Chikungunya infection in Malaysia: Comparison with dengue infection in adults and predictors of persistent arthralgia

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Abstract

Background

Chikungunya virus (CHIKV) and dengue virus (DENV) co-circulate in areas endemic with the Aedes mosquito vectors. Both viruses cause similar illnesses which may be difficult to distinguish clinically. CHIKV is also associated with persistent arthralgia.

Objectives

To compare and describe factors which differentiate between DENV and CHIKV infections on presentation; and to describe predictors of persistent arthralgia in CHIKV patients.

Study design

Patients aged >14 years diagnosed with acute CHIKV and DENV infections in Kuala Lumpur, Malaysia were retrospectively identified. Clinical and laboratory data were obtained from medical records, and compared. CHIKV patients were telephoned 15–24 months later and interviewed about persistent symptoms. Logistic regression analysis was performed.

Results

A total of 53 CHIKV and 113 DENV patients were included. CHIKV patients were older and more likely to be female. CHIKV was independently associated with arthralgia and rash, while DENV was associated with myalgia, raised aspartate transaminase, and leucopaenia. Forty CHIKV patients were followed up, with a median duration of self-reported arthralgia of 3 months (range, 0–24 months). Eighteen (45%) had persistent arthralgia beyond 4 months, for which age >40 years was an independent predictor. At 1 year, 9 (22.5%) patients had arthralgia.

Conclusion

In Kuala Lumpur, selected clinical and laboratory predictors help to distinguish between DENV and CHIKV infections. Persistent arthralgia was a frequent sequel of CHIKV infection in this cohort.

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).

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