RESUMEN

BACKGROUND: Chikungunya fever compromises the functionality and quality of life in the affected individuals, even one year after the acute phase of the disease. Chronically affected people experience direct impairment in performing daily activities, along with a risk of developing other morbidities. BACKGROUND: ◼ Even after a year, chikungunya fever-affected people experience damage to their physical and mental health. BACKGROUND: ◼ Positive screening for depression risk was 13.5 times more likely in chronically affected. BACKGROUND: ◼ Patients with chronic chikungunya fever had a 76 times higher risk of walking impairments. OBJECTIVE: To evaluate the impact of chronic illness caused by chikungunya fever on the quality of life and functionality of affected individuals. METHODS: A cross-sectional and comparative study was conducted in which two groups were investigated: a Chikungunya Group comprising 25 patients with chronic fever screened after 1 year of illness via a telephonic survey, and a Healthy Group comprising 25 healthy individuals matched for sex and age by face-to-face interview. The Stanford HAQ 20-Item Disability Scale (HAQ) and the Short Form Health Survey (SF-12) questionnaires were administered to both groups. Generalized Linear Models, Pearson χ2 tests, and odds ratios were used to evaluate the test results. RESULTS: Significant differences in functional capacity and quality of life were observed between the Chikungunya and Healthy Groups. The chance of some impairment in functionality was also much higher in the Chikungunya Group in four of the HAQ categories, especially in the "walking" category (adjusted OR= 109.40). Further, the Chikungunya Group had a higher chance of presenting a below-average score in the mental component summary of the SF-12 (adjusted OR= 16.20) and of being positive in depression risk screening (adjusted OR= 34.57). CONCLUSION: Even one year after the acute phase, chikungunya fever can compromise the functionality and quality of life in affected individuals, with direct impairment in performing daily activities. Studies and therapeutic plans for chikungunya fever should consider the long-term impacts of this disease.

Asunto(s)

Fiebre Chikungunya , Calidad de Vida , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/fisiopatología , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Enfermedad Crónica , Adulto , Estudios de Casos y Controles , Actividades Cotidianas , Encuestas y Cuestionarios , Anciano

RESUMEN

Introducción: La fiebre chikungunya es una infección causada por el virus chikungunya (CHIKV), ocasionando una enfermedad con un espectro que varía desde asinto-mática hasta presentaciones con compromisos graves. El presente trabajo tiene como objetivo describir las ca-racterísticas clínicas y laboratoriales de pacientes con CHIKV y las complicaciones neurológicas asociadas, de noviembre a abril de 2023, con el fin de conocer el espec-tro de enfermedades asociadas con el sistema nervioso y su progresión. Metodología: Estudio multicéntrico de cohorte retros-pectivo, analítico, en pacientes mayores de 18 años, con diagnóstico de Infección por CHIKV, con compromiso neurológico asociado. Las variables cualitativas fueron expresadas como frecuencias absolutas y porcentuales; y las cuantitativas como media y desvío estándar. Resultados: 87 pacientes; 57 sexo masculino (65%), me-dia de 62 años. Las manifestaciones neurológicas más frecuentes: 42 (48,28%) encefalitis, 20 (22,99%) convul-siones febriles, 13 (14,94%) síndrome Guillain Barre, 12 (13,79%) meningoencefalitis, 6 (6,90%) mielitis, 3 (3,45%) alteración de pares craneales, y 1 paciente ADEM. 40 pa-cientes (46%) requirieron ingreso a UTI. La mortalidad global se estimó en un 32% (28/87). Discusión: La presentación de complicaciones neurológi-cas fue observada principalmente en pacientes del sexo masculino, mayores de 60 años, siendo la encefalitis la manifestación más frecuente. Comparando los grupos de fallecidos y los no fallecidos, no se encontró relación significativa entre los factores de riesgo ni en las caracte-RESUMENCOMUNICACIÓN BREVEDesirée Almiron1 , Gonzalo Aranda2, Luis Báez2, Gustavo Benítez1, Cynthia Caballero3, Miguel Cardozo1, Ariel Fretes4, Martha Sady Galeano2 , Belén Gaona1, Amílcar García5, Leticia Gómez6, Oscar Gómez7, Amanda Guerrero4, Anwar Miranda8, Gerardo Müller2, Williams Ortiz7, Fátima Ovando2, Melisa Ramírez8, Julio Rolón6, Liz Rondelli5, Joaquín Villalba1y Gustavo Villar9.rísticas laboratoriales halladas. Aproximadamente en la tercera parte de los pacientes se observó desenlace fatal

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Introduction: Chikungunya Fever is an infection caused by the Chikungunya virus (CHIKV), resulting in a disease with a spectrum that ranges from asymptomatic cases to severe presentations. The purpose of this study is to delineate the clinical and laboratory characteristics of patients with CHIKV and associated neurological complications, from november 2023 to April 2023. This was done in order to gain insight into the spectrum of diseases associated with the nervous system and their progression. Methodology: A retrospective, analytical, multicenter cohort study involving patients over 18 years of age diagnosed with Chikungunya virus infection (CHIKV) and associated neurological compromise. Descriptive and analytical statistics were utilized. Qualitative variables were expressed as absolute frequencies and percentages, while quantitative variables were presented as mean and standard deviation. Results: 87 patients were included, with 57 being male (65%), with an average age of 62. CHIKV PCR analysis was performed in 92% of the cases, and it was positive in 89% (71 patients). The most frequent neurological manifestations were encephalitis in 42 (48.28%) cases, febrile seizures in 20 (22.99%) cases, Guillain-Barré syndrome (GBS) in 13 (14.94%) patients, meningoencephalitis in 12 (13.79%) patients, myelitis in 6 (6.90%) patients, cranial nerve involvement in 3 (3.45%) patients, and 1 patient with acute disseminated encephalomyelitis (ADEM). Forty patients (46%) required admission to the Intensive Care Unit (ICU). The overall mortality was estimated at 32% (28/87). Discussion: The presentation of neurological complications was mainly observed in male patients over 60 years of age, with encephalitis being the most frequent manifestation. Comparing the deceased and non-deceased groups, no significant relationship was found between risk factors and laboratory characteristics. Fatal outcomes were observed in approximately one- third of the patients

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Encefalitis por Arbovirus/complicaciones , Fiebre Chikungunya/complicaciones , Manifestaciones Neurológicas

RESUMEN

BACKGROUND: Chikungunya fever (CF) is a viral disease, transmitted by alphavirus through Aedes aegypti, and albopictus mosquitoes, affecting several people, mainly in tropical countries, when its transmitter is not under control, and the main symptom of the chronic phase of CF is joint pain. OBJECTIVES: The primary objective of this study was to observe the prevalence, most affected joints, and intensity of chronic joint pain in individuals affected by CF, and also identify the factors associated with chronic joint pain in these individuals. METHODS: Cross-sectional study that evaluated one hundred and thirty volunteers, of both sexes, aged between 20-65 years, with a clinical and/or laboratory diagnosis of CF. The presence of joint pain was investigated using the Brazilian version of the Nordic Questionnaire of Musculoskeletal Symptoms and the intensity of pain using the Visual Analogue Scale. RESULTS: Of the 130 volunteers evaluated, n = 112 (86%) reported currently experiencing chronic joint pain, persistent, for approximately 38.6 ± 1.73 months, with the greatest predominance in the morning (58%). The joints most affected by pain were: the ankles (65.5%), interphalangeal joints of the hands (59.2%), and knees (59.2%). The joints that presented the greatest intensity of pain were: the ankles (5.13 ± 0.34), interphalangeal joints of the hands (4.63 ± 0.34), and knees (4.33 ± 0.33). Sedentary behavior (p = 0.037), increasing age (p = 0.000), and overweight/obesity (p = 0.002) were factors associated with chronic joint pain. CONCLUSION: A high prevalence of chronic, persistent joint pain was observed, with a greater prevalence in the morning. The joints most affected by chronic pain and with the greatest pain intensity were the ankles, and interphalangeal joints of the hands and knees. Sedentary behavior, increasing age, and overweight/obesity were the factors associated with chronic joint pain in individuals affected by CF in this study. Key Points • Individuals affected by CF had a high prevalence of chronic joint pain, persistent and more prevalent in the mornings • The ankles and interphalangeal joints of the hands and knees were the joints with the highest prevalence of pain • The ankles and interphalangeal joints of the hands and knees were the joints with the greatest pain intensity • Sedentary behavior, increasing age, and overweight/obesity were factors associated with chronic joint pain in individuals affected by CF.

Asunto(s)

Artralgia , Fiebre Chikungunya , Dolor Crónico , Obesidad , Sobrepeso , Conducta Sedentaria , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/epidemiología , Estudios Transversales , Artralgia/epidemiología , Obesidad/complicaciones , Obesidad/epidemiología , Anciano , Adulto Joven , Dolor Crónico/epidemiología , Factores de Edad , Sobrepeso/complicaciones , Sobrepeso/epidemiología , Brasil/epidemiología , Prevalencia , Dimensión del Dolor

RESUMEN

Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given.

Asunto(s)

Infecciones por Arbovirus , Humanos , Infecciones por Arbovirus/epidemiología , Arbovirus , Brasil/epidemiología , Trasplante de Riñón , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico , Enfermedades Renales/virología , Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Enfermedades Renales/etiología , Dengue/epidemiología , Dengue/complicaciones , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/complicaciones , Fiebre Amarilla/epidemiología

RESUMEN

BACKGROUND: Musculoskeletal inflammatory lesions in chronic Chikungunya virus (CHIKV) infection have not been thoroughly assessed using whole-body magnetic resonance imaging (WBMRI). This study aimed to determine the prevalence of these lesions in such patients. METHODS: From September 2018 to February 2019, patients with positive Chikungunya-specific serology (Immunoglobulin M/Immunoglobulin G anti-CHIKV), with a history of polyarthralgia for > 6 months prior to MRI with no pre-existing rheumatic disorders, underwent 3T WBMRI and localized MRI. The evaluation focused on musculoskeletal inflammatory lesions correlated with chronic CHIKV infection. Pain levels were assessed using a visual analogue scale on the same day as WBMRI. RESULTS: The study included 86 patients of whom 26 met the inclusion criteria. All patients reported pain and most (92.3%) categorized it as moderate or severe. The most common finding across joints was effusion, particularly in the tibiotalar joint (57.7%) and bursitis, with the retrocalcaneal bursa most affected (48.0%). Tenosynovitis was prevalent in the flexor compartment of the hands (44.2%), while Kager fat pad and soleus edema were also observed. Bone marrow edema-like signals were frequently seen in the sacroiliac joints (19.2%). Most WBMRI findings were classified as mild. CONCLUSIONS: This study represents the first utilization of 3T WBMRI to assess musculoskeletal inflammatory disorders in chronic CHIKV infection. The aim was to identify the most affected joints and prevalent lesions, providing valuable insights for future research and clinical management of this condition regarding understanding disease pathophysiology, developing targeted treatment strategies, and using advanced imaging techniques in the assessment of musculoskeletal manifestations.

Asunto(s)

Fiebre Chikungunya , Imagen por Resonancia Magnética , Imagen de Cuerpo Entero , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Adulto , Enfermedad Crónica , Anciano , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Adulto Joven

RESUMEN

BACKGROUND: Chikungunya fever is an emerging global infection transmitted by Aedes mosquitoes that manifests as an acute febrile illness with joint pain and can lead to chronic arthritis. The mechanism underlying chronic joint damage remains unclear; however, chronic chikungunya arthritis shares similarities with rheumatoid arthritis. Disease-modifying antirheumatic drugs have revolutionized rheumatoid arthritis treatment by preventing joint damage. However, the role of these therapies in chronic chikungunya arthritis has not been determined. We conducted a systematic review to evaluate the burden of joint structural damage in chronic chikungunya arthritis to help to define the role of disease-modifying therapy in this disease. METHODS: This systematic review included retrospective and prospective studies, trials, and case reports evaluating joint damage caused by chikungunya virus. Various databases were searched without any date or language restrictions. Study selection was conducted independently by two researchers, and data were extracted from the articles selected. RESULTS: A total of 108 studies were initially evaluated, with 8 meeting the inclusion criteria. Longitudinal studies have reported persistent joint pain from chikungunya infection and the progression of radiographic joint damage up to 13 years post-infection. Joint imaging revealed synovial inflammation, bone erosion, and cartilage destruction in patients with chronic chikungunya arthritis. CONCLUSIONS: Few studies have addressed chikungunya-induced joint damage, limiting our understanding of chronic chikungunya arthritis. Nevertheless, chronic chikungunya arthritis has similarities to rheumatoid arthritis. The success of early disease-modifying antirheumatic drug therapy in rheumatoid arthritis underscores the need for comprehensive research on its role in chikungunya arthritis.

Asunto(s)

Antirreumáticos , Artritis Reumatoide , Fiebre Chikungunya , Virus Chikungunya , Humanos , Antirreumáticos/uso terapéutico , Artralgia/etiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Fiebre Chikungunya/complicaciones , Estudios Prospectivos , Estudios Retrospectivos

RESUMEN

Sickle Cell Disease (SCD) is a hereditary disease characterized by extravascular and intravascular hemolysis and clinical variability, from mild pain to potentially life-threatening. Arboviruses include mainly Zika (ZIKV), Chikungunya (CHKV), and Dengue (DENV) virus, and are considered a public and social health problem. The present cross-sectional observational study aimed to investigate the prevalence of arbovirus infection in SCD patients from two Brazilian cities, Salvador and Manaus located in Bahia and Amazonas states respectively. A total of 409 individuals with SCD were included in the study, and 307 (75.06 %) patients tested positive for DENV-IgG, 161 (39.36 %) for ZIKV-IgG, and 60 (14.67 %) for CHIKV-IgG. Only one individual was positive for DENV-NS1 and another for DENV-IgM, both from Salvador. No individuals had positive serology for ZIKV-IgM or CHIKV-IgM. Arbovirus positivity by IgG testing revealed that the SCD group presented high frequencies in both cities. Interestingly, these differences were only statistically significant for ZIKV-IgG (p = 0.023) and CHIKV-IgG (p = 0.005) among SCD patients from Manaus. The reshaping of arbovirus from its natural habitat by humans due to disorderly urban expansion and the ease of international Mobility has been responsible for facilitating the spread of vector-borne infectious diseases in humans. We found the need for further studies on arboviruses in this population to elucidate the real association and impact, especially in acute infection. We hope that this study will contribute to improvements in the personalized clinical follow-up of SCD patients, identifying the influence of arbovirus infection in severe disease manifestations.

Asunto(s)

Anemia de Células Falciformes , Infecciones por Arbovirus , Arbovirus , Humanos , Brasil/epidemiología , Anemia de Células Falciformes/epidemiología , Anemia de Células Falciformes/complicaciones , Estudios Transversales , Masculino , Femenino , Adulto , Prevalencia , Infecciones por Arbovirus/epidemiología , Infecciones por Arbovirus/virología , Adulto Joven , Adolescente , Arbovirus/aislamiento & purificación , Inmunoglobulina G/sangre , Niño , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/complicaciones , Anticuerpos Antivirales/sangre , Persona de Mediana Edad , Dengue/epidemiología , Inmunoglobulina M/sangre , Virus del Dengue/inmunología , Virus Zika/inmunología , Virus Zika/aislamiento & purificación , Preescolar , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/complicaciones

RESUMEN

BACKGROUND: Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia. OBJECTIVE: To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood. METHODS: In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits. RESULTS: There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests. CONCLUSION: tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7.

Asunto(s)

Fiebre Chikungunya , Dolor Crónico , Corteza Motora , Calidad de Vida , Estimulación Transcraneal de Corriente Directa , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estimulación Transcraneal de Corriente Directa/métodos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/terapia , Método Doble Ciego , Adulto , Dolor Crónico/terapia , Dolor Crónico/etiología , Dolor Crónico/psicología , Corteza Motora/fisiopatología , Artralgia/terapia , Artralgia/etiología , Resultado del Tratamiento , Dimensión del Dolor , Enfermedad Crónica

RESUMEN

Chikungunya can result in debilitating arthralgia, often presenting as acute, self-limited pain, but occasionally manifesting chronically. Little is known about differences in chikungunya-associated arthralgia comparing children to adults over time. To characterize long-term chikungunya-associated arthralgia, we recruited 770 patients (105 0-4 years old [y/o], 200 5-9 y/o, 307 10-15 y/o, and 158 16+ y/o) with symptomatic chikungunya virus infections in Managua, Nicaragua, during two consecutive chikungunya epidemics (2014-2015). Participants were assessed at ~15 days and 1, 3, 6, 12, and 18 months post-fever onset. Following clinical guidelines, we defined participants by their last reported instance of arthralgia as acute (≤10 days post-fever onset), interim (>10 and <90 days), or chronic (≥90 days) cases. We observed a high prevalence of arthralgia (80-95%) across all ages over the study period. Overall, the odds of acute arthralgia increased in an age-dependent manner, with the lowest odds of arthralgia in the 0-4 y/o group (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.14-0.51) and the highest odds of arthralgia in the 16+ y/o participants (OR: 4.91, 95% CI: 1.42-30.95) relative to 10-15 y/o participants. Females had higher odds of acute arthralgia than males (OR: 1.63, 95% CI: 1.01-2.65) across all ages. We found that 23-36% of pediatric and 53% of adult participants reported an instance of post-acute arthralgia. Children exhibited the highest prevalence of post-acute polyarthralgia in their legs, followed by the hands and torso - a pattern not seen among adult participants. Further, we observed pediatric chikungunya presenting in two distinct phases: the acute phase and the subsequent interim/chronic phases. Thus, differences in the presentation of arthralgia were observed across age, sex, and disease phase in this longitudinal chikungunya cohort. Our results elucidate the long-term burden of chikungunya-associated arthralgia among pediatric and adult populations.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Adulto , Masculino , Femenino , Humanos , Niño , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/epidemiología , Estudios Prospectivos , Nicaragua/epidemiología , Artralgia/etiología , Artralgia/complicaciones , Fiebre/complicaciones

RESUMEN

BACKGROUND: Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. OBJECTIVE: This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. METHODS: Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. RESULTS: Patients showed different neuroimaging patterns. Six patients exhibited a "clock dial pattern" with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. CONCLUSION: The "clock dial pattern" observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

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ANTECEDENTES: A chikungunya é uma doença transmitida por mosquitos causada pelo vírus chikungunya (CHIKV) e pode levar a complicações neurológicas em casos graves. OBJETIVO: Este estudo examinou padrões de neuroimagem em casos de chikungunya durante dois surtos no Brasil para identificar padrões específicos para o diagnóstico e tratamento de neurochikungunya. MéTODOS: Oito pacientes com chikungunya confirmada e envolvimento neurológico foram incluídos. Exames clínicos e ressonâncias magnéticas (RM) foram realizados, e os achados foram analisados por neurorradiologistas. Dados sobre idade, sexo, sintomas neurológicos, testes diagnósticos, achados de RM e desfechos clínicos foram registrados. RESULTADOS: Os pacientes apresentaram diferentes padrões de neuroimagem. Seis pacientes apresentaram um "padrão de mostrador de relógio" com lesões pontilhadas hiperintensas na periferia da medula espinhal. Um paciente apresentou espessamento e realce das raízes nervosas anteriores. A RM do cérebro revelou múltiplas lesões hiperintensas na substância branca, especialmente no bulbo em seis pacientes. Um paciente apresentou uma RM cerebral normal. CONCLUSãO: O "padrão de mostrador de relógio" observado na RM da medula espinhal pode ser indicativo de lesões do sistema nervoso relacionadas à chikungunya. O envolvimento isolado da substância branca da medula espinhal na chikungunya pode ajudar a diferenciá-la de outras infecções virais. Além disso, o envolvimento distinto do tronco cerebral na encefalite associada à chikungunya, especialmente na região rostral, a distingue de outras infecções por arbovírus. O reconhecimento desses padrões de neuroimagem pode contribuir para o diagnóstico precoce e manejo adequado da neurochikungunya.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Enfermedades del Sistema Nervioso , Animales , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico por imagen , Enfermedades del Sistema Nervioso/complicaciones , Imagen por Resonancia Magnética , Neuroimagen

RESUMEN

BACKGROUND: Chikungunya virus infection, transmitted by Aedes mosquito vectors, causes outbreaks of chikungunya fever (CHIKF), throughout the tropical and subtropical world. Following acute infection, many CHIKF patients develop a second phase, chronic and disabling arthritis. OBJECTIVE: To evaluate the impact of chikungunya arthritis (CHIKA) on quality of life and disability in a cohort of Brazilian CHIKA patients. METHODS: We conducted a descriptive, non-interventionist, retrospective cross-sectional study analysing data collected from the medical records of chikungunya virus-infected patients treated between June 1, 2022, and June 30, 2022, in the Brazilian rheumatology clinic of one of us (JKA). To assess disability, quality of life, and pain, patients were evaluated using the Health Assessment Questionnaire Disability Index (HAQ-DI), 12-Item Short-Form Health Survey (SF-12), and Visual Analog Scale (VAS) pain. RESULTS: Forty-two women with a mean (± SD) age of 57.83 (± 13.05) years had CHIKF confirmed by chikungunya-specific serology. The mean (± SD) time between the onset of chikungunya symptoms and the first clinic visit was 55.19 (± 25.88) days. At this visit, the mean (± SD) VAS pain score and DAS28-ESR were 77.26 (± 23.71) and 5.8 (± 1.29), respectively. The mean (± SD) HAQDI score was 1.52 (± 0.67). The mean (± SD) SF-12 PCS-12 was 29.57 (± 8.62) and SF-12 MCS-12 was 38.42 (± 9.85). CONCLUSION: CHIKA is often highly disabling. As the mosquito vectors that transmit this illness have spread to every continent except Antarctica, there is a potential for widespread public health impact from CHIKA and the need for more effective, early intervention to prevent CHIKA.

Asunto(s)

Artritis , Fiebre Chikungunya , Animales , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/complicaciones , Calidad de Vida , Estudios Transversales , Estudios Retrospectivos , Artritis/epidemiología , Artritis/etiología , Dolor , Índice de Severidad de la Enfermedad

Asunto(s)

Fiebre Chikungunya , Humanos , Pregabalina/uso terapéutico , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/tratamiento farmacológico , Método Doble Ciego , Analgésicos/uso terapéutico , Artralgia/tratamiento farmacológico , Artralgia/etiología

RESUMEN

OBJECTIVES: To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. METHODS: A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. RESULTS: Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. CONCLUSIONS: Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Coinfección , Virus del Dengue , Dengue , Pérdida Auditiva Sensorineural , Pérdida Auditiva , Infección por el Virus Zika , Virus Zika , Adulto , Masculino , Femenino , Humanos , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/epidemiología , Dengue/complicaciones , Dengue/diagnóstico , Dengue/epidemiología , Coinfección/epidemiología , Pérdida Auditiva/etiología , Pérdida Auditiva Sensorineural/etiología , Audición

RESUMEN

Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Coinfección , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico , Enfermedad Aguda , Dolor Abdominal

RESUMEN

Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.

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Dengue, zika e chikungunya são arboviroses de grande relevância epidemiológica em todo o mundo. A emergência e reemergência dessas infecções virais transmitidas por mosquitos constituem um grave problema de saúde pública humana. As manifestações neurológicas causadas por esses vírus têm alto potencial de morte ou sequelas. As complicações que ocorrem no sistema nervoso associadas às arboviroses podem representar um desafio diagnóstico e de tratamento. Em áreas endêmicas, casos suspeitos devem incluir encefalite, mielite, encefalomielite, polirradiculoneurite e/ou outras síndromes do sistema nervoso central ou periférico, na ausência de explicação conhecida. Caso confirmado de arbovirose neuroinvasivo é baseado na detecção viral (isolamento ou RT-PCR) ou de antígenos em tecidos, sangue, líquido cefalorraquidiano ou outros fluidos corporais, aumento dos títulos de anticorpos IgG entre amostras de soro pareadas, anticorpo IgM específico no líquido cefalorraquidiano e conversão sorológica para IgM entre amostras de soro pareadas. O exame do líquido cefalorraquidiano pode demonstrar: 1. agente etiológico; 2. reação inflamatória ou dissociação proteico-citológica, dependendo do quadro neurológico; 3. valor absoluto de IgM específica; 4. síntese intratecal de anticorpos IgG específicos (dengue e chikungunya); 5. exclusão de outros agentes infecciosos. O tratamento das complicações neurológicas visa melhorar os sintomas, enquanto a vacina representa a grande esperança para o controle e a prevenção das arboviroses neuroinvasivas. Esta revisão narrativa resume a atualização da epidemiologia, características gerais, neuropatogênese e manifestações neurológicas associadas à infecção pelos vírus da dengue, zika e chikungunya.

Asunto(s)

Fiebre Chikungunya , Dengue , Enfermedades del Sistema Nervioso , Infección por el Virus Zika , Virus Zika , Animales , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/epidemiología , Dengue/complicaciones , Dengue/diagnóstico , Dengue/epidemiología , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología , Enfermedades del Sistema Nervioso/diagnóstico , Inmunoglobulina M

RESUMEN

BACKGROUND: Chikungunya can cause persistent chronic joint pain. Knowledge of the risk factors for disease progression is important for preventing and controlling complications. This study aimed to identify factors associated with chronic joint pain. METHODS: This prospective cohort study was conducted at a reference center in Rio de Janeiro. Men and women (aged ≥ 18 years) in the acute phase of Chikungunya were included. Clinical data and samples were collected over three months. Risk factors were evaluated using multivariate and logistic regression analyses. RESULTS: A total of 107 patients were followed up. The incidence rate of joint tenderness was 61.7 %. Female sex (adjusted odds ratio [AOR] 3.24, 95 % confidence interval [CI]:1.07-9.77), diarrhea (AOR 5.08, 95 % CI:1.55-16.67), severe joint pain (AOR 4.26, 95 % CI:1.06-17.06), and CHIKV real-time reverse transcription polymerase chain reaction positivity up to 5 days after the onset of symptoms in urine or saliva (AOR 4.56, 95 % CI:1.41-14.77) were identified as predictors of persistent chronic pain. CONCLUSIONS: In a predominantly female population, musculoskeletal symptoms are not the sole determinant of chronic pain, and careful evaluation of CHIKV detection in alternative body fluids (such as saliva and urine) during the early phase of the disease is warranted.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Dolor Crónico , Masculino , Humanos , Femenino , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/diagnóstico , Virus Chikungunya/genética , Dolor Crónico/etiología , Dolor Crónico/complicaciones , Estudios Prospectivos , Brasil/epidemiología , Artralgia/epidemiología , Artralgia/etiología

RESUMEN

BACKGROUND: Acute undifferentiated febrile illness is a common challenge for clinicians, especially in tropical and subtropical countries. Incorrect or delayed diagnosis of febrile patients may result in medical complications or preventable deaths. Common causes of acute undifferentiated febrile illness in Colombia include leptospirosis, rickettsioses, dengue fever, malaria, chikungunya, and Zika virus infection. In this study, we described the acute undifferentiated febrile illness in postmortem patients reported as suspected cases of leptospirosis through the national leptospirosis surveillance in Colombia, 2016-2019. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyze human fresh and formalin-fixed tissue samples from fatal suspected leptospirosis cases reported by the Public Health Laboratories in Colombia. Leptospirosis confirmation was made by immunohistochemistry, real-time polymerase chain reaction (PCR) in the tissue samples. In some cases, the serum sample was used for confirmation by Microagglutination test (MAT). Simultaneously, tissue samples were tested by PCR for the most common viral (dengue, Zika, and chikungunya), bacterial (Brucella spp., and Rickettsia spp.), and parasitic (malaria). Fresh tissue samples from 92 fatal suspected leptospirosis cases were reported to the National Reference Laboratory from 22/32 departments in Colombia. We confirmed leptospirosis in 27% (25/92) of cases. Other pathogens identified by real-time PCR were Brucella spp. (10.9%), Rickettsia spp. (14.1%), and dengue (2.2%). Dengue (6.9%), hepatitis (3.5%), and Yellow Fever cases (2.2%) were detected by the pathology. All patients were negative for chikungunya and Plasmodium spp. Most cases were classified as undifferentiated febrile illnesses (45.7%; 42/92). CONCLUSIONS/SIGNIFICANCE: This study underscores the importance of early and accurate recognition of leptospirosis to prevent mortalities. Moreover, it draws attention to the existence of other febrile syndromes in Colombia, including rickettsiosis and brucellosis, that currently lack sufficient human surveillance and regular reporting. Expanding laboratory surveillance to include viruses such as Hantavirus, Mayaro virus, Oropouche virus, and West Nile virus is crucial.

Asunto(s)

Fiebre Chikungunya , Dengue , Leptospirosis , Malaria , Infecciones por Rickettsia , Rickettsia , Infección por el Virus Zika , Virus Zika , Humanos , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/complicaciones , Estudios Retrospectivos , Colombia/epidemiología , Leptospirosis/diagnóstico , Leptospirosis/epidemiología , Leptospirosis/complicaciones , Fiebre/diagnóstico , Infecciones por Rickettsia/epidemiología , Infección por el Virus Zika/complicaciones , Reacción en Cadena en Tiempo Real de la Polimerasa , Malaria/epidemiología , Dengue/diagnóstico , Dengue/epidemiología , Dengue/complicaciones

RESUMEN

INTRODUCTION: Chikungunya chronic joint disease causes debilitating arthralgia, significantly impacting the quality of life of affected individuals. METHODS: In this study, patients underwent clinical follow-ups, joint biopsies, and pre-biopsy and 24 months post-biopsy serum dosage of cytokines. RESULTS: All participants were female and had pain in 12 joints on average, with 41.17% exhibiting moderate disease activity. Histopathological analysis revealed collagen deposition. Indirect immunofluorescence detected the CHIKV glycoprotein E1 antigen, and an increase in cytokines. CONCLUSIONS: Persistent inflammation and ineffective antiviral immune responses leading to antigen persistence may contribute to chronic CHIKV arthritis.

Asunto(s)

Artritis , Fiebre Chikungunya , Virus Chikungunya , Humanos , Femenino , Masculino , Fiebre Chikungunya/complicaciones , Calidad de Vida , Inflamación , Artralgia , Citocinas , Glicoproteínas , Fibrosis

RESUMEN

Chronic cases of chikungunya fever represent a public health problem in countries where the virus circulates. The disease is prolonged, in some cases, for years, resulting in disabling pain and bone erosion among other bone and joint problems. As time progresses, tissue damage is persistent, although the virus has not been found in blood or joints. The pathogenesis of these conditions has not been fully explained. Additionally, it has been considered that there are multiple factors that might intervene in the viral pathogenesis of the different conditions that develop. Other mechanisms involved in osteoarthritic diseases of non-viral origin could help explain how damage is produced in chronic conditions. The aim of this review is to analyze the molecular and cellular factors that could be involved in the tissue damage generated by different infectious conditions of the chikungunya virus.

Asunto(s)

Fiebre Chikungunya , Virus Chikungunya , Humanos , Fiebre Chikungunya/complicaciones , Dolor , Salud Pública

Asunto(s)

Trastornos Cerebrovasculares , Fiebre Chikungunya , Accidente Cerebrovascular , Vasoespasmo Intracraneal , Humanos , Vasoconstricción , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico , Trastornos Cerebrovasculares/complicaciones , Accidente Cerebrovascular/complicaciones , Vasoespasmo Intracraneal/complicaciones , Vasoespasmo Intracraneal/diagnóstico por imagen