Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia☆
Introduction
Chikungunya virus disease (CHIKV) has expanded in Latin America since 2013, with a clear increase in the epidemiological and disability burden, by high morbidity attributed to its acute phase, as well as by persistence of symptoms in its chronic phase and consequences [1], [2]. There is an association between CHIKV and subsequent development of unspecified arthritis or rheumatoid arthritis, seronegative spondylitis and other non-inflammatory musculoskeletal manifestations such as persistent arthralgia [3], [4]. Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is defined as arthritis, musculoskeletal pain or unspecified arthralgia, which persists for more than 3 months after acute infection, without previous history of rheumatic disease or musculoskeletal discomfort [5], [6].
Previous studies, estimate about 47.57% (95%CI 45.08–50.13) of infected patients in endemic areas would develop pCHIK-CIR, with a median follow-up of 20.12 months, during a maximum time of 72 months (6 years); and these sequelae have been reported in tropical and subtropical areas, and also in European countries among imported cases [7], [8]. The most recent systematic review and meta-analysis about prevalence of pCHIK-CIR in the literature, describes that in the most conservative scenario, about 25% of CHIK cases could develop this rheumatologic sequel and 14% chronic arthritis [6].
However, those estimates were obtained from studies carried out in France and India [8] and may not be extrapolated to Latin American countries, because of environmental variations by geographical area, genetic and immunological profile of the hosts and variation of the viral characteristics [9]. Therefore, three cohorts have been published in Colombia and Latin America, reporting a significant proportion of cases that progress to pCHIK-CIR, especially polyarthralgia [9], [10], [11], [12]. One of these investigations was carried out during 2015 in the municipality of Venadillo in the department of Tolima [11], which is part of the Colombian endemic areas for dengue virus (DENV) and CHIKV, and they share the same vector, Aedes aegypti and A. albopictus [12]. The initial study in Tolima [11] evidenced that about half of the patients persisted with post-CHIK arthralgia after 24 weeks of follow-up [11], which is higher than the results reported in other countries [13]. All these findings represent a great challenge for infectious diseases, rheumatology and travel medicine practitioners, but still many aspects need to be clarified [14], [15], [16], [17], [18], [19], [20].
After one year the initial diagnosis of patients observed in Venadillo, Tolima, Colombia, a new assessment, with the objective to determine the prevalence of chronic rheumatic sequelae attributable to CHIKV, was necessary and done. This, to providing information regard the progression, knowledge and some risk factors, about pCHIK-CIR as a growing consequence of CHIK in Colombia and Latin America. Furthermore, continuing searching for related factors and relevant information in predicting consequences that increase the prevalence and morbidity of this chronic manifestation of CHIKV infection.
Section snippets
Methods
This retrospective cohort study included patients previously diagnosed by CHIK positive serology between January and May 2015, belonging to the Venadillo cohort, Tolima, Colombia [11], after a year of initial infection.
Results
A total of 128 (97.7%) of the 131 patients who were diagnosed by CHIKV positive serology between January and May 2015 in Venadillo, Tolima, completed a period of time at least one year since initial infection in April 2016, when the survey was conducted and they were reassessed.
A total of 73 subjects were contacted, 70 (95.9%) consented to participate in a new telephone survey and 5 (7.1%) were excluded because they had previous history of rheumatic disease. Out of the total participants
Discussion
This study represents one of three cohorts of CHIK patients published in Colombia and followed for chronic rheumatologic sequelae [9], [10], [11]. Furthermore, in this cohort it is highlighted that over half of assessed patients, reported at least one persistent rheumatological symptom as a sequel of the first infection along one year and one third of the total, reported pCHIK-PCA even during the week in which the survey was conducted.
Our results are comparable to those obtained in other
Conflicts of interest
The authors have no conflicts of interest to disclose.
Acknowledgements
To Yuan Lian (USA) and Bao Cai (USA), for their critical review and English improvement of the manuscript. This study was previously presented as part of the Thesis of Epidemiology (Postgraduate Specialization) of MPCR. This study was previously presented in part at the Second Latin-American Meeting of Public Health, Santiago de Cali, Valle del Cauca, Colombia, September 1-3, 2016, Poster Session; as well at the XVIII Pan-American Congress of Infectious Diseases (API), Panama City, Panama, May
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This study was previously presented as part of the Thesis of Epidemiology (Postgraduate Specialization) of MPCR. This study was previously presented in part at the Second Latin-American Meeting of Public Health, Santiago de Cali, Valle del Cauca, Colombia, September 1–3, 2016, Poster Session; as well at the XVIII Pan-American Congress of Infectious Diseases (API), Panama City, Panama, May 16–20, 2017 (Poster H-19).