Chikungunya infection in Malaysia: Comparison with dengue infection in adults and predictors of persistent arthralgia
Section snippets
Background
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that has caused large outbreaks affecting millions around the world in recent years, particularly in the Indian Ocean,1 Asia,2 and Africa.3 In Malaysia, there have been sporadic limited outbreaks in the past,4, 5 prior to the largest reported outbreak affecting the whole country in 2008–2010.6 Dengue virus (DENV) is endemic in Malaysia.
Both CHIKV and DENV are transmitted by the mosquito vectors Aedes aegypti and Ae. albopictus. Both
Objectives
This study aimed to compare and describe factors which would help differentiate between DENV and CHIKV infections on presentation. A secondary objective was to ascertain the rate and describe predictors of persistent arthralgia in CHIKV patients.
Study design
This study was conducted at the University Malaya Medical Centre, in Kuala Lumpur, Malaysia. Patients aged >14 years with acute CHIKV and DENV infections confirmed by the diagnostic virology laboratory from April 2008 to July 2009 were retrospectively identified. Two DENV cases were randomly selected for each CHIKV case identified. Confirmed CHIKV infections had a positive culture, positive PCR detection of the E1 gene,11 or positive IgM by indirect immunofluorescence.4 As serum samples were
Results
A total of 60 patients with confirmed CHIKV and 120 patients with confirmed DENV were identified from laboratory records, for which medical records could not be located for 7 CHIKV and 7 DENV patients. A total of 53 CHIKV patients and 113 DENV patients were therefore included in the study. For CHIKV, 35 patients were diagnosed by IgM, 12 by PCR, and 17 by culture, or a combination of these. The predominant DENV serotypes were DENV1 (46, 40.7%) and DENV2 (46, 40.7%), followed by DENV3 (20,
Discussion
Studies comparing adult patients with DENV or CHIKV are few, due to the previous relative rarity of CHIKV and its occurrence in countries with historically limited diagnostic capacity. The few available studies indicate variations in different countries, which prompted the present study to be carried out in Malaysia.
We found demographic differences between patients with DENV or CHIKV. CHIKV patients were older, as seen in other sites.2, 14, 15 The endemic nature of DENV in Malaysia results in
Funding
This study was funded by University Malaya (High Impact Research Grant J-73565) and the European Union's Seventh Framework Programme (grant agreement no. 261202).
Competing interests
None declared.
Ethical approval
Ethical approval was obtained from the Medical Ethics Committee of the University Malaya Medical Centre (reference number 800.70).
References (31)
- et al.
Chikungunya virus of Asian and Central/East African genotypes in Malaysia
J Clin Virol
(2009) - et al.
Factors associated with persistence of arthralgia among Chikungunya virus-infected travellers: report of 42 French cases
J Clin Virol
(2010) - et al.
Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging
Trans R Soc Trop Med Hyg
(2010) - et al.
Chikungunya fever in Singapore: acute clinical and laboratory features, and factors associated with persistent arthralgia
J Clin Virol
(2010) - et al.
Prospective study of Chikungunya virus acute infection in the island of La Réunion during the 2005–2006 outbreak
PLoS ONE
(2009) - et al.
Concurrent outbreaks of Chikungunya and dengue fever in Kandy, Sri Lanka, 2006–07: a comparative analysis of clinical and laboratory features
Postgrad Med J
(2009) - et al.
Clinical forms of Chikungunya in Gabon, 2010
PLoS Negl Trop Dis
(2012) - et al.
Chikungunya infection – an emerging disease in Malaysia
Southeast Asian J Trop Med Public Health
(2001) - et al.
Seroprevalence survey of Chikungunya virus in Bagan Panchor, Malaysia
Am J Trop Med Hyg
(2010) - et al.
The first dominant co-circulation of both dengue and chikungunya viruses during the post-monsoon period of 2010 in Delhi, India
Epidemiol Infect
(2012)
Chikungunya virus infection – a retrospective study of 107 cases
S Afr Med J
Outbreak of Chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients
Clin Infect Dis
Post-epidemic Chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period
PLoS Negl Trop Dis
Combined detection and genotyping of chikungunya virus by a specific reverse transcription-polymerase chain reaction
J Med Virol
Studies with pain rating scales
Ann Rheum Dis
Cited by (65)
Arthralgia resolution rate following chikungunya virus infection
2021, International Journal of Infectious DiseasesClinical characteristics and predictive score of dengue vs. chikungunya virus infections
2019, Medecine et Maladies InfectieusesCitation Excerpt :A 2010 study performed in Gabon concluded that the two infections were clinically indistinguishable, unlike the conclusion of a 2008 study performed in Singapore [7,18]. Patients who consulted during the CHIKV epidemic were on average 10 years older than DENV patients, as already mentioned in other studies [16,18,21]. Dengue fever is endemic in French Guiana.
Togaviridae: Alphaviruses
2018, Principles and Practice of Pediatric Infectious DiseasesPrevalence of and risk factors for long-term disabilities following chikungunya virus disease: A meta-analysis
2020, Travel Medicine and Infectious DiseaseCitation Excerpt :Subgroup analysis were not carried out for different risk factors in this analysis because of information unavailability. Nevertheless, variety among various individual studies results were found for the CHIKV patients in Asia for the risk of growing long-term disabilities for older patients and comorbidities [39,44]. An enormous heterogeneity of the subsequent time was established among the included studies.
Joint Involvement Can Predict Chikungunya in a Dengue Syndemic Setting in India
2023, Journal of Epidemiology and Global HealthClinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available
2023, Tropical Medicine and Infectious Disease