Prospective study of Chikungunya virus acute infection in the Island of La Réunion during the 2005-2006 outbreak
Autor(es): Staikowsky Frederik, Talarmin François, Grivard Philippe, Souab Abdel, Schuffenecker Isabelle, Le Roux Karin, Lecuit Marc, Michault Alain
Resumo: Chikungunya virus (CHIKV) is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean - India, - extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa - America. Our objective was to determine the clinical - biological features of patients at the acute phase of CHIKV infection. A prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March - May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR), one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM - negative IgG), - one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM - IgG). Bivariate analyses of clinical - biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5%) affecting the lower (98%) - small joints (74.8%), as well as asthenia (88.6%), headache (70%), digestive trouble (63.3%), myalgia (59%), exanthems (47.8%), conjunctival hyperhemia (23%) - adenopathy (8.9%). Vertigo, cutaneous dysesthesia, pharyngitis - haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%), entesopathies (1.6%), talalgia (14%) were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001), whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001). Others biological abnormalities included leukopenia (38.3%), thrombocytopenia (37.3%), increased ASAT - ALAT blood levels (31.6 - 7.3%, respectively) - hypocalcemia (38.7%). Lymphopenia <1,000/mm(3) was very closely associated with viremic patients (Yule coefficient 0.82, positive predictive value 92.3%). Age under 65 was associated with a benign course, as no patients younger than 65 had to be hospitalized (Yule coefficient 0.78). The diagnosis of CHIKV infection in acute phase is based on commonly accepted clinical criteria (fever - arthralgia), however clinical - biological diffrences exist in acute phase depending on whether or not the patient is within the viremic phase of the infection.
Imprenta: PloS One, v. 4, n. 10, p. e7603, 2009
Identificador do objeto digital: 10.1371/journal.pone.0007603
Descritores: Chikungunya virus - Biosynthesis ; Chikungunya virus - Pathogenesis ; Chikungunya virus - Viral infections ; Chikungunya virus - RT-PCR ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemiology ; Chikungunya virus - Public health
Data de publicação: 2009
