Reconociendo el virus del chikunguña / Rediscovering the chikungunya virus

Resumen | El virus de chikunguña (CHIKV) es un Alfavirus perteneciente al grupo denominado del Viejo Mundo; estos son virus artritogénicos que causan una enfermedad febril caracterizada por artralgias y mialgias. Aunque la muerte por CHIKV es poco frecuente, la enfermedad puede llegar a ser incapacitante y generar un amplio espectro de manifestaciones atípicas, como complicaciones cardiovasculares, respiratorias, oculares, renales y dérmicas, entre otras. Cuando el dolor articular persiste por tres o más meses, da lugar a la forma crónica de la enfermedad denominada reumatismo inflamatorio crónico poschikunguña, el cual es la principal secuela de la enfermedad. Se considera que este virus no es neurotrópico, sin embargo, puede afectar el sistema nervioso central y generar secuelas graves y permanentes, principalmente, en niños y ancianos. En África, Asia y Europa se habían reportado anteriormente brotes epidémicos por CHIKV, pero solo hasta finales del 2013 se documentó la introducción del virus a las Américas; desde entonces, el virus se ha propagado a 45 países o territorios del continente y el número de casos acumulados ascendió a cerca de dos millones en dos años. Esta revisión describe de manera general la biología molecular del virus, sus manifestaciones clínicas, su patogénesis y las principales complicaciones posteriores a la infección. Además, reúne la información de la epidemia en Colombia y el continente americano publicada entre el 2014 y el 2020.

Abstract | The chikungunya virus (CHIKV) is an Alphavirus that belongs to the Old World group. These arthritogenic viruses cause a febrile illness characterized by arthralgias and myalgias. Although fatal cases during CHIKV infection are rare, the disease may be disabling and generate a broad spectrum of atypical manifestations, such as cardiovascular, respiratory, eye, kidney, and skin complications, among others. When joint pain persists for three or more months, it results in the chronic form of the disease called post-chikungunya chronic inflammatory rheumatism, which constitutes the main disease sequel. CHIKV is not considered a neurotropic virus; however, it can affect the central nervous system, especially in children and the elderly, causing severe and permanent sequelae. CHIKV outbreaks had been previously reported in Africa, Asia, and Europe, but the virus introduction to the American continent was documented until the end of 2013. Since then, the virus has spread to 45 countries and territories causing near two million cases in just two years. This review describes the molecular biology, clinical manifestations, pathogenesis, and significant post-infection complications of CHIKV. Additionally, it collects published information about the outbreak in Colombia and the American continent between 2014 and 2020.

Chikungunya: educación y prevención como pilares fundamentales para enfermedad sin cura / Chikungunya: education and prevention as fundamental support for disease without cure

Chikungunya virus is an alphavirus, member of the Togaviridae family, first discovered in Africa in 1952. Since then it caused sporadic outbreaks in Africa and Asia, but since 2000, outbreaks had been more frequent, being identified in Europe, America and the Caribbean. Chikungunya virus can cause chronic and incapacitating arthralgia, with an important morbidity, being considered as a relevant re-emerging public health problem. This review intends to update our knowledge in epidemiology, transmission, pathogenesis, treatment and vaccination strategies of Chikungunya virus. (AU)

Perfil epidemiológico dos pacientes com evolução subaguda e crônica de infecção por Chikungunya / Epidemiologic profile of patients with subacute and chronic Chikungunya infection evolution

OBJETIVO: Analisar o perfil epidemiológico dos pacientes com evolução subaguda e crônica da infecção por Chikungunya, e avaliar suas principais alterações laboratoriais. MÉTODOS: Estudo observacional, realizado por meio da análise de 31 prontuários de pacientes atendidos em um centro de referência de doenças imunoinfecciosas, no Estado do Rio de Janeiro, no período de janeiro a maio de 2016. Foram selecionados prontuários de pacientes com Chikungunya em fase subaguda ou crônica com diagnóstico confirmado por sorologia IgM, de ambos os sexos e de todas as faixas etárias. As seguintes variáveis foram consideradas: sexo, idade, leucócitos, plaquetas, velocidade de hemossedimentação, e aspartato aminotransferases e alanina transaminase (AST/ALT). RESULTADOS: A faixa etária predominante foi de 50 a 69 anos (64,5%). Pertenciam ao sexo feminino 83,9% dos pacientes. Dentre as alterações laboratoriais, destacaram-se elevação da velocidade de hemossedimentação (46,15%), leucopenia (37%), elevação de transaminases (30,8% AST e 23% ALT) e trombocitopenia (11,1%). CONCLUSÃO: Observou-se a importância epidemiológica na determinação de pacientes potencialmente capazes de desenvolver tais sequelas, representada principalmente pela artralgia incapacitante. A identificação desse grupo, caracterizado como pacientes do sexo feminino e de faixa etária entre 50 e 69 anos, pode ser de grande valia para a prevenção da evolução mórbida dessa arbovirose, sabendo que tais pacientes necessitam de cuidados especiais e acompanhamento clínico mais rigoroso.(AU)

OBJECTIVES: To analyze the epidemiological profile of patients with subacute and chronic Chikungunya infection, and to evaluate their main laboratory abnormalities. METHODS: This is an observational study, carried out through the analysis of 31 medical records of patients attended at a Reference Center for Immunopathological Diseases in the state of Rio de Janeiro, from January to May 2016. Patients with Chikungunya were selected in the subacute or chronic phase with diagnosis confirmed by IgM serology; both genders and all age ranges. The following variables were considered: gender, age, leukocytes, platelets, erythrocyte sedimentation rate, and aspartate aminotransferases and alanine transaminase (ASTALT). RESULTS: The predominant age range was 50 to 69 years (64.5%), with 83.9% of the patients being female. Among the laboratory alterations, high erythrocyte sedimentation rate (46.15%), leukopenia (37%), high transaminases (30.8% AST, and 23% ALT), and thrombocytopenia (11.1%) were observed. CONCLUSIONS: The epidemiological importance in the determination of patients potentially capable of developing such sequels, represented mainly by incapacitating arthralgia, was observed. The identification of this group, characterized as female patients, and between 50 and 69 years of age, may be of great value in the prevention of the morbid progression of this arbovirosis, knowing that such patients require special care, and stricter clinical follow-up.(AU)

Estudio Transversal: Conocimientos, Actitudes y Prácticas sobre el Chikungunya en la Población de la Parroquia Bartolomé Ruiz del Cantón Esmeraldas ­ Ecuador, 2015 / Cross-Sectional Research: Knowledge, Attitudes and Practices on the Chikungunya in the Population of the Parish Bartolome Ruiz of the Canton Esmeraldas ­ Ecuador, 2015

INTRODUCCIÓN: En el año 2016 se reportaron 34261 casos de Chikungunya en Ecuador, La provincia de Esmeraldas ocupó el primer lugar con la mayor cantidad de casos. La enfermedad superó la capacidad de respuesta de los servicios sanitarios de esta provincia. Las condiciones socio-económicas y culturales de su población, así como su geografía están relacionadas con la aparición de esta enfermedad endémica, casos originarios y diseminación de la enfermedad. El objetivo del estudio fue determinar los conocimientos, actitudes y prácticas sobre el Chikungunya en los habitantes de la Parroquia Bartolomé Ruiz del Cantón Esmeraldas. MÉTODO: Se trató es un estudio descriptivo transversal de los conocimientos, actitudes y prácticas sobre Chikungunya en los habitantes de la Parroquia Bartolomé Ruiz Del Cantón Esmeraldas - Ecuador. Universo: 2679 habitantes. Muestra: 396 habitantes. Se aplicó un formulario de conocimientos, actitudes y prácticas. El puntaje obtenido se categorizó en: bueno, regular, malo. El análisis de la información se realizó en SPSS versión 20.0. RESULTADOS: La media de edad fue 39.46 años. El 31.3 % poseían buenos conocimientos, buenas actitudes 31.3 % y buenas practicas 8.8 %. CONCLUSIONES: Se encontró un déficit en el nivel de conocimientos, buenas actitudes y buenas prácticas como medidas de prevención frente a la fiebre del Chikungunya. La presencia de factores ambientales de riesgo, así como la poca práctica de conductas protectoras predispuso a la gran incidencia de la enfermedad. La principal recomendación para disminuir la incidencia del Chikungunya es la adopción de medidas preventivas, las cuales dependen de factores socioculturales y cognitivos.

BACKGROUND: In 2016, 34261 cases of Chikungunya were reported in Ecuador. The province of Esmeraldas occupies the first place with more cases. The disease exceeded the capacity of health services in this province. The socio-economic and cultural conditions of its population, as well as its geography, are related to the appearance ofthis endemic disease, original cases and dissemination of the disease. The aim of this study was to determine the knowledge, attitudes and practices about the Chikungunya in the inhabitants ofthe Parish Bartolome Ruiz ofthe Esmeraldas Canton. METHODS: A cross-sectional research descriptive study of the knowledge, attitudes and practices on Chikungunya in the inhabitants ofthe ParishBartolome Ruiz ofthe Canton Esmeraldas - Ecuador. Universe: 2679 inhabitants. Sample: 396 inhabitants. Knowledge, attitudes and practices form was applied. And the obtained score was categorized in: good,regular, bad. The analysis of the information was done in SPSS version 20.0. RESULTS: The mean age was 39.46 years. 31.3% had good knowledge, good attitudes 31.3 % and good practices 8.8%. CONCLUSIONS: There was a shortfall in the level of knowledge, good attitudes and good practices as prevention measures against Chikungunya fever. The presence of environmental risk factors, as well as the little practice of protective behaviors predisposed the high incidence of the disease. The main recommendation to reduce the incidence of Chikungunya is the adoption of preventivemeasures, which depend on socio-cultural and cognitive factors.

Chikungunya Outbreak in Pakistan

The Chikungunya outbreak reported from Pakistan [Please see weekly epidemiological monitor-issue no 01; volume-10; 01 January 2017] showed a slight peak in recent time with additional cases reported. A total of 2,267 cases were notified to WHO from 19 December 2016 to 05 May 2017. All the cases have been reported from Karachi, Sindh Province

Metanálisis sobre la utilidad de ELISA, PCR e inmunocromatografía en el diagnóstico de chikungunya / Meta-analysis of the usefulness of ELISA, PCR, and immunochromatography for the diagnosis of Chikungunya / Meta-análise da utilidade dos exames ELISA, PCR e imunocromatografia no diagnóstico de febre chikungunya

RESUMEN Objetivo Evaluar la utilidad de ELISA, PCR e inmunocromatografía para el diagnóstico de chikungunya. Métodos Se realizó un metanálisis de estudios que reportaran datos de validez diagnóstica, a partir de un protocolo ex-ante con seis estrategias de búsqueda en tres bases de datos multidisciplinarias. Se garantizó la reproducibilidad en la selección y extracción de información, se evaluó la calidad con la guía QUADAS (Quality Assessment of studies of Diagnostic Accuracy), los análisis se realizaron en MetaDisc con medidas puntuales, intervalos de confianza y resultados combinados bajo un modelo de efectos aleatorios. Resultados Se incluyeron 19 estudios, uno con ELISA para anticuerpos IgG, dos con ELISA para antígenos, cinco con ELISA de anticuerpos IgM, ocho con qPCR y tres con inmunocromatografía. Los artículos fueron publicados entre 2009 y 2015, principalmente en India (37%), usando como prueba de referencia la combinación de sintomatología clínica, RT-PCR, ELISA, ensayo de neutralización o aislamiento viral. La población fue 1 108 individuos sanos, 394 con otra infección (principalmente dengue) y 1 288 con chikungunya. En ELISA para IgM y qPCR la sensibilidad y especificidad fueron mayores al 90%, el cociente de probabilidad positivo mayor a 10, el cociente de probabilidad negativo menor a 0,1; razón de Odds diagnóstica mayor a 100 y área bajo la curva de 0,99. Conclusión Se halló una excelente utilidad diagnóstica de la ELISA IgM y qPCR, mientras que para inmunocromatografía la utilidad fue escasa.

ABSTRACT Objective Evaluate the usefulness of ELISA, PCR, and immunochromatography for the diagnosis of Chikungunya. Methods A meta-analysis of studies reporting diagnostic validity data was performed, using an ex-ante protocol with six search strategies in three multidisciplinary databases. Replicability in the selection and retrieval of information was guaranteed; quality was evaluated using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) guide; the analyses were performed in MetaDisc, with specific measures, confidence intervals, and combined results under a random-effects model. Results A total of 19 studies were included, one with IgG ELISA, two with antigencapture ELISA, five with IgM ELISA, eight with qPCR, and three with immunochromatography. The articles were published primarily in India (37%) between 2009 and 2015, using a combination of clinical symptoms, RT-PCR, ELISA, neutralization assay, or viral isolation as the reference test. The population consisted of 1 108 healthy individuals, 394 with another infection (mainly dengue), and 1 288 with Chikungunya. In IgM ELISA and qPCR, the sensitivity and specificity were greater than 90%, the positive probability quotient was greater than 10, the negative probability quotient was less than 0.1, the diagnostic odds ratio was greater than 100, and the area under the curve was 0.99. Conclusion IgM ELISA and qPCR were found to be excellent for diagnosis, while immunochromatography was only of limited usefulness.

RESUMO Objetivo Avaliar a utilidade dos exames ELISA, PCR e imunocromatografia no diagnóstico de febre chikungunya. Métodos Uma meta-análise de estudos com dados de validade diagnóstica foi conduzida em três bases de dados multidisciplinares segundo um protocolo de avaliação ex-ante contendo seis estratégias de busca. Foi garantida a reprodutibilidade na seleção e extração de informação e avaliada a qualidade segundo os critérios do guia QUADAS (Quality Assessment of Studies of Diagnostic Accuracy). As análises foram realizadas no programa Meta-DiSc com estimativas pontuais, intervalos de confiança e resultados combinados em um modelo de efeitos aleatórios. Resultados A meta-análise incluiu 19 estudos, a saber: um sobre ELISA de anticorpos IgG, dois sobre ELISA de antígenos, cinco sobre ELISA de anticorpos IgM, oito sobre PCR quantitativa (qPCR) e três sobre imunocromatografia. Os artigos foram publicados entre 2009 e 2015, sobretudo na Índia (37%), e usaram como referência critérios clínicos, PCR em tempo real (RT-PCR), ELISA, ensaio de neutralização ou isolamento viral. A população abrangeu 1.108 indivíduos saudáveis, 394 que apresentavam outra infecção (mais comumente, dengue) e 1.288 com febre chikungunya. Com relação ao ELISA-IgM e qPCR, a sensibilidade e a especificidade foram superiores a 90%, a razão de probabilidade positiva foi maior que 10 e a razão de probabilidade negativa menor que 0,1, a razão de chances diagnóstica foi maior que 100 e a área sob a curva foi de 0,99. Conclusão Verificou-se excelente utilidade diagnóstica do ELISA-IgM e qPCR e baixa utilidade da imunocromatografia no diagnóstico de febre chikungunya.

Chlkungunya in Somalia

During the month of May 2016, Somalia reported few sporadic cases of Chikungunya from its capital city–Mogadishu. At-least 11 blood samples were tested positive for chikungunya at the Kenya Medical Research Institute [KEMRI]. The tests were done using Real Time PCR as well as ELISA

Manifestaciones oculares de infección del virus del Chikunguña: revisión de literatura / Ocular manifestations of Chikungunya virus infection: a review

La fiebre por virus de Chikunguña es producida por un arbovirus, RNA virus el cual es trasmitido por la picadura de mosquitos infectados. Los síntomas más importantes en estado agudo son fiebre, dolor articular y rash cutáneo. Aunque la enfermedad no se considera una amenaza para la vida del paciente, se han realizado varios reportes de mortalidad por la enfermedad. Hay también numerosos casos con descripción de manifestaciones atípicas las cuales son causa de morbilidad, que pueden dejar secuelas en el organismo y a nivel ocular con repercusiones en calidad de vida de los pacientes; por lo cual médicos de diferentes especialidades y oftalmólogos debemos estar al corriente de la enfermedad para realizar un diagnóstico y tratamiento oportuno. Esta revisión hace énfasis en la etiología, epidemiología, manifestaciones sistémicas y oculares, diagnóstico y tratamiento disponible.

Chikungunya fever is caused by an arbovirus, a RNA virus that is transmitted by the bite of infected mosquitoes. The most relevant acute symptoms of the disease are fever, joint pain and rash. Although Chikungunya is generally not considered life threatening, there are reports of cases with mortality; atypical clinical manifestations resulting in significant morbidity have been documented, besides sequels that may cause several different manifestation in the organism and the eyes and repercussions in the quality of life of patients; physicians of different specialties of medicine and ophthalmologist should be aware of it to perform a promptly diagnosis and treatment. This review highlights the current understanding on the etiology, pathogenesis, epidemiology, systemic changes with an emphasis on ocular findings, diagnosis and available treatment of the disease.

Entomological study of chikungunya infections in the State of Kelantan, Malaysia.

Background & objectives: Chikungunya infection has become a public health threat in Malaysia since the 2008 nationwide outbreaks. Aedes albopictus Skuse has been identified as the chikungunya vector in Johor State during the outbreaks. In 2009, several outbreaks had been reported in the State of Kelantan. Entomological studies were conducted in Kelantan in four districts, namely Jeli, Tumpat, Pasir Mas and Tanah Merah to identify the vector responsible for the virus transmission. Methods: CHIKV cases records were obtained from State Health Department, Kelantan and localities involved were identified. Larva survey was conducted to collect the immature mosquito stages. Modified aspirators were used to collect the adult mosquitoes. All samples on dry ice were transferred to laboratory and the presence of the virus was detected using reverse transcriptase PCR. Results: A total of 1,245 mosquito larvae were collected during larval survey and 2,019 adult mosquitoes were collected using aspirator. From these collections, 640 mosquito pools were tested for the presence of CHIKV by RT-PCR but none found positive. Ae. albopictus was the most abundant mosquito collected, followed by Culex sp., Armigeres sp. and Anopheles sp. A total of 2, 814 artificial containers were inspected during the study. Interpretation & conclusions: Since none of the mosquito samples was found to be positive for chikungunya virus, the vector(s) of chikungunya virus in these localities could not be identified.

Amenaza del virus Chikungunya: la globalización de las enfermedades transmitidas por insecto vector / The Chikungunya threat: the globalization of vectorborne diseases

El brote de infección Chikungunya (CHIKV) que se produjo en el verano de 2007 en una zona templada del norte de Italia, constituye un nuevo modelo para la difusión de una enfermedad tropical fuera de los lugares convencionales, esta situación ha sido causada principalmente, por la peligrosa mezcla de la gran población de un competente vector, el mosquito tigre de Asia, y la posibilidad de que una persona regrese de la zona de la difusión normal de CHIKV durante la fase de viremia asintomática. Teniendo en cuenta las dificultades para controlar la propagación de Aedes albopictus y el gran número de personas que viajan hacia y desde los ámbitos de la difusión normal de las enfermedades transmitidas por vectores tropicales, pensamos que la epidemia de 2007 podría ser sólo la primera de una serie de posibles brotes. En conclusión, esta epidemia urbana de la infección CHIKV en un país templado, determina una nueva perspectiva en la preparación para las inesperadas infecciones emergentes por el virus, las que deben ser afrontadas mediante una estrategia combinada de difusión de vigilancia de vectores, y el diagnóstico inmediato de cualquier caso sospechoso de importación transmitido por vectores de enfermedades exóticas.

The outbreak of CHIKV infection that occurred in summer 2007 in a temperate area of northern Italy constitues a new model for the diffusion of a tropical disease outside the conventional locations; this situation has been caused mainly by the dangerous mixture of the large population of a highly competent vector, the Asian tiger mosquito, and the possibility that an individual comes back from the area of normal diffusion of CHIKV during the asymptomatic viremic stage. Considering the difficulties in controlling the spread of Aedes albopictus and the large number of people travelling to and from the areas of normal diffusion of vector-borne tropical diseases, we think that the 2007 epidemic could be only the first of a possible series of these aoutbreaks. In conclusion, this urban epidemic of CHIKV infection in a temperate country determines a new perspective in the preparedness to unexpected emerging virus infections that must be faced by using a combined strategy of vector diffusion monitoring and immediate diagnosis of any suspected cases of imported vector-borne exotic disease.

Failure to demonstrate experimental vertical transmission of the epidemic strain of Chikungunya virus in Aedes albopictus from La Réunion Island, Indian Ocean

Aedes albopictus was responsible for transmission in the first outbreak of chikungunya (CHIK) on La Réunion Island, Indian Ocean, in 2005-2006. The magnitude of the outbreak on this island, which had been free of arboviral diseases for over 30 years, as well as the efficiency of Ae. albopictus as the main vector, raises questions about the maintenance of the CHIK virus (CHIKV) through vertical transmission mechanisms. Few specimens collected from the field as larvae were found to be infected. In this study, Ae. albopictus originating from La Réunion were orally infected with a blood-meal containing 10(8) pfu/mL of the CHIKV epidemic strain (CHIKV 06.21). Eggs from the first and second gonotrophic cycles were collected and raised to the adult stage. The infectious status of the progeny was checked (i) by immunofluorescence on head squashes of individual mosquitoes to detect the presence of viral particles or (ii) by quantitative RT-PCR on mosquito pools to detect viral RNA. We analysed a total of 1,675 specimens from the first gonotrophic cycle and 1,709 from the second gonotrophic cycle without detecting any viral particles or viral RNA. These laboratory results are compared to field records.