Rheumatology Advance Access originally published online on August 18, 2006
Rheumatology 2006 45(11):1449-1450; doi:10.1093/rheumatology/kel275
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Chikungunya outbreak—remember the arthropathy
Department of Internal Medicine, Sacro Cuore Hospital, Negrar, 1Department of Clinical and Experimental Medicine, University of Verona, Verona and 2Department of Tropical Medicine, Sacro Cuore Hospital, Negrar, Italy
Correspondence to: A. Volpe, MD, Department of Internal Medicine, Sacro Cuore Hospital, Via Sempreboni 5, 37024 Negrar, VR, Italy. E-mail: reumatologia{at}sacrocuore.it
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Introduction |
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 Top Introduction Case reportDiscussionReferences |
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SIR, Chikungunya (CHIK) virus, a member of the Alphavirus genus in the family Togaviridae, was first isolated from the serum of a febrile human in the Newala district, Tanzania, in 1953 [1].
CHIK is an important human pathogen that causes a syndrome characterized by fever, chills, headache and severe joint pain with or without swelling (usually the smaller joints). The name is derived from the Makonde word meaning ‘that which bends up’ in reference to the stooped posture developed as a result of the arthritic symptoms of the disease [2, 3].
CHIK is geographically distributed from Africa through Southeast Asia and South America, and its transmission to humans is mainly through Aedes species mosquitoes [4].
Since 1953, CHIK has caused numerous well-documented outbreaks and epidemics in both Africa and Southeast Asia, involving hundreds of thousands of people [2].
CHIK virus outbreak of unprecedented magnitude is currently ongoing in Indian Ocean territories principally involving Réunion Island, Comoro, Mauritius, Seychelles and southwestern India [3, 5].
On Réunion Island, between March 2005 and March 2006, 3115 cases of CHIK were notified. Estimates from a mathematical model indicate that 204 000 people may have been infected by CHIK virus since March 2005 on Réunion Island. The peak of the outbreak was during the week of 30 January to 5 February 2006 [6]. Currently, although a decreasing trend is reported since mid February, the epidemic is still very active.
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Case report |
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TopIntroductionCase reportDiscussionReferences |
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A 46-yr-old woman was admitted to our department of Tropical Medicine with a 1 month history of polyarthralgia affecting the wrists, hands and ankles. She became ill 5 days before her return to Italy after 2 weeks holiday on Réunion Island (from 15th to 30th of January 2006). She had acute symptoms of fever, shivering, headache and joint pain. Fever lasted only 2 days while joint symptoms persisted and she had to take non-steroidal anti-inflammatory drugs (NSAIDs) continuously. Her past history included hypothyroidism for which she has been currently taking levotiroxin 75 mcg daily.
The physical examination was non-contributory except wrists, hand and ankles tenderness, while there was no synovitis. Laboratory tests were normal except slightly increased C-reactive protein (1.35 mg/dl, normal value 0–1.0). Standard tests for rheumatological disorders including rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies were negative. Tests for dengue and malaria were also negative.
On the grounds of the clinical and epidemiological features, CHIK arthropathy was suspected. The diagnosis was confirmed with specific haemagglutination inhibition test. The patient was treated with NSAID (ibuprofen 1200 daily); joint pain was relieved in 2 months, but a residual joint stiffness persists.
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Discussion |
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TopIntroductionCase reportDiscussionReferences |
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Arthritogenic alphaviruses are globally distributed mosquito-borne RNA viruses causing epidemics of polyarthritis/polyarthralgia, with disease emerging or re-emerging and increasingly being reported in travellers. Only six of the many alphavirus known to affect humans can cause articular manifestations. They are the CHIK, O'Nyong Nyong and Sindbis viruses from tropical Africa, the Ross River and Barmah Forest viruses from the South Pacific and the Mayaro virus from South America [7]. The current outbreak induced us to pay attention to CHIK arthropathy.
Most cases of CHIK arthropathy recover from the severe joint pains within several weeks but up to 12% retain some residual joint symptoms for a long time (up to 18 months) [8]. Usually, CHIK arthropathy does not cause permanent joint damage, but one case of destructive arthropathy was described [9].
Treatment of CHIK arthropathy with NSAID is usually sufficient; in refractory cases, Brighton SW [10] found significant improvement with chloroquine phosphate.
After the recent CHIK outbreak, several European countries including Germany, Italy, Belgium, Switzerland and Norway have been reporting cases imported in people returning from Indian Ocean islands [11].
CHIK arthropathy should be considered in the differential diagnosis of joint pain in people returning from areas where transmission occurs (sub-Saharan Africa, South East Asia, Indian subcontinent).
The authors have declared no conflicts of interest.
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References |
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- Ross RW. (1956) The Newala epidemic. III. The virus: isolation, pathogenic properties and relationship to the epidemic. Journal of Hygiene 54:177–91.
- Rao TR. (1966) Recent epidemics caused by Chikungunya virus in India, 1963–1965. Scientific Culture 32:215.
- Ravi V. (2006) Re-emergence of Chikungunya virus in India. Indian J Med Microbiol 24:83–4.[Medline]
- Diallo M, Thonnon J, Traore-Lamizana M, Fontenille D. (1999) Vectors of Chikungunya virus in Senegal: current data and transmission cycles. Am J Trop Med Hyg 60:281–6.[Abstract]
- Chastel C. (2005) Chikungunya virus: its recent spread to the southern Indian Ocean and Reunion Island (2005–2006). Bull Acad Natl Med 189:1827–35.[Medline]
- Outbreak news. Chikungunya and dengue, south-west Indian Ocean. Wkly Epidemiol Rec (2006) 81:106–8.[Medline]
- McGill PE. (1995) Viral infections: alpha-viral arthropathy. Baillieres Clin Rheumatol 9:145–50.[CrossRef][Web of Science][Medline]
- Kennedy AC, Fleming J, Solomon L. (1980) Chikungunya viral arthropathy: a clinical description. J Rheumatol 7:231–6.[Web of Science][Medline]
- Brighton SW, Prozesky OW, de la Harpe AL. (1983) Chikungunya virus infection. A retrospective study of 107 cases. S Afr Med J 63:313–5.[Web of Science][Medline]
- Brighton SW. (1984) Chloroquine phosphate treatment of chronic Chikungunya arthritis. An open pilot study. S Afr Med J 66:217–8.[Web of Science][Medline]
- Pfeffer M and Löscher T. Editorial Team. (2006) Cases of Chikungunya imported into Europe. Eurosurveillance Weekly 11: Available from: http://www.eurosurveillance.org/ew/2006/060316.asp#2.
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