CHIKUNGUNYA VIRUS INFECTION

Cesar Ponce S.
Medical Microbiologist and Parasitologist. Epidemiologist
ADC Medical Microbiology Department Director

Curacao,

Aug. 2014

TOPICS:
Definition
History
Epidemiology
Clinical symptoms
Differential diagnosis
Laboratory diagnosis
Treatment
Prevention

CHIKV INFECTION

Aug. 2014

I. Definition
Chikungunya is a viral disease transmitted to
humans by infected mosquitoes. It causes fever
and severe joint pain. Other symptoms include
muscle pain, headache, nausea, fatigue and rash.
The disease shares some clinical signs with
dengue, and can be misdiagnosed in areas where
dengue is common.
http://www.who.int/mediacentre/factsheets/f
s327/en/

Chikungunya virus (CHIKV)

Positive-strand RNA virus
Alphavirus genus Togaviridae
family
CHIKV is an arthropodborne
(ARBO)-virus

Genetic analysis on E1 envelope: 3 subtypes

West African cluster

East-South-Central Africa (ESCA) cluster
Asian cluster
Robinson MC. Trans R Soc Trop Med Hyg.
1955;49:28-32

II. History:
1952 first detection, Africa
Makonde Plateau outbreak
Virus isolation in serum
Chikungunya = the illness of the bended walker
Makonde root verb kungunyala
Sylvatic cicle / urban centers
Africa, Asia, Europe and America
2008 listed as category C priority pathogen (NIAID)

http://www.chikungunyavirusnet.com/histor
y-of-chikungunya.html

III. Epidemiology: life cycle

CHIKV INFECTION

Aug. 2014

III. Epidemiology: Risk area

III. Epidemiology: outbreaks

1999-2000 Democratic Republic of the Congo.
2005, a major outbreak in islands of the Indian Ocean.
2006 Indian Ocean.
2006 and 2007 India.
Since 2005, India, Indonesia, Thailand, Maldives and Myanmar
have reported over 1.9 million cases.
In 2007 first time in Europe, Italy.
There were 197 cases recorded, Ae. Albopictus are plausible in
Europe.
December 2013, autochthonous cases in St Martin.
Transmission has been confirmed in Anguilla, British Virgin
Islands, Dominica, French Guiana, Guadeloupe, Martinique and
St Barthelemy. Aruba only reported imported cases.
As of 6 March 2014, there have been over 8000 suspected
cases in the region.
http://www.who.int/mediacentre/factsheets/fs327
/en/

III. Epidemiology: ChikV in America

http://www.cdc.gov/chikungunya/geo/

III. Epidemiology: ChikV in the Caribbean

http://www.cdc.gov/chikungunya/geo/caribb
ean.html

IV. Clinical symptoms:

Febrile illness
Replicates skin

Polyarthralgia
Bilateral 96%
Lower 98%
Small joints 75%

Liver and joints

High level viremia

Incubation: 3-7 days

Maculopapular rash 48%

Asthenia 89%

Asymptomatic: 5-15% Headache 70%

Fatality ratio: 1:1000
Digestive trouble 63%
Neonates
Underlaying conditions

Myalgia 59%

Conjuntival hyperhemia 23%

Older people

Adenopathy 9%

CHIKV INFECTION

Aug. 2014

Acute stage, multifocal pain

1/17/15

12
Queyriaux et al. Lancet Infect Dis. 2008;8:2-

Unusual clinical
presentation

Hepatitis
Guillain-Barr
Cardiologic manifestations
Enephalitis
Myelopathy
Myopathy
Mother to child transmission
Deaths
CHIKV INFECTION

Acute stage, joint manifestations

Periarticular swelling and joint
effusion

1/17/15

RIVM, Netherlands
Simon et al. Medicine, 86 (3), May 2007

Joint findings (MRI)

Effusion
Erosion
Synovial thickening
Tendinitis
Tenosynovitis
Chronic inflammatory erosive
arthritis
Chikungunya infection

Aug. 2014

V. Differential diagnosis

Dengue fever
Leptospirosis
Malaria
Meningitis
Post Infection arthritis
Other viruses
Mayaro, Rubella, Measles,
Parvovirus, Enteroviruses
Chikungunya infection

PAHO/WHO

VI. Laboratory diagnosis

General
Leukopenia
Thrombocytopenia

Specific
Antibodies detection

Aminotransferases
Hypocalcemia
Lymphopenia

Anti-ChikV IgM
Anti-ChikV IgG

Viral detection
PCR

<1000/mL

Chikungunya infection

Aug. 2014

Viremia and immune response

Chikungunya virus infection

pfu/ml

ELISA
P/N

106
CHIK
viremia

IgM

20

IgG Neutralizing Ab

-14 to -2

10

DAYS POST ONSET

1/17/15

RIVM, Netherlands

VII. Treatment
No specific

1/17/15

RIVM, Netherlands

VIII. Prevention

CHIKV INFECTION

Aug. 2014

Avoid mosquito bites!

o
H

CHIKV INFECTION

?
w

Aug. 2014

Prevention
Vector control
Adult
Breeding

Protection
Nets
Repelent
Appropriate clothing

1/17/15

RIVM, Netherlands

References

1/17/15

PAHO
WHO
CDC, USA
RIVM, Netherlands
Medscape.com
www.chikungunyavirusnet.com/hi
story-of-chikungunya.html
RIVM, Netherlands