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      Demographic and clinical characteristics of chikungunya patients from six Colombian cities, 2014–2015

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          Abstract

          In 2014, the chikungunya virus reached Colombia for the first time, resulting in a nationwide epidemic. The objective of this study was to describe the demographics and clinical characteristics of suspected chikungunya cases. Chikungunya infection was confirmed by enzyme-linked immunosorbent assay and 548 patients where included in the study. Of these patients, 295 were positive for antibodies against chikungunya (53.8%), and 27.6% (151/295) were symptomatic for chikungunya infection, with a symptomatic:asymptomatic ratio of 1.04:1. Factors associated with infection included low income and low socio-economic strata (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0–3.2, p = 0.003 and OR: 2.1; CI: 1.3–3.4, p = 0.002, respectively). Confirmed symptomatic cases were associated with symmetric arthritis (OR: 11.7; CI: 6.0–23.0, p < 0.001) of ankles (OR: 8.5; CI: 3.5–20.9, p < 0.001), hands (OR: 8.5; CI: 3.5–20.9, p < 0.001), feet (OR: 6.5; CI: 2.8–15.3, p < 0.001), and wrists (OR: 17.3; CI: 2.3–130.5, p < 0.001). Our study showed that poverty is associated with chikungunya infection. Public health strategies to prevent and control chikungunya should focus on poorer communities that are more vulnerable to infection. The rate of asymptomatic infections among confirmed cases was 48.8%. However, those with symptoms displayed a characteristic rheumatic clinical picture, which could help differentiate chikungunya infection from other endemic viral diseases.

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          Changing patterns of chikungunya virus: re-emergence of a zoonotic arbovirus.

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            Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients.

            Chikungunya is a reemerging disease. In 2005-2006, a severe outbreak occurred on Reunion Island in the southwestern part of the Indian Ocean. Other islands in this area were affected during the same period. Adult patients with acute chikungunya (defined as onset of fever and/or polyarthralgia in the 5 days preceding consultation) and laboratory-confirmed chikungunya who were referred to Groupe Hospitalier Sud Reunion during the period from March 2005 through April 2006 were included in this retrospective study. Their clinical and laboratory features are reported. Laboratory-confirmed acute chikungunya was documented in 157 patients. The mean age of patients was 57.9 years, and the ratio of male to female patients was 1.24 : 1. Sixty percent of patients had at least 1 comorbidity. Ninety-seven patients (61.8%) were hospitalized, and 60 (38.2%) were treated as outpatients. Five fatalities were reported. One hundred fifty-one patients (96.1%) experienced polyarthralgia, and 129 (89%) experienced fever. Gastrointestinal symptoms were reported by 74 patients (47.1%), and skin rash was reported by 63 (40.1%). Hemorrhagic signs were rare. Lymphopenia and hypocalcemia were the prominent laboratory findings. Severe thrombocytopenia was rarely observed. Chikungunya virus can be responsible for explosive outbreaks of disease. Polyarthralgia and fever are the 2 main clinical features. In this era of travel and globalization, chikungunya should be considered in the differential diagnosis of febrile polyarthralgia with an abrupt onset.
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              Zika Virus Infection, Cambodia, 2010

              To the Editor: Zika virus (ZIKV), a member of the family Flaviviridae, genus Flavivirus, was first isolated from the blood of a sentinel rhesus monkey from the Zika Forest of Uganda in 1948 ( 1 ). Since that time, serologic studies and virus isolations have demonstrated that the virus has a wide geographic distribution, including eastern and western Africa; the Indian subcontinent; Southeast Asia; and most recently, Micronesia ( 2 – 5 ). The virus is transmitted primarily through the bite of infected mosquitoes and most likely is maintained in a zoonotic cycle involving nonhuman primates ( 1 ), although recent evidence suggests the possibility of occasional sexual transmission in humans ( 4 ). Few case reports have described the clinical characteristics of ZIKV infection in humans. Most reports describe a self-limiting febrile illness that could easily be mistaken for another arboviral infection, such as dengue or chikungunya fever. We report a confirmed case of ZIKV infection in Cambodia. Since 2006, the US Naval Medical Research Unit No. 2 (NAMRU-2) has conducted surveillance for acute fever to determine causes of the infection among patients who seek health care at local clinics in Cambodia. Patients were enrolled by the health clinic physician after they gave informed consent in accordance with an institutional review board protocol approved by NAMRU-2 and the National Ethics Committee for Human Research of Cambodia. At enrollment, the physician administered a questionnaire and collected specimens (blood and throat swabs). All items were transported to the NAMRU-2 laboratory in Phnom Penh, where testing was conducted for a variety of viral, bacterial, and parasitic pathogens. In August 2010, a blood specimen was collected from a 3-year-old boy at a health clinic in Kampong Speu Province, Cambodia. The child’s reported clinical symptoms included 4 days of fever and sore throat and cough and a headache for 3 days. A maculopapular rash was not observed, and the boy was not hospitalized. The clinic staff conducted a follow-up interview and reported that the patient recovered fully. ZIKV infection was confirmed in this patient by using PCR, sequencing, and serology and through virus isolation. ELISA for chikungunya and dengue virus IgM and IgG antibodies on acute- and convalescent-phase serum was negative. A universal flavivirus real-time PCR screen that targets the nonstructural (NS) 5 gene ( 6 ) determined that the patient’s serum was positive for flavivirus RNA, but subsequent species-specific PCR ruled out 2 other flaviviruses that are highly endemic to the region (dengue and Japanese encephalitis viruses) ( 7 – 9 ). This result was the first nondengue, non–Japanese encephalitis virus flavivirus detected after samples from ≈10,000 enrolled patients were tested. Nucleic acid sequencing of the amplicon isolated by gel purification produced a 100-bp fragment with 100% sequence identity to ZIKV (nucleotide position 8,969 of the NS5 gene of the isolate GenBank accession no. EU545988). ZIKV infection subsequently was serologically confirmed by hemagglutination-inhibition tests on paired serum samples. The patient’s acute-phase sample was negative, but a convalescent-phase sample gave a positive reaction with ZIKV antigen to a serum dilution of 1:320 and was negative to antigens for the 4 dengue serotypes and yellow fever and West Nile viruses. These results demonstrate that the patient had a clear monotypic flavivirus immune response with seroconversion against ZIKV, indicating a recent primary infection. The most common signs and symptoms reported in confirmed ZIKV infections are fever, headache, malaise, maculopapular rash, fatigue or myalgia, and arthritis and arthralgia (Table). In addition to fever and headache, the patient in this study had a sore throat and cough. Because of the patient’s age, additional information about symptoms was difficult to obtain. Table Reported or observed clinical signs and symptoms in persons with Zika virus infection, 1962–2010 Sign or symptom Country, year of infection origin,* no. (%) patients Uganda, 1962, n = 1 Laboratory acquired, 1973, n = 1 Indonesia,
1977–1978, n = 7 Micronesia, 2007, n = 28 Senegal/United States, 2009, n = 3 Cambodia, 2010, n = 1 Fever 1 (100) 1 (100) 7 (100) 20 (65) 1 (100) Headache 1 (100) 14 (45) 3 (100) 1 (100) Malaise 1 (100) 5 (71) 3 (100) Maculopapular rash 1 (100) 28 (100) 3 (100) Fatigue or myalgia 1 (100) 1 (100) 1 (14) 14 (45) 1 (33) Arthritis and arthralgia 1 (14) 20 (65) 3 (100) Chills 1 (100) 2 (29) 2 (67) Dizziness 5 (71) Joint swelling or edema 6 (19) 2 (67) Stomachache 6 (86) Retro-orbital pain 1 (100) 12 (39) Conjunctivitis 1 (14) 17 (55) 1 (33) Anorexia 4 (57) Photophobia 1 (33) Vomiting 1 (14) 3 (10) Diarrhea 3 (43) Constipation 3 (43) Sore throat 1 (100) Cough 1 (100) Aphthous ulcer 2 (67) Hypotension 2 (29) Hematuria 1 (14) Prostatitis 1 (33) Hematospermia 1 (33) Sweating 1 (100) Lightheadedness 1 (33) *References: Uganda ( 2 ), laboratory-acquired ( 10 ), Indonesia ( 5 ), Micronesia ( 9 ), Senegal/United States ( 4 ). Blank cells indicate no reported information. The clinical characteristics exhibited by this case-patient are similar to those of shown in a small cluster of ZIKV infections described in Indonesia during 1977–1978 in which maculopapular rash was not observed ( 5 ). Maculopapular rash was reported as a common sign in case-patients from the recent Yap Island outbreak ( 3 ), as well as in case reports from Uganda ( 2 ), Senegal, and the United States ( 4 ), A case report of laboratory-acquired ZIKV infection also noted the lack of maculopapular rash ( 10 ). The clinical features of ZIKV infection are similar to those of dengue virus and chikungunya virus infections, and both arboviruses are found in Southeast Asia. In this region, laboratory-based confirmation is essential. The extent of ZIKV infections in Cambodia is unknown; further studies are needed to clarify the prevalence and geographic distribution of ZIKV infection in the country.
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                Author and article information

                Journal
                Emerg Microbes Infect
                Emerg Microbes Infect
                TEMI
                temi20
                Emerging Microbes & Infections
                Taylor & Francis
                2222-1751
                2019
                21 October 2019
                : 8
                : 1
                : 1490-1500
                Affiliations
                [a ]Biosciences Doctoral Programme, Faculty of Medicine and Engineering, Universidad de La Sabana , Chía, Colombia
                [b ]Grupo Espondiloartropatías, Department of Rheumatology, Universidad de La Sabana , Chía, Colombia
                [c ]Department of Rheumatology, Hospital Militar Central , Bogotá, Colombia
                [d ]Department of Rheumatology and Internal Medicine, Universidad del Norte , Barranquilla, Colombia
                [e ]Rheumatology Unit, Hospital General de México “Doctor Eduardo Liceaga” , Mexico City, Mexico
                [f ]Centro de Investigación Clínica de Morelia SC , Morelia, Mexico
                [g ]Unidad de Investigación Científica, Hospital Militar Central , Bogotá, Colombia
                Author notes
                [CONTACT ] John Londono john.londono@ 123456unisabana.edu.co Grupo Espondiloartropatías, Department of Rheumatology, Universidad de La Sabana , Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá, Cundinamarca, Chía, Colombia
                Author information
                http://orcid.org/0000-0002-6263-2914
                http://orcid.org/0000-0002-1973-8043
                http://orcid.org/0000-0002-3065-3278
                http://orcid.org/0000-0003-1344-5677
                http://orcid.org/0000-0002-4067-4478
                http://orcid.org/0000-0002-5432-4401
                http://orcid.org/0000-0002-6723-7251
                http://orcid.org/0000-0002-9754-7656
                http://orcid.org/0000-0001-5188-7375
                http://orcid.org/0000-0002-2731-9180
                http://orcid.org/0000-0002-0422-5173
                http://orcid.org/0000-0003-1074-644X
                Article
                1678366
                10.1080/22221751.2019.1678366
                6819954
                31631794
                580696f9-7f15-4f47-bc40-e3ac90760734
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 May 2019
                : 12 September 2019
                : 04 October 2019
                Page count
                Figures: 3, Tables: 4, Equations: 0, References: 66, Pages: 11
                Funding
                Funded by: Colombian Rheumatology Association (Asociación Colombiana de Reumatología – ASOREUMA)
                Award ID: Acta 169 10th July 2015
                Funded by: Universidad de La Sabana 10.13039/501100010628
                Award ID: MED-197-2015
                Funded by: Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS)
                Award ID: 757-2016
                The study was supported by the Colombian Rheumatology Association (Asociación Colombiana de Reumatología – ASOREUMA) [grant number Acta 169 10th July 2015]; Universidad de La Sabana [grant number MED-197-2015]; and Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) doctoral scholarship [grant number 757-2016].
                Categories
                Article

                chikungunya virus,colombia,epidemic,south america,arbovirus
                chikungunya virus, colombia, epidemic, south america, arbovirus

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