Mansyur Arif1, Patricia Tauran1, Herman Kosasih2, Ninny Meutia Pelupessy1, Nurhayana Sennang1, Risna Halim Mubin1, Pratiwi Sudarmono3, Emiliana Tjitra4, Dewi Murniati5, Anggraini Alam6, Muhammad Hussein Gasem7, Abu Tholib Aman8, Dewi Lokida9, Usman Hadi10, Ketut Tuti Merati Parwati11, Chuen-Yen Lau12, Aaron Neal12, Muhammad Karyana2,4. 1. Faculty of Medicine, Universitas Hasanuddin/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. 2. *Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia. 3. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. 4. National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta, Indonesia. 5. Sulianti Saroso Hospital, Jakarta, Indonesia. 6. Hasan Sadikin Hospital-Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia. 7. Dr. Kariadi Hospital-Diponegoro University, Semarang, Indonesia. 8. Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. 9. Tangerang District Hospital, Tangerang, Indonesia. 10. Dr. Soetomo Academic General Hospital-Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia. 11. Medical Faculty, Udayana University and Sanglah General Hospital, Denpasar, Indonesia. 12. National Institute of Allergy and Infectious Disease (NIAID), National Institutes of Health, Bethesda, Maryland, United States of America.
Abstract
BACKGROUND: Chikungunya virus (CHIKV) is often-overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. METHODOLOGY/PRINCIPAL FINDINGS: Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI. CONCLUSIONS/SIGNIFICANCE: CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.
BACKGROUND:Chikungunya virus (CHIKV) is often-overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. METHODOLOGY/PRINCIPAL FINDINGS: Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI. CONCLUSIONS/SIGNIFICANCE:CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.
Authors: Khin S A Myint; Arthur H P Mawuntu; Sotianingsih Haryanto; Darma Imran; Sofiati Dian; Yora P Dewi; Ahmad R Ganiem; Riane Anggreani; Mirna M Iskandar; Janno B B Bernadus; Kartika Maharani; David Susanto; Riwanti Estiasari; Hasna Dewi; Amanda Kristiani; Lidia Gaghiwu; Edison Johar; Frilasita A Yudhaputri; Ungke Antonjaya; Jeremy P Ledermann; Reinout van Crevel; Raph L Hamers; Ann M Powers Journal: Am J Trop Med Hyg Date: 2022-06-13 Impact factor: 3.707
Authors: Samuel C B Stubbs; Edison Johar; Frilasita A Yudhaputri; Benediktus Yohan; Marsha S Santoso; Rahma F Hayati; Dionisius Denis; Barbara A Blacklaws; Ann M Powers; R Tedjo Sasmono; Khin Saw Aye Myint; Simon D W Frost Journal: PLoS Negl Trop Dis Date: 2020-12-21