Correspondence

Chikungunya, the emerging migratory rheumatism

Chikungunya (CHIKV) es un virus RNA endémico en algunas regiones de Asia y África. En Colombia en el año 2014 inicia su dispersión de manera explosiva y rápida. La presentación del CHIKV es una condición febril con síntomas musculoesqueléticos que pueden progresar a artropatía erosiva y deformidad poliarticular. El propósito de este estudio es evaluar en pacientes aquejados por la infección por CHIKV en Neiva, Huila que acuden a la consulta de Reumatología, el comportamiento sintomático y serológico, y describir comorbilidades asociadas a la fase crónica de la enfermedad.

Se realizó un análisis observacional, longitudinal y retrospectivo, de datos recolectados en 410 pacientes aquejados por el virus CHIKV con síntomas de más de tres meses de duración que persistían con afecciones musculoesqueléticas y articulares. Los pacientes fueron clasificados según su compromiso en: artralgias postvirales, poliartritis postviral, artritis reumatoide (AR) postCHIKV, espondiloartritis postCHIKV y reumatismo de tejidos blandos. El análisis estadístico fue realizado usando SPSS software (versión 24). Se llevó a cabo análisis descriptivo para evaluar variables cuantitativas como la media (desviación estándar) y variables categóricas como la frecuencia (%). Las variables categóricas fueron comparadas usando la ecuación X². Como significancia estadística se consideró una p < 0,05.

De los 410 pacientes, 89,23% fueron mujeres, con compromiso poliarticular en 92,26% de los casos. El 49,83% de los pacientes presentaban de base osteoartritis. Al momento de la evaluación en la consulta de Reumatología, 46,3% de los pacientes cursaron con artralgias no inflamatorias persistentes y 53,7% de los casos presentaban artritis al examen físico, de los cuales, de manera remarcable 20,3% cumplieron criterios para AR postCHIKV.

El desarrollo de síntomas musculoesqueléticos luego de la infección por CHIKV es un problema de salud pública bastante serio, con complicaciones persistentes y riesgo de morbilidad a largo plazo en la vida real. La presencia de artritis postviral neta es de resaltar, sin embargo, el desarrollo de AR postCHIKV requiere usualmente medidas de índole farmacológico más avanzadas, incluso, en algunos casos es necesario referir a los pacientes a terapia biológica. La presencia de síntomas de insuficiencia venosa en miembros inferiores desarrollados con la infección por CHIKV, fue un hallazgo incidental que requiere de un estudio más preciso.

Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread starts explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, the symptomatic and serological behavior, and to describe comorbidities associated to the chronic phase of the disease.

An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered.

Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV.

The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.

Geographical information systems (GIS) use for development of epidemiological maps in dengue has been extensively used, however not in other emerging arboviral diseases, nor in Central America. Surveillance cases data (2015) were used to estimate annual incidence rates of dengue and chikungunya (cases/100,000 pop) to develop the first maps in the departments and municipalities of Honduras. The GIS software used was Kosmo Desktop 3.0RC1^®. Four thematic maps were developed according departments, municipalities, diseases incidence rates. A total of 19,289 cases of dengue and 85,386 of chikungunya were reported (median, 726 cases/week for dengue and 1460 for chikungunya). Highest peaks were observed at weeks 25th and 27th, respectively. There was association between progression by weeks (p < 0.0001). The cumulated crude national rate was estimated in 224.9 cases/100,000 pop for dengue and 995.6 for chikungunya. The incidence rates ratio between chikungunya and dengue is 4.42 (ranging in municipalities from 0.0 up to 893.0 [San Vicente Centenario]). Burden of both arboviral diseases is concentrated in capital Central District (>37%, both). Use of GIS-based epidemiological maps allow to guide decisions-taking for prevention and control of diseases that still represents significant issues in the region and the country, but also in emerging conditions.

Chikungunya (CHIKV) and Zika (ZIKV) significantly affected Latin America in the period 2015–2017. Most studies were reported from urban areas of Brazil and Colombia. In this paper we estimate Incidence rates for CHIKV and ZIKV in Caqueta, the Amazonian gateway area of Colombia, from 2015 to 2018.

Using surveillance data of CHIKV and ZIKV in Caqueta, Colombia, incidence rates were estimated (cases/100,000 population). Sixteen geographical information systems (GIS)-based municipal maps were developed. GIS software used was Kosmo 3.0®.

From 1st of January 2015 to the 24th of November 2018, 825 cases of CHIK and 1079 of ZIKV were reported, yielding cumulated incidence rates of 169.42 and 221.59 cases/100,000 population respectively. In 2016, 48.7% of the CHIKV cases (402) and 96.6% of the ZIKV cases (1042) were reported. The highest number of both arboviral diseases occurred at Florencia (capital department city), 225 cases for CHIKV (127.17 cases/100,000 pop.) and 611 for ZIKV (345.34 cases/100,000 pop.).

The temporo-spatial distribution of CHIKV and ZIKV infections in Caquetá reflected the pattern of concurrent epidemics, especially in 2016. Studies using GIS-linked maps are necessary to attain accurate epidemiological analyses for public health decisions. That is also useful for an epidemiologically based assessment of traveler risks when visiting specific areas in destination countries.