Chikungunya fever: a clinical and virological investigation of outpatients on Reunion Island, South-West Indian Ocean
Autor(es): Thiberville Simon-Djamel, Boisson Veronique, Gaudart Jean, Simon Fabrice, Flahault Antoine, de Lamballerie Xavier
Resumo: Chikungunya virus (CHIKV) is responsible for acute febrile polyarthralgia -, in a proportion of cases, severe complications including chronic arthritis. CHIKV has spread recently in East Africa, South-West Indian Ocean, South-Asia - autochthonous cases have been reported in Europe. Although almost all patients are outpatients, medical investigations mainly focused on hospitalised patients. Here, we detail clinico-biological characteristics of Chikungunya (CHIK) outpatients in Reunion Isl- (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 - excluded in 22. A detailed clinical - biological follow-up was organised, that included analysis of viral intrahost diversity - 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 - improvement of clinical presentation; the 'convalescent stage' (day 5-day 14) was associated with no detectable viraemia but a slower clinical improvement. Women - elderly had a significantly higher number of arthralgia at inclusion - 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 h-s - wrists, a minor or absent myalgia - the presence of lymphopenia (<1G/L) as major orientation criteria. Finally, we observed that CHIKV intra-host genetic diversity increased over time - that a higher viral amino-acid complexity at the acute stage was associated with increased number of arthralgia - intensity of sequelae at day 300. This 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 - investigated for the first time the impact of viral intra-host genetic diversity on the disease course.
Imprenta: PLoS Neglected Tropical Diseases, v. 7, n. 1, p. e2004, 2013
Identificador do objeto digital: 10.1371/journal.pntd.0002004
Descritores: Chikungunya virus - Cytopathology ; Chikungunya virus - Pathogenesis ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Public health
Data de publicação: 2013
