive, 2 (6.25%) being salmonella WIDAL positive, 1 (3.125%) being Scrub typhus IgM reactive, 4 (12.5%) being chikungunya IgM positive, 9 (28.125%) being UTI positive, and 4 (12.5%) having Blood Stream Infections.

Congenital chikungunya infection

Chikungunya is an arboviral disease transmitted by Aedes species mosquito. As per systematic reviews, vertical transmission is seen in upto 50 % cases. Congenital infection in neonates present with predominant central nervous system involvement, characteristic cutaneous hyperpigmentation and thrombocytopenia. We are presenting here two cases. First baby presented with fever and hyperpigmentation while other neonate had encephalopathy followed by facial hyperpigmentation. Maternal chikungunya IgM antibody titres were positive and baby’s blood RT-PCR for chikungunya virus were also positive in both the cases .A strong clinical suspicion should be kept when a newborn presents with features of encephalopathy, perioral hyperpigmentation, especially in endemic areas, where mother is suffering from viral fever with or without rash in the peripartum period.

Evidence of chikungunya virus infections among febrile patients at three secondary health facilities in the Ashanti and the Bono Regions of Ghana.

BackgroundChikungunya is now of public health concern globally due to its re-emergence in endemic areas and introduction into new areas of the world. Worldwide, the vectors for transmission of the chikungunya virus are Aedes mosquitoes and these are prevalent in Ghana. Despite its global significance, the true burden of chikungunya virus infection in Ghana is largely unknown and the threat of outbreak remains high owing to international travel. This study sought to determine chikungunya virus infection among febrile patients suspected of having malaria infections at some selected health facilities in the Ashanti, Bono East, and Bono Regions of Ghana.MethodologyThis cross-sectional study recruited six hundred (600) febrile patients suspected of having malaria who submitted their clinical samples to the laboratories of the selected health facilities for the diagnosis of their infections. Five to ten millilitres (5-10ml) of venous blood were collected from each study participant. Sera were separated and tested for anti-chikungunya (IgM and IgG) antibodies using InBios ELISA kit following the manufacturer’s instruction. Samples positive for chikungunya IgM and IgG were selected and tested for chikungunya virus RNA using Reverse Transcription-quantitative Polymerase Chain Reaction. Malaria Rapid Diagnostic Test kits were used to screen the participants for malaria. Structured questionnaires were administered to obtain demographic and clinical information of the study participants.ResultOf the 600 samples tested, the overall seroprevalence of chikungunya was 6%. The seroprevalence of chikungunya IgM and IgG antibodies were 1.8% and 4.2% respectively. None of the chikungunya IgM and IgG positive samples tested positive for chikungunya RNA by RT-qPCR. Of the 600 samples, tested 32.3% (194/600) were positive for malaria parasites. Malaria and chikungunya co-infection was detected in 1.8% (11/600) of the participants.ConclusionFindings from the current study indicate low-level exposure to the chikungunya virus suggesting the virus is circulating and potentially causing morbidity in Ghana.

Prevalence and trend of emerging and re-emerging arboviral infections in the state of Odisha

Newly emerging or re-emerging infections are posing continuous threat to both public health system and clinical care globally. The emergence of infections especially caused by arboviruses can be linked to several mechanisms which include geographical expansion linked to human development and transportation, global warming, enhanced transmission in peridomestic area and close proximity of human habitations to domestic as well as wild animals. The co-circulation of Dengue, Chikungunya and Zika is a matter of public health priority due to the fact that they are transmitted by the same vector as well as increase in the number of reported cases of severe dengue, post-chikungunya chronic joint disease and microcephaly related to Zika virus disease. The study was designed to estimate the prevalence of these arboviral infections in Odisha. About 5198 cases presenting with common clinical symptoms of fever, arthralgia, headache, myalgia and malaise were screened during 2016–2019. A total of 42.2% patients tested positive for dengue NS1 antigen (n = 4154), 30.2% for dengue IgM (n = 2161) and 14.3% for chikungunya IgM (n = 1816). A total of 1684 samples were subjected to Zika RT-PCR and none was tested positive. Peak in the numbers of dengue/ chikungunya cases was evident in the post-monsoon months of July – October. Circulation of all four serotypes of dengue i.e. DEN 1, 2, 3, and 4 was noticed in the state. Molecular investigation of suspected Chik cases in early phases showed circulation of Eastern Central Southern African genotype (E1:226A). There is dearth of knowledge about disease severity during arbovirus co-infections and importance of adequate management of patients at an early stage residing in risk areas. It is the first study in Odisha to study the pattern and status of these three arboviral diseases Dengue, Chikungunya and Zika. The outcome of this study will help in focusing and improvement of existing surveillance systems and vector control tools, as well as on the development of suitable antiviral agents and formulating candidate vaccine.

COMPARISON OF STEROIDS TO NSAIDS, AND OTHER FORMS OF ANALGESIA IN THE MANAGEMENT OF POST-CHIKUNGUNYA ARTHRITIS

Objective: To compare steroids with other treatment options like NSAIDS and other analgesics for management of postchikungunya arthritis based on visual analogue scale (VAS).
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Department of Rheumatology, Liaquat National Hospital, Karachi, from Jan to Jul 2018.
 Methodology: A total of 112 patients were included in this study, of both genders. Patients with history of fever >38.5°C and polyarthralgia who had positive chikungunya IgM serology or PCR were included in this study. Patients fulfilling inclusion criteria and who were treatment naïve were given NSAIDs or other analgesics if contraindication to NSAIDs was present. Those who had received 2 weeks of NSAIDs were given a single dose of intramuscular steroids. Response to treatment was characterized by clinical examination according to visual analogue scale (VAS) taken at baseline, 2 weeks and 4 weeks. All analyses will be conducted by using SPSS-20.
 Results: Overall, 66 (58.9%) received steroids, 37 (33%) patients were given NSAIDs, and other forms of analgesics were prescribed to 9 (8%) patients. In nearly half of the patients, i.e. 57 (50.89%) partial response was seen, 13 (11.6%) showed complete response, while 42 (37.5%) had persistent arthralgia, which was statistically significant p-value <0.001.
 Conclusion: This study shows that improvement in symptoms is seen with a single dose of intra-muscular steroid and it helped bring down the VAS score.

Etiological Trends and Epidemiological Profile of Tropical Fever in Children Presenting with Acute Undifferentiated Fever at a Tertiary Care Centre in North India


 
 
 
 Introduction: The objective of this study was to determine the etiology of acute undifferentiated fevers (AUF) in hospitalised children with in a tertiary care centre in North India. The various causes of acute undifferentiated fevers included dengue, malaria, scrub typhus, enteric fever, leptospirosis and Chikungunya. The clinical spectrum and therapeutic outcome of these cases was also studied.
 Methods: This retrospective study was conducted over a period of 6 months from June 2019 to December 2019. The clinical information of 126 children who tested positive for any of the causes of AUF namely dengue, malaria, scrub typhus, enteric fever, chikungunya and leptospirosis was obtained from the Paediatrics Department. The information was recorded in a predesigned proforma. Various tests performed for the diagnosis of these illnesses were noted. They included dengue NS1 antigen ELISA and IgM ELISA, peripheral blood smear (PBS) for malarial parasite and rapid malarial antigen detection test (RMAT), scrub typhus IgM ELISA, leptospira IgM ELISA, and Chikungunya IgM ELISA.
 Results: The diagnosis of AUF were dengue (55.5%; 70/126), malaria (19%; 24/126) and scrub typhus (19%; 24/126), enteric fever (4.7%;6/126) and Chikungunya (1.5%; 2/126). The most common presenting symptom was fever or pyrexia followed by myalgia, generalised aches and pains in the body and vomiting. Commonly observed complications included thrombocytopenia, hepatitis and shock.
 Conclusions: Dengue, malaria and scrub typhus are the major causes of AUF in the hospitalised children with dengue being the most prevalent infection. The study further emphasises the need to develop a systematic approach to the diagnosis of AUFs. This should be using a combination of clinical, epidemiological and laboratory parameters, which will be very useful for developing a relevant action plan for treatment and prevention of such fevers in any hospital setup.
 
 
 

Seroprevalence of chikungunya fever in a tertiary care hospital in North Karnataka

Introduction: Chikungunya disease is caused by Chikungunya virus, an Alpha virus under the family Togaviridae, transmitted through the vector Aedes spp. mosquitoes. The sudden onset of very high fever along with rash and severe arthralgia are the main symptoms. It’s a major public health problem similar to other arboviral diseases like Dengue and Japanese B encephalitis infections. Materials and Methods: A cross sectional study was conducted at a tertiary care hospital in north Karnataka. Serum samples of 555 suspected cases of Chikungunya fever were tested for Chikungunya IgM antibodies by ELISA (from NIV, Pune) over a period of 4 years, from January 2013 to December 2016. Results: Of the 555 serum samples tested, 128 (23.06%) were positive for Chikungunya IgM antibodies. The most affected age group was 21 to 30 years 35 (27.34%), followed by 31 to 40 years 26(20.31%). Male to female ratio was 1:1.56. Of the seropositive cases, all the cases presented with the history of fever and joint pain. The maximum number of cases were seen during the monsoon i.e. June 32 (25%), followed by the post monsoon period September 26 (20.31%).) Conclusions: The seroprevelance of Chikungunya cases in the present study is 23.06% with high prevalence in the monsoon and post monsoon months affecting the productive age group of the population. This reiterates the fact that Chikungunya continues to be a major health concern in our setting and indicates the need for appropriate strategies to reduce the severity of disease. Keywords: ELISA, Serology, Joint pain, Tagoviridae, IgM..

Epidemiological surveillance of Chikungunya cases – Findings from a tertiary care hospital in New Delhi

Background: Chikungunya epidemic is a major public health problem in metro cities in India especially during rainy season. There was an epidemic of chikungunyain the year 2016 in New Delhi. Therefore, this present study was planned to understand epidemiological and clinical profile of Chikungunya cases attending fever clinic in a tertiary care teaching hospital in Delhi. Methods & Materials: A total of 200 patients with fever of up to 7 days duration who reported at fever clinic of a tertiary care hospital in New Delhi were studied over a period of 6 months. A total of 47,874 fever cases were reported in fever clinic in same duration. Serum specimens were screened for chikungunya infection by serology (IgM). Chikungunya infection was detected in 16.5% patients by anti-CHIKV IgM antibodies by ELISA. A preformed semi-structured, interviewer administered questionnaire was used for the purpose of data collection. Results: Among these 200 suspected cases of chikungunya, fever (96.0%), joint pain (81.0%), myalgia (77.5%) and lower backache (57.5%) were the major clinical features. Major joints involved were knee joint (45.5%), wrist (32.5%), hand (phalanges) (34.5%) and ankle joints (31.0%). Myalgia, rashes, joint pain and joint swelling was frequently observed among chikungunya confirmed cases (p < 0.05). All group of ages, both gender and all class of socioeconomic scale were equally susceptible to chikungunya infection. Conclusion: Chikungunya virus had a wide spectrum of clinical features and all age groups, gender and socioeconomic status people were equally susceptible to Chikungunya infection. All acute febrile illness patients with joint pain should be screened in the laboratory for both Chikungunya IgM antibodies. Predictability of chikungunya is more in presence of joint pain and swelling, myalgia and rashes. This study emphasizes the need for a continuous surveillance on the disease burden.

Chikungunya-Induced Arthritis in Reunion Island: A Long-Term Observational Follow-Up Study Showing Frequently Persistent Joint Symptoms, Some Cases of Persistent Chikungunya Immunoglobulin M Positivity, and No Anticyclic Citrullinated Peptide Seroconversion After 13 Years.

Reunion Island was struck by a massive Chikungunya outbreak in 2005-2006. Chikungunya infection is characterized by inflammatory joint symptoms, which may evolve into chronic arthritis. In this long-term longitudinal observational monocentric study, after the 2005-2006 outbreak in Reunion Island, 159 patients were first referred to a rheumatologist for post-Chikungunya chronic musculoskeletal pain, 73 of them were diagnosed with classifiable Chikungunya-related chronic inflammatory rheumatic diseases (>3 month symptom duration from the initial viral infection). Thirty of these 73 patients were clinically evaluated by a second rheumatologist in 2018-2019. The main objective of this second examination was to estimate the proportion of patients with persistent Chikungunya-related inflammatory joint symptoms after 13 years. Inflammatory joint symptoms persisted in 17/30 patients after 13 years (therefore in at least 23.3% of the 73 patients initially diagnosed with Chikungunya-related inflammatory joint symptoms and 10.7% of the 159 patients referred for post-Chikungunya chronic musculoskeletal pain). In the symptom persistence subgroup, the prevalence of positive autoantibodies (antinuclear or ACPA) was significantly higher - without any seroconversion, Chikungunya IgG and IgM levels were higher, long-term IgM positivity and radiographic damage were more frequent. Overall, after 13 years, pain and fatigue levels remained significant, 5 patients were still treated by methotrexate, 3 by TNF-blockers, highlighting long-term Chikungunya-related patient burden. Such a long-term persistence of Chikungunya-related chronic inflammatory rheumatic diseases had not been reported so far. Furthermore, the long-term Chikungunya IgM positivity we observed in some cases might corroborate the hypothesis of residual viral antigen-driven chronic arthritis.

Chikungunya in infants: a descriptive study in a district hospital

Background: To define the clinical profile of Chikungunya in infants admitted at a District Hospital in South India.Methods: All infants admitted in Government District Headquarters Hospital, Namakkal from January 2019 to December 2019 with fever (defined as axillary temperature &gt; 99.6 F) and any one of the following features; seizure, loose stools, peripheral cyanosis, skin manifestations or pedal edema in children less than one year with chikungunya IgM ELISA positive were included in this study. Details of disease from onset of illness till admission were noted. This was a descriptive observational study.Results: Fifty-six (46) infants were included in this study, out of it 27(58.69%) were males and 19(41.30%) were females. 7(15.21%) infants were less than 1 month of age, 21(45.65%) were 2-6 months old and 18(39.13%) were 7-12 months old. Fever was invariably present but associated constitutional symptoms in infants consisted of lethargy or irritability and excessive cry. The most characteristic feature of the infection in infants was acrocyanosis and symmetrical erythematous rash were noted in most infants. Erythematous macules and patches were observed which later progressed to morbilliform rashes.Conclusions:Atypical clinical manifestations of chikungunya infection in infants as compared to older children to be carefully observed for its proper management. The morbidity and mortality of the disease may be avoided by the rational use of drugs and close monitoring of all infants.