Chikungunya Virus

No Results

No Results

processing….

Chikungunya fever is a self-remitting febrile viral illness that has been associated with frequent outbreaks in tropical countries of Africa and Southeast Asia. The illness has only recently become a concern in Western countries and temperate zones around the world. The recent re-emergence and travel-related spread of Chikungunya infection to Europe and the United States has drawn global attention. In fact, international travel stands out as one of the major risk factors for the rapid global spread of the disease. ^{[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]}

The term “Chikungunya” often refers to both the virus (CHIKV) and the illness or fever (CHIKF) caused by this virus. It was derived from the African dialect Swahili or Makonde and translates as “to be bent over.” In Congo, it is referred to as “buka-buka,” which means “broken-broken.” These terms refer to the “stooped-over posture” exhibited by individuals with the disease as a consequence of severe chronic incapacitating arthralgias.

The roots of this viral illness date back to 1953, when it was first described during an outbreak in a Swahili village in the Newala district of Tanzania, Africa. ^{[14, 15]} Chikungunya virus is transmitted to humans through day-biting mosquitoes that belong to the Aedes genus (see the image below).

See 11 Travel Diseases to Consider Before and After the Trip, a Critical Images slideshow, to help identify and manage infectious travel diseases.

Pathophysiology

The exact pathophysiology of Chikungunya virus remains to be investigated. To date, most of the research in this field has been from the Indian subcontinent and other Asian countries.

Chikungunya virus infection has a clinical presentation that overlaps with that of Ross River virus infection (fever, rash, polyarthritis) and dengue fever virus transmitted by the same mosquitoes. Evaluation of the T-cell– and B-cell–mediated immunity has shed light on some possible mechanisms.

Using a murine model, Lum et al have shown that anti–Chikungunya virus antibodies were elicited early in the course of the illness and were directed against the C-terminus of the viral E2 glycoprotein. They showed that both natural and Chikungunya virus infection–induced specific antibodies were essential for controlling Chikungunya virus infections. ^[16]

Waquier et al conducted a large ex vivo multiplex study of T-cell immunity and 50 cytokine, chemokine, and growth factor plasma profiles in 69 acutely infected patients from the Gabonese outbreak in 2007. They concluded that Chikungunya virus infection elicited strong innate immunity with an abundant production of proinflammatory markers and cytokines, including high levels of alpha interferon, interleukin (IL)–4, IL10, and gamma interferon. By flow cytometric analysis, the authors also demonstrated that humans show a CD8+ lymphocytic response in the early stages and a CD4+ predominant response in the later stages. Most importantly, the authors described a CD95-based apoptosis of CD4+ lymphocytes that could partially explain the lymphopenia in these patients. Hence, severe or chronic infections could be attributed to an absence or deregulation of one of these pathways. ^[17]

The exact mechanism of entry of the virus into mammalian cells is under investigation. ^{[18, 19]} Bernard et al evaluated this mechanism and found that Chikungunya virus enters mammalian epithelial cells via a clathrin-independent, Esp-15–dependent, dynamin 2–dependent route and requires an endocytic pathway in combination with other unknown pathways. The authors speculate that Chikungunya virus is capable of undergoing genetic drifts and could acquire alternate entry mechanisms. ^[20]

Several murine models with Chikungunya virus–related joint and neurological diseases are being investigated. Other state-of-the-art in vivo imaging techniques using bioluminescence imaging with luciferase-tagged pathogens and intravital 2-photon imaging systems are being evaluated for study of Chikungunya infection’s chronic phase. ^{[21, 22, 23, 24]} . It has now been shown that type 1 interferon sensing by nonmyeloid cells plays a significant role in fighting Chikungunya infection. ^[25]

Research on antiviral agents to treat Chikungunya infection is ongoing. Molecules that inhibit chikungunya viral replication by direct inhibition of the virus or that act via host defense mechanisms have been identified. ^[26] Das et al have designed and validated a set of 12 compounds that inhibit the functional moiety of the nsP2 viral protease. All these compounds suppressed Chikungunya viral replication in cell culture assays and appear promising. ^[27]

Further research in this field would undoubtedly provide a better understanding of the in vivo interactions between Chikungunya virus and immune cells and shed light on the immunopathogenesis.

Chikungunya virus is an alpha virus that belongs to the Togaviridae family. It is a single-stranded RNA virus and is approximately 11.8 kb long with a capsid and a phospholipid envelope. Phylogenetic analysis has revealed 3 distinct groups based on partial sequences of NS4 and E1 genes: (1) the West African, (2) the East-Central-South African (ECSA), and (3) the Asian. ^{[7, 8]}

Chikungunya virus is transmitted to humans through day-biting mosquitoes that belong to the Aedes genus. Being an arbovirus, the virus is maintained in the environment between humans or other animals and mosquitoes. Humans serve as major reservoirs during epidemics.

During inter-epidemic quiescence in Africa, the virus is thought to be maintained in an epizootic cycle that involves vertebrates such as monkeys, rodents, and birds. In Africa, the virus is maintained in a sylvatic cycle among wild primates, monkeys and, wild Aedes mosquitoes (Aedes furcifer, Aedes taylori, Aedes luteocephalus, Aedes africanus, Aedes neoafricanus). A sylvatic cycle has not yet been identified outside the African continent.

In Asia, the virus is maintained in an urban cycle involving Aedes aegypti mosquitoes (see image below) and humans. The method of viral maintenance in the environment during the quiescent inter-epidemic periods in Asia remains unknown. Unlike its counterpart, the dengue virus, a transovarian transmission has not yet been reported, supporting the historical theory that the virus first originated in Africa and later spread to other countries in Asia. Historically, Chikungunya outbreaks are known to demonstrate a secular, cyclical, and seasonal trend. ^{[28, 29, 30]}

Epidemics are characterized by explosive outbreaks between years-long periods of quiescence. The exact reason for this is unknown. Several socioeconomic factors, susceptibility of humans and mosquitoes to the virus, and ability of transmission all seem to play a role.

Phylogenetic analysis has revealed that the Chikungunya virus genome has remained stable over the years since its first discovery in 1952. ^[30] Comparison of two Asian Chikungunya virus strains that were isolated 10 years apart showed 99.4% identity. Most of the early strains isolated from the Reunion Island Chikungunya virus outbreak were similar to the ECSA cluster. ^{[5, 31, 32]} However, the strains isolated from the 2006-2007 outbreak revealed an alanine to valine amino acid mutation at position 226 in the E1 glycoprotein. The presence of alanine (A226) denotes cholesterol-dependent growth and replication of Chikungunya virus in certain Aedes species.

This particular mutation raised considerable interest in the research field, as it resulted in cholesterol-independent growth and replication of Chikungunya virus and was exclusively seen in Chikungunya virus isolated from Aedes albopictus mosquitoes. This mutation was also associated with enhanced fitness in Chikungunya virus, enabling it to infect A albopictus mosquitoes and other species that normally lack cholesterol. This ability of the Chikungunya virus to adapt to a new species has significant implications with respect to the range of transmission and spread across the globe. ^{[33, 34, 35, 36, 37]}

The above findings led experts to speculate that Chikungunya virus would no longer be restricted to the tropical countries but could spread to temperate regions, as A albopictus predominates in temperate zones where A aegypti is scarce (the Americas, Europe, China, Japan). ^{[38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48]}

Numerous Chikungunya epidemics have been reported in several countries in Southern and South East Asia. Distinct strains of Chikungunya virus within varying transmission cycles have been reported from different locations. The African variant has managed to persist over the years with frequent outbreaks due to a sylvatic cycle maintained between monkeys and wild mosquitoes. Conversely, the Asian variant causes epidemics that are maintained by an urban cycle, characterized by long inter-epidemic quiescence for more than 10 years or so.

The first Asian epidemic was reported in Bangkok, Thailand, in 1958, continued until 1964, and reappeared after a hiatus in the mid-1970s and declined again in 1976. Major outbreaks were also reported from northwestern and southern parts of India, Sri Lanka, Myanmar, and Thailand in the early 1960s. The cases then declined before sporadic outbreaks were later reported in the Philippines and Indonesia in 1980s and Malaysia in the 1990s. ^{[7, 9, 11]}

The next major outbreak occurred in 2001 on islands in the Indian Ocean (Mauritius, Mayotte, Madagascar, Reunion Island). The most severe Chikungunya fever outbreak was reported in 2006 on Reunion Island, where one-third of the population was infected, resulting in 237 deaths. Around the same time, an historical outbreak on the Indian subcontinent involved 1.42 million people, with high morbidity rates. ^[5]

By 2007, the disease was no longer considered a tropical illness, as it had spread to several nontropical and temperate areas, including Singapore.

According to figures from 2013-2014 from the Centers for Disease Control and Prevention (CDC), European Center for Disease Prevention and Control (ECDC), and the Pan American Health Organization (PAHO), several imported cases of travel-related Chikungunya fever have been reported in the United States, Caribbean islands, Britain, France, Germany, Sweden, Portugal, Canary Islands, and the archipelagos off the coast of Western Africa. ^{[39, 40, 41, 42, 43, 44]}

Many travel-related cases of Chikungunya infection have been imported into the United States since 2006. As of December 2014, a total of 1,938 travel-associated cases from 47 states and 2 US territories (Puerto Rico, Virgin Islands) have been reported.

The first case of local transmission to a person who had not traveled outside the United States was reported in July 2014, which was the first documented case of mosquitoes in the United States spreading the illness to a nontraveler. ^[39] As of December 2014, a total of 11 locally transmitted cases have been reported in the United States, all in Florida. ^[49]

In addition, 3402 locally mosquito-transmitted cases in Puerto Rico and 86 cases in the Virgin Islands have been reported. ^{[49, 40, 41]} However, a recent study by the Puerto Rico Department of Health (PRDH) and the CDC shows that cases are underreported in Puerto Rico. From June 20 to August 19, 2014, The PRDH and CDC collected passive surveillance data in 250 participants, 70 (28%) of whom tested positive for past or current chikungunya virus infection. Only two of 25 participants (8%) with chikungunya infection who sought care had been reported to health authorities. ^[50]

These cases illustrate the magnitude of the global spread of Chikungunya infection. They also emphasize the need to maintain efficient surveillance networks and implementation of adequate prevention measures, both at the personal and community level, to contain the infection and to prevent outbreaks.

Although Chikungunya fever is a self-remitting illness, rare cases of complications have been reported in India during major outbreaks among patients with comorbidities (cardiovascular, respiratory, neurological), neonates, elderly patients, immunocompromised patients. In a report from the Reunion Island outbreak in 2005, 610 patients with comorbidities had atypical presentations, 65 of whom died. Some of the complications included hepatitis, meningoencephalitis, bullous dermatosis, and pneumonia. ^[51]

The overall mortality in this report was 10.6% and was higher among elderly individuals. The most common risk factors associated with a high mortality and severe infection were cardiovascular (226 patients), respiratory (150 patients), and neurological (147 patients) conditions. ^{[51, 52, 53]}

Chikungunya virus is not known to be neurovirulent or neuroinvasive, unlike other alpha viruses. However, rare cases of encephalitis (predominantly demyelinating), myelitis, entrapment neuropathy, seizures, abnormal cerebrospinal fluid (CSF) chemistries, flaccid paralysis, neurological sequelae, and severe peripheral neuropathy and Guillain Barré–type presentations have been reported from several centers in India. ^{[54, 55, 56]} During the epidemic in the Reunion Islands, 4 newborns had severe attacks of meningoencephalitis, 3 with disseminated intravascular coagulation (DIC) and 1 with intracerebral hemorrhage from severe thrombocytopenia. ^[51]

Coinfection of Chikungunya fever with dengue has been reported from Yemen. ^{[45, 57]} Unlike dengue fever (see Table 1), hemorrhagic manifestations are uncommon with Chikungunya fever and are generally mild (epistaxis, gingival bleeding, subconjunctival hemorrhage, petechial or purpuric rash) if present. Other rare complications include sudden sensorineural hearing loss, granulomatous and nongranulomatous anterior uveitis, optic neuritis, retrobulbar neuritis, dendritic lesions, hypokalemic periodic paralysis, and multiorgan failure. The prognosis of eye disease was good, with most patients recovering their vision. In general, the neurological outcome was good, with most patients recovering from the initial episode.

Complications were more commonly seen in infants, adults with comorbidities, and elderly patients. ^{[58, 59, 60]} Intrauterine infection in pregnant women with vertical transmission has also been reported. ^{[61, 62]}

Das et al have described the capacity of Chikungunya virus to infect the neurons and glial cells, indicating the neuroinvasive and neurovirulent potential of this virus. ^[60] However, the neurotropism of Chikungunya virus remains controversial and merits further investigation.

Persistent severe arthralgias could lead to long-term disability and loss of work days. ^{[63, 64, 65, 66]} Thus, the burden on the economy in terms of loss of productivity and income is estimated to be significant.

See Prevention.

Update: chikungunya fever diagnosed among international travelers–United States, 2006. MMWR Morb Mortal Wkly Rep. 2007 Mar 30. 56(12):276-7. [Medline].

Gibney KB, Fischer M, Prince HE, et al. Chikungunya fever in the United States: a fifteen year review of cases. Clin Infect Dis. 2011 Mar 1. 52(5):e121-6. [Medline].

Lanciotti RS, Kosoy OL, Laven JJ, Panella AJ, Velez JO, Lambert AJ. Chikungunya virus in US travelers returning from India, 2006. Emerg Infect Dis. 2007 May. 13(5):764-7. [Medline].

Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009 Sep 15. 49(6):942-8. [Medline].

Renault P, Solet JL, Sissoko D, Balleydier E, Larrieu S, Filleul L. A major epidemic of chikungunya virus infection on Reunion Island, France, 2005-2006. Am J Trop Med Hyg. 2007 Oct. 77(4):727-31. [Medline].

Bodenmann P, Genton B. Chikungunya: an epidemic in real time. Lancet. 2006 Jul 15. 368(9531):258. [Medline].

Mohan A, Kiran DH, Manohar IC, Kumar DP. Epidemiology, clinical manifestations, and diagnosis of Chikungunya fever: lessons learned from the re-emerging epidemic. Indian J Dermatol. 2010. 55(1):54-63. [Medline].

Chhabra M, Mittal V, Bhattacharya D, Rana U, Lal S. Chikungunya fever: a re-emerging viral infection. Indian J Med Microbiol. 2008 Jan-Mar. 26(1):5-12. [Medline].

Outbreak news. Chikungunya and dengue, south-west Indian Ocean. Wkly Epidemiol Rec. 2006 Mar 24. 81(12):106-8. [Medline].

Simon F, Savini H, Parola P. Chikungunya: a paradigm of emergence and globalization of vector-borne diseases. Med Clin North Am. 2008 Nov. 92(6):1323-43, ix. [Medline].

Pialoux G, Gauzere BA, Jaureguiberry S, Strobel M. Chikungunya, an epidemic arbovirosis. Lancet Infect Dis. 2007 May. 7(5):319-27. [Medline].

Powers AM, Logue CH. Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus. J Gen Virol. 2007 Sep. 88(Pt 9):2363-77. [Medline].

Sam IC, AbuBakar S. Chikungunya virus infection. Med J Malaysia. 2006 Jun. 61(2):264-9. [Medline].

Robinson MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. I. Clinical features. Trans R Soc Trop Med Hyg. 1955 Jan. 49(1):28-32. [Medline].

Lumsden WH. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. II. General description and epidemiology. Trans R Soc Trop Med Hyg. 1955 Jan. 49(1):33-57. [Medline].

Lum FM, Teo TH, Lee WW, Kam YW, Renia L, Ng LF. An essential role of antibodies in the control of Chikungunya virus infection. J Immunol. 2013 Jun 15. 190(12):6295-302. [Medline]. [Full Text].

Wauquier N, Becquart P, Nkoghe D, Padilla C, Ndjoyi-Mbiguino A, Leroy EM. The acute phase of Chikungunya virus infection in humans is associated with strong innate immunity and T CD8 cell activation. J Infect Dis. 2011 Jul 1. 204(1):115-23. [Medline]. [Full Text].

Teo TH, Lum FM, Claser C, Lulla V, Lulla A, Merits A. A pathogenic role for CD4+ T cells during Chikungunya virus infection in mice. J Immunol. 2013 Jan 1. 190(1):259-69. [Medline].

Teo TH, Lum FM, Lee WW, Ng LF. Mouse models for Chikungunya virus: deciphering immune mechanisms responsible for disease and pathology. Immunol Res. 2012 Sep. 53(1-3):136-47. [Medline].

Bernard E, Solignat M, Gay B, Chazal N, Higgs S, Devaux C. Endocytosis of chikungunya virus into mammalian cells: role of clathrin and early endosomal compartments. PLoS One. 2010. 5(7):e11479. [Medline].

Rulli NE, Suhrbier A, Hueston L, et al. Ross River virus: molecular and cellular aspects of disease pathogenesis. Pharmacol Ther. 2005 Sep. 107(3):329-42. [Medline].

Ziegler SA, Nuckols J, McGee CE, Huang YJ, Vanlandingham DL, Tesh RB. In vivo imaging of chikungunya virus in mice and Aedes mosquitoes using a Renilla luciferase clone. Vector Borne Zoonotic Dis. 2011 Nov. 11(11):1471-7. [Medline].

Chaaitanya IK, Muruganandam N, Sundaram SG, Kawalekar O, Sugunan AP, Manimunda SP. Role of proinflammatory cytokines and chemokines in chronic arthropathy in CHIKV infection. Viral Immunol. 2011 Aug. 24(4):265-71. [Medline].

Briant L, Despres P, Choumet V, Misse D. Role of skin immune cells on the host susceptibility to mosquito-borne viruses. Virology. 2014 Jul 17. 464-465C:26-32. [Medline].

Couderc T, Lecuit M. Chikungunya virus pathogenesis: From bedside to bench. Antiviral Res. 2015 Sep. 121:120-31. [Medline].

Abdelnabi R, Neyts J, Delang L. Towards antivirals against chikungunya virus. Antiviral Res. 2015 Sep. 121:59-68. [Medline].

Das PK, Puusepp L, Varghese FS, Utt A, Ahola T, Kananovich DG, et al. Design and validation of novel chikungunya virus protease inhibitors. Antimicrob Agents Chemother. 2016 Oct 10. [Medline].

Jupp PG. Chikungunya virus disease. The arboviruses:epidemiology and ecology. Boca Raton: CRC Press. 1988. II:137-57.

Yergolkar PN, Tandale BV, Arankalle VA, et al. Chikungunya outbreaks caused by African genotype, India. Emerg Infect Dis. 2006 Oct. 12(10):1580-3. [Medline]. [Full Text].

Paramasivan R, Philip Samuel P, Thenmozhi V, Rajendran R, Victor Jerald Leo S, Dhananjeyan KJ. Chikungunya virus isolated in Lakshadweep islands in the Indian Ocean: evidence of the Central/East African genotype. Jpn J Infect Dis. 2009 Jan. 62(1):67-9. [Medline].

Lakshmipathy DT, Dhanasekaran D. Molecular epidemiology of Chikungunya virus in Vellore district, Tamilnadu, India in 2006. East Afr J Public Health. 2008 Aug. 5(2):122-5. [Medline].

Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC. Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med. 2006 Jul. 3(7):e263. [Medline].

Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S. A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog. 2007 Dec. 3(12):e201. [Medline].

Reiskind MH, Pesko K, Westbrook CJ, Mores CN. Susceptibility of Florida mosquitoes to infection with chikungunya virus. Am J Trop Med Hyg. 2008 Mar. 78(3):422-5. [Medline]. [Full Text].

Sourisseau M, Schilte C, Casartelli N, Trouillet C, Guivel-Benhassine F, Rudnicka D. Characterization of reemerging chikungunya virus. PLoS Pathog. 2007 Jun. 3(6):e89. [Medline].

Singh RK, Tiwari S, Mishra VK, Tiwari R, Dhole TN. Molecular epidemiology of Chikungunya virus: mutation in E1 gene region. J Virol Methods. 2012 Nov. 185(2):213-20. [Medline].

M Naresh Kumar CV, Anthony Johnson AM, R Sai Gopal DV. Molecular characterization of chikungunya virus from Andhra Pradesh, India & phylogenetic relationship with Central African isolates. Indian J Med Res. 2007 Dec. 126(6):534-40. [Medline].

Simon F, Parola P, Grandadam M, Fourcade S, Oliver M, Brouqui P. Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. Medicine (Baltimore). 2007 May. 86(3):123-37. [Medline].

McCarthy M. First case of locally acquired chikungunya is reported in US. BMJ. 2014. 349:g4706. [Medline].

Noel H, Rizzo C. Spread of chikungunya from the Caribbean to mainland Central and South America: a greater risk of spillover in Europe?. Euro Surveill. 2014. 19(28):[Medline].

Requena-Mendez A, Garcia C, Aldasoro E, et al. Cases of chikungunya virus infection in travellers returning to Spain from Haiti or Dominican Republic, April-June 2014. Euro Surveill. 2014 Jul 17. 19(28):[Medline].

Paty M, Six C, Charlet F, Heuze G, Cochet A, Wiegandt A. Large number of imported chikungunya cases in mainland France, 2014: a challenge for surveillance and response. Euro Surveill. 2014. 19(28):[Medline].

Cauchemez S, Ledrans M, Poletto C, et al. Local and regional spread of chikungunya fever in the Americas. Euro Surveill. 2014 Jul 17. 19(28):[Medline].

Nasci RS. Movement of chikungunya virus into the Western hemisphere. Emerg Infect Dis. 2014 Aug. 20(8):1394-5. [Medline].

Rezza G, El-Sawaf G, Faggioni G, Vescio F, Al Ameri R, De Santis R. Co-circulation of Dengue and Chikungunya Viruses, Al Hudaydah, Yemen, 2012. Emerg Infect Dis. 2014 Aug. 20(8):1351-4. [Medline].

Wanlapakorn N, Thongmee T, Linsuwanon P, et al. Chikungunya outbreak in bueng kan province, Thailand, 2013. Emerg Infect Dis. 2014 Aug. 20(8):1404-6. [Medline]. [Full Text].

Mansuy JM, Grouteau E, Mengelle C, Claudet I, Izopet J. Chikungunya in the Caribbean-threat for europe. Emerg Infect Dis. 2014 Aug. 20(8):1423-5. [Medline].

Tun MM, Thant KZ, Inoue S, Nabeshima T, Aoki K, Kyaw AK. Detection of east/central/south african genotype of chikungunya virus in myanmar, 2010. Emerg Infect Dis. 2014 Aug. 20(8):1378-81. [Medline].

CDC. Chikungunya virus in the United States. Centers for Disease Control and Prevention. Available at http://92. http://www.cdc.gov/chikungunya/geo/united-states.html. Accessed: December 4, 2014.

Sharp TM, Roth NM, Torres J, et al. Chikungunya Cases Identified Through Passive Surveillance and Household Investigations. MMWR Morb Mortal Wkly Rep. Dec 2014. 63 (48):1121-28.

Economopoulou A, Dominguez M, Helynck B, et al. Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion. Epidemiol Infect. 2009 Apr. 137(4):534-41. [Medline].

Bandyopadhyay B, Bandyopadhyay D, Bhattacharya R, De R, Saha B, Mukherjee H. Death due to chikungunya. Trop Doct. 2009 Jul. 39(3):187-8. [Medline].

Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani KV. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis. 2008 Mar. 14(3):412-5. [Medline].

Wadia RS. A neurotropic virus (Chikungunya) and a neuropathic amino acid (homocysteine). Ann Indian Acad Neurol. 2007. 10:198–213.

Rampal, Sharda M, Meena H. Neurological complications in Chikungunya fever. J Assoc Physicians India. 2007 Nov. 55:765-9. [Medline].

Chandak NH, Kashyap RS, Kabra D, et al. Neurological complications of Chikungunya virus infection. Neurol India. 2009 Mar-Apr. 57(2):177-80. [Medline].

Nimmannitya S, Halstead SB, Cohen SN, Margiotta MR. Dengue and chikungunya virus infection in man in Thailand, 1962-1964. I. Observations on hospitalized patients with hemorrhagic fever. Am J Trop Med Hyg. 1969 Nov. 18(6):954-71. [Medline].

Gerardin P, Samperiz S, Ramful D, Boumahni B, Bintner M, Alessandri JL. Neurocognitive Outcome of Children Exposed to Perinatal Mother-to-Child Chikungunya Virus Infection: The CHIMERE Cohort Study on Reunion Island. PLoS Negl Trop Dis. 2014 Jul. 8(7):e2996. [Medline].

Lewthwaite P, Vasanthapuram R, Osborne JC, et al. Chikungunya virus and central nervous system infections in children, India. Emerg Infect Dis. 2009 Feb. 15(2):329-31. [Medline]. [Full Text].

Das T, Jaffar-Bandjee MC, Hoarau JJ, et al. Chikungunya fever: CNS infection and pathologies of a re-emerging arbovirus. Prog Neurobiol. 2010 Jun. 91(2):121-9. [Medline].

Gerardin P, Barau G, Michault A, et al. Multidisciplinary prospective study of mother-to-child chikungunya virus infections on the island of La Réunion. PLoS Med. 2008 Mar 18. 5(3):e60. [Medline]. [Full Text].

Lenglet Y, Barau G, Robillard PY, Randrianaivo H, Michault A, Bouveret A. [Chikungunya infection in pregnancy: Evidence for intrauterine infection in pregnant women and vertical transmission in the parturient. Survey of the Reunion Island outbreak]. J Gynecol Obstet Biol Reprod (Paris). 2006 Oct. 35(6):578-83. [Medline].

Fourie ED, Morrison JG. Rheumatoid arthritic syndrome after chikungunya fever. S Afr Med J. 1979 Jul 28. 56(4):130-2. [Medline].

Kennedy AC, Fleming J, Solomon L. Chikungunya viral arthropathy: a clinical description. J Rheumatol. 1980 Mar-Apr. 7(2):231-6. [Medline].

Brighton SW, Simson IW. A destructive arthropathy following Chikungunya virus arthritis–a possible association. Clin Rheumatol. 1984 Jun. 3(2):253-8. [Medline].

Krishnamoorthy K, Harichandrakumar KT, Krishna Kumari A, Das LK. Burden of chikungunya in India: estimates of disability adjusted life years (DALY) lost in 2006 epidemic. J Vector Borne Dis. 2009 Mar. 46(1):26-35. [Medline].

Brighton SW, Prozesky OW, de la Harpe AL. Chikungunya virus infection. A retrospective study of 107 cases. S Afr Med J. 1983 Feb 26. 63(9):313-5. [Medline].

Borgherini G, Poubeau P, Jossaume A, Gouix A, Cotte L, Michault A. Persistent arthralgia associated with chikungunya virus: a study of 88 adult patients on reunion island. Clin Infect Dis. 2008 Aug 15. 47(4):469-75. [Medline].

Chang AY, Martins KAO, Encinales L, et al. A cross-sectional analysis of chikungunya arthritis patients 22-months post-infection demonstrate no detectable viral persistence in synovial fluid. Arthritis Rheumatol. 2017 Dec 20. [Medline].

Bandyopadhyay D, Ghosh SK. Mucocutaneous features of Chikungunya fever: a study from an outbreak in West Bengal, India. Int J Dermatol. 2008 Nov. 47(11):1148-52. [Medline].

Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008 Feb. 47(2):154-9. [Medline].

Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis. 2007 Jun 1. 44(11):1401-7. [Medline].

Valamparampil JJ, Chirakkarot S, Letha S, Jayakumar C, Gopinathan KM. Clinical profile of Chikungunya in infants. Indian J Pediatr. 2009 Feb. 76(2):151-5. [Medline].

Suryawanshi SD, Dube AH, Khadse RK, et al. Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India. Indian J Med Res. 2009 Apr. 129(4):438-41. [Medline].

Kannan M, Rajendran R, Sunish IP, et al. A study on chikungunya outbreak during 2007 in Kerala, south India. Indian J Med Res. 2009 Mar. 129(3):311-5. [Medline].

Bandyopadhyay B, Pramanik N, De R, et al. Chikungunya in west bengal, India. Trop Doct. 2009 Jan. 39(1):59-60. [Medline].

Obeyesekere I, Hermon Y. Myocarditis and cardiomyopathy after arbovirus infections (dengue and chikungunya fever). Br Heart J. 1972 Aug. 34(8):821-7. [Medline].

Obeyesekere I, Hermon Y. Arbovirus heart disease: myocarditis and cardiomyopathy following dengue and chikungunya fever–a follow-up study. Am Heart J. 1973 Feb. 85(2):186-94. [Medline].

Bouquillard E, Combe B. Rheumatoid arthritis after Chikungunya fever: a prospective follow-up study of 21 cases. Ann Rheum Dis. 2009 Sep. 68(9):1505-6. [Medline].

Tandale BV, Sathe PS, Arankalle VA, Wadia RS, Kulkarni R, Shah SV. Systemic involvements and fatalities during Chikungunya epidemic in India, 2006. J Clin Virol. 2009 Oct. 46(2):145-9. [Medline].

Singh SS, Manimunda SP, Sugunan AP, Sahina, Vijayachari P. Four cases of acute flaccid paralysis associated with chikungunya virus infection. Epidemiol Infect. 2008 Sep. 136(9):1277-80. [Medline].

Mahesh G, Giridhar A, Shedbele A, Kumar R, Saikumar SJ. A case of bilateral presumed chikungunya neuroretinitis. Indian J Ophthalmol. 2009 Mar-Apr. 57(2):148-50. [Medline].

Mittal A, Mittal S, Bharathi JM, Ramakrishnan R, Sathe PS. Uveitis during outbreak of Chikungunya fever. Ophthalmology. 2007 Sep. 114(9):1798. [Medline].

Mahendradas P, Ranganna SK, Shetty R, et al. Ocular manifestations associated with chikungunya. Ophthalmology. 2008 Feb. 115(2):287-91. [Medline].

Bhavana K, Tyagi I, Kapila RK. Chikungunya virus induced sudden sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2008 Feb. 72(2):257-9. [Medline].

Rampal, Sharda M, Meena H. Hypokalemic paralysis following Chikungunya fever. J Assoc Physicians India. 2007 Aug. 55:598. [Medline].

World Health Organization, Regional Office for South-East Asia. Proposed case definition of Chikungunya fever. Available at http://www.searo.who.int/entity/emerging_diseases/topics/Def_Chikungunya_Fever.pdf. Accessed: August 7, 2014.

Lakshmi V, Neeraja M, Subbalaxmi MV, Parida MM, Dash PK, Santhosh SR. Clinical features and molecular diagnosis of Chikungunya fever from South India. Clin Infect Dis. 2008 May 1. 46(9):1436-42. [Medline].

Grivard P, Le Roux K, Laurent P, et al. Molecular and serological diagnosis of Chikungunya virus infection. Pathol Biol (Paris). 2007 Dec. 55(10):490-4. [Medline].

National Institute of Communicable Disease, New Delhi. Chikungunya fever. CD Alert. 2006. 10:6–8.

Pastorino B, Bessaud M, Grandadam M, Murri S, Tolou HJ, Peyrefitte CN. Development of a TaqMan RT-PCR assay without RNA extraction step for the detection and quantification of African Chikungunya viruses. J Virol Methods. 2005 Mar. 124(1-2):65-71. [Medline].

Levitt NH, Ramsburg HH, Hasty SE, Repik PM, Cole FE Jr, Lupton HW. Development of an attenuated strain of chikungunya virus for use in vaccine production. Vaccine. 1986 Sep. 4(3):157-62. [Medline].

Edelman R, Tacket CO, Wasserman SS, Bodison SA, Perry JG, Mangiafico JA. Phase II safety and immunogenicity study of live chikungunya virus vaccine TSI-GSD-218. Am J Trop Med Hyg. 2000 Jun. 62(6):681-5. [Medline].

Weger-Lucarelli J, Chu H, Aliota MT, Partidos CD, Osorio JE. A Novel MVA Vectored Chikungunya Virus Vaccine Elicits Protective Immunity in Mice. PLoS Negl Trop Dis. 2014 Jul. 8(7):e2970. [Medline].

Roth A, Hoy D, Horwood PF, et al. Preparedness for threat of chikungunya in the pacific. Emerg Infect Dis. 2014 Aug. 20(8):[Medline]. [Full Text].

Robillard PY, Boumahni B, Gerardin P, Michault A, Fourmaintraux A, Schuffenecker I. [Vertical maternal fetal transmission of the chikungunya virus. Ten cases among 84 pregnant women]. Presse Med. 2006 May. 35(5 Pt 1):785-8. [Medline].

Sebastian MR, Lodha R, Kabra SK. Chikungunya infection in children. Indian J Pediatr. 2009 Feb. 76(2):185-9. [Medline].

Feature

Chikungunya Virus Infection

Dengue Virus Infection

Fever (>39°C)

+++

++

Arthralgia

+++

+/-

Arthritis

+

–

Headache

++

++

Rash

++

+

Myalgia

+

++

Hemorrhage

+/-

++

Shock

–

+

Lymphopenia

+++

++

Neutropenia

+

+++

Thrombocytopenia

+

+++

Hemoconcentration

–

++

Suganthini Krishnan Natesan, MD Associate Professor of Medicine, Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine; Section Chief of Infectious Diseases, John D Dingell Veterans Affairs Medical Center

Suganthini Krishnan Natesan, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Chikungunya Virus

Research & References of Chikungunya Virus|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us