Antoine Bertolotti1,2, Marême Thioune3, Sylvie Abel3,4, Gilda Belrose5, Isabelle Calmont6, Raymond Césaire4,7, Minerva Cervantes8,9, Laurence Fagour7, Émilie Javelle10, Catherine Lebris3, Fatiha Najioullah4,7, Sandrine Pierre-François3, Benoît Rozé3, Marie Vigan9,11, Cédric Laouénan8,9,11, André Cabié3,4,6. 1. INSERM, CIC1410, CHU de la Réunion, Saint-Pierre, France. 2. CHU de la Réunion, service de maladies infectieuses-médecine interne-dermatologie, Saint Pierre, France. 3. CHU de Martinique, service de maladies infectieuses et tropicales, Fort-de-France, France. 4. Université des Antilles, EA 4537, Fort-de-France, France. 5. CHU de Martinique, Centre de ressource biologique de la Martinique, Fort-de-France, France. 6. INSERM, CIC1424, CHU de Martinique, Fort-de-France, France. 7. CHU de Martinique, laboratoire de virologie, Fort-de-France, France. 8. INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France. 9. INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France. 10. Hôpital d'instruction des Armées Laveran, service de pathologie infectieuse et tropicale, Marseille, France; Aix Marseille Université, Institut de Recherche pour le Développement (IRD); Assistance Publique-Hôpitaux de Marseille, Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME); Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France. 11. Département d'Épidémiologie, Biostatistique et Recherche clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.
Abstract
BACKGROUND: The chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity. METHODOLOGY/PRINCIPAL FINDINGS: A total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5-59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4-32.2, p = 0.04). CONCLUSIONS: This cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders. TRIAL REGISTRATION: clinicaltrials.gov (NCT01099852).
BACKGROUND: The chikungunya virus (CHIKV) is a re-emerging alphavirus that can cause chronic and potentially incapacitating rheumatic musculoskeletal disorders known as chronic chikungunya arthritis (CCA). We conducted a prospective cohort study of CHIKV-infected subjects during the 2013 chikungunya outbreak in Martinique. The aim of this study was to assess the prevalence of CCA at 12 months and to search for acute phase factors significantly associated with chronicity. METHODOLOGY/PRINCIPAL FINDINGS: A total of 193 patients who tested positive for CHIKV RNA via qRT-PCR underwent clinical investigations in the acute phase (<21 days), and then 3, 6, and 12 months after inclusion. The Asian lineage was identified as the circulating genotype. A total of 167 participants were classified as either with or without CCA, and were analyzed using logistic regression models. The overall prevalence of CCA at 12 months was 52.1% (95%CI: 44.5-59.7). In univariate analysis, age (RD 9.62, 95% CI, 4.87;14.38, p<0.0001), female sex (RD 15.5, 95% CI, 1.03;30.0, p = 0.04), headache (RD 15.42, 95% CI, 0.65;30.18 p = 0.04), vertigo (RD 15.33, 95% CI, 1.47;29.19, p = 0.03), vomiting (RD 12.89, 95% CI, 1.54;24.24, p = 0.03), dyspnea (RD 13.53, 95% CI, 0.73;26.33, p = 0.04), intravenous rehydration (RD -16.12, 95% CI, -31.58; -0.66 p = 0.04) and urea (RD 0.66, 95% CI, 0.12;1.20, p = 0.02) were significantly associated with the development of CCA. For the subpopulation with data on joint involvement in the acute phase, the risk factors significantly associated with CCA were at least one 1 enthesitis (RD 16.7, 95%CI, 2.8; 30.7, p = 0.02) and at least one tenosynovitis (RD 16.8, 95% CI, 1.4-32.2, p = 0.04). CONCLUSIONS: This cohort study conducted in Martinique confirms that CCA is a common complication of acute chikungunya disease. Our analysis emphasized the importance of age and female sex for CCA occurrence, and highlighted the aggravating role of dehydration during the acute phase. Early and adequate hydration were found to reduce the risk chronic chikungunya disorders. TRIAL REGISTRATION: clinicaltrials.gov (NCT01099852).
Authors: Hugh Watson; Ramão Luciano Nogueira-Hayd; Maony Rodrigues-Moreno; Felipe Naveca; Giulia Calusi; Karol Suchowiecki; Gary S Firestein; Gary Simon; Aileen Y Chang Journal: Sci Rep Date: 2021-09-17 Impact factor: 4.379