Chikungunya natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2], Alonso Alvarado, M.D. [3]
Overview
Complications are rare and include uveitis, retinitis, myocarditis, hepatitis, nephritis, bullous skin lesions, hemorrhage, meningoencephalitis, myelitis, Guillain-Barré syndrome, and cranial nerve palsies. Persons at risk for severe disease include neonates exposed intrapartum, older adults (e.g., > 65 years), and persons with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular disease). Most patients recover uneventfully, but variable proportions of patients may have persistent arthralgias (joint pains) for months to years.
Natural History
In a 14-month prospective observational study among travelers from areas with outbreaks, nearly all confirmed cases had fever, rash, and arthritis within 10 days of the disease onset, and the majority had rheumatism persisting longer than 2 weeks, characterized by finger and toe polyarthritis with morning stiffness, subacute tenosynovitis of wrists, hands, and ankles, or exacerbation of mechanic pain in previously injured joints and bones.[1]
Complications
- Complications are rare and include uveitis, retinitis, myocarditis, hepatitis, nephritis, bullous skin lesions, hemorrhage, meningoencephalitis, myelitis, Guillain-Barré syndrome, and cranial nerve palsies.
- Some patients may experience relapse of rheumatic symptoms (eg, polyarthralgia, polyarthritis, or tenosynovitis) in the months following acute illness. It has been suggested that musculoskeletal complications are immune-mediated, and the presence of autoantibodies has been reported in infected patients with rheumatic symptoms.[2]
- Neurologic complications including encephalitis, febrile seizures, and encephalopathies are common causes of hospitalization for pediatric patients with Chikungunya virus infection.[3]
Risk factors for Complications
Persons at risk for severe disease include neonates exposed intrapartum, older adults (e.g., > 65 years), and persons with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular disease).
Prognosis
- Most patients recover uneventfully.
- Mortality is rare and risk factors for death include older age.
- Persistent arthralgic forms had been described in 1980 in South Africa, where a retrospective study has shown complete resolution in 87.9 %;, 3.7 % had episodic stiffness and pain , 2.8% had persistent stiffness without pain and 5.6% had persistent painful restriction of joint movements.
- Enthesopathy and tendinitis of Achilles tendon was observed in up to 53% of those who had musculoskeletal involvement.
- Neurological, emotional and dermatologic sequelae are also described.
References
- ↑ Simon, Fabrice; Parola, Philippe; Grandadam, Marc; Fourcade, Sabrina; Oliver, Manuela; Brouqui, Philippe; Hance, Pierre; Kraemer, Philippe; Mohamed, Anzime Ali; de Lamballerie, Xavier; Charrel, R??mi; Tolou, Hugues (2007). "Chikungunya Infection". Medicine. 86 (3): 123–137. doi:10.1097/MD/0b013e31806010a5. ISSN 0025-7974.
- ↑ Maek-a-nantawat, Wirach; Silachamroon, Udomsak (2009). "Presence of Autoimmune Antibody in Chikungunya Infection". Case Reports in Medicine. 2009: 1–4. doi:10.1155/2009/840183. ISSN 1687-9627.
- ↑ Robin, S.; Ramful, D.; Le Seach, F.; Jaffar-Bandjee, M.-C.; Rigou, G.; Alessandri, J.-L. (2008). "Neurologic Manifestations of Pediatric Chikungunya Infection". Journal of Child Neurology. 23 (9): 1028–1035. doi:10.1177/0883073808314151. ISSN 0883-0738.