Table of Contents  
LETTER TO THE EDITOR
Year : 2017  |  Volume : 19  |  Issue : 2  |  Page : 139-140

Chikungunya virus-associated arthralgia could have been misdiagnosed by healthcare providers in Nigeria


1 Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
2 Department of Medical Laboratory Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
3 Department of Immunology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
4 Department of Clinical Laboratory Services, National Board for Technical Education, Kaduna State, Nigeria

Date of Web Publication15-Nov-2017

Correspondence Address:
Idris-Abdullahi Nasir
Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, PMB 1515, Ilorin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomt.jomt_3_17

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How to cite this article:
Nasir IA, Medugu JT, Shuwa HA, Yahaya F. Chikungunya virus-associated arthralgia could have been misdiagnosed by healthcare providers in Nigeria. J Med Trop 2017;19:139-40

How to cite this URL:
Nasir IA, Medugu JT, Shuwa HA, Yahaya F. Chikungunya virus-associated arthralgia could have been misdiagnosed by healthcare providers in Nigeria. J Med Trop [serial online] 2017 [cited 2020 Jul 7];19:139-40. Available from: http://www.jmedtropics.org/text.asp?2017/19/2/139/218403



Sir,

The mosquito-borne Chikungunya virus (CHKV) is a group A alpha virus in the Togaviridae family. CHKV causes a febrile illness known as Chikungunya fever (CHKF), typically accompanied by rash and severe debilitating arthralgia. Musculoskeletal manifestations of CHKV have been shown to affect 4–75% of those infected.[1] These data vary depending on the genetic susceptibility of populations. Excruciating pain and, occasionally, swelling are usually found in the wrists, the hands, the feet and the ankle in bilateral and symmetric distribution. These can persist after the resolution of the infection. Considering the long-term effects of CHKV infection, it is not only regarded as a public health problem but has also led to the loss of human productivity.[1] The virus was first isolated in Tanzania in 1952 where it circulates enzootically among non-human primates and Aedes mosquitoes.[1] These cycles lead to regular outbreaks of spillover across non-human primates-to-mosquitoes-to-humans and Sylvatic-to-Urban infections in Africa, and beyond. CHIKF has an epidemiological pattern with both sporadic and epidemic cases in West Africa. In Nigeria, CHKV epidemic was first recorded in 1969 at Ibadan.[2] For over 4 decades after its first emergence in Nigeria, no record of similar published study surfaced again (partly due to negligence by researchers, policymakers and government), until in 2013 when Baba et al.[3] demonstrated neutralizing antibodies against CHKV in 50% of the 310 febrile patients in Maiduguri, Northeastern Nigeria. Shortly after, in 2015, a traveller from Nigeria to India was confirmed to have imported CHKV implicating international travel and cross-border transmission.[4]

The death rate attributable to CHKF is at a lower rate; however, high mortality has been observed in concomitance with old age. Deregulation of the innate immune system, such as cytokine inflammatory response, may have a role in the main clinical signs of CHIKV infection and the establishment of persistent disease. There are currently no licensed vaccines and antivirals for CHIKV infections. Although several drugs have been found to have modest effect by targeting viral replication or host cellular components, these mainly target acute viral infection, and little is known about the effect of antiviral treatments on chronic infections. Consequently, avoiding vector population and bite are the feasible preventive measures against CHKF.

Plasma markers of inflammation, such as erythrocyte sedimentary rate and C-reactive protein, are unreliable in predicting the severity of joint diseases associated with CHKF. Specific laboratory tests have improved significantly in the accurate diagnosis of CHKV infections. Reverse-Transcription Polymerase Chain Reaction (RT-PCR) tests are particularly useful in the acute phase of illness. Serological assays have largely been used to determine whether the patient has a recent infection or has been previously infected. These are accomplished through the help of enzyme immunoassays that detect Immunoglobulin-M and Immunoglobulin-G (IgM and IgG). Recently, rapid immunochromatographic test (strips) that detects CHKV has been developed and evaluated. However, they are best used in the first 5 days of illness, with sensitivity between 80 and 89% and specificity between 90 and 94%.[5] This would allow the rapid diagnosis of CHKF at the point of care, thus precluding the need for further investigations.

The availability of literature in regards to the debilitating musculoskeletal manifestation of diseases following CHKV infection has been observed in recent times. This has allowed certain recommendations to be drawn regarding treatment strategies from the experience of physicians globally. As the arthralgia often has a strong semblance to well-described rheumatic presentations, it has often been treated as such, but with poor outcomes. In view of these, it is important to maintain holistic and evidence-based healthcare approach in the diagnosis and management of CHKV-associated arthralgia, especially in older patients.

Acknowledgements

We are grateful to Muhammad Sagir Shehu and Abdurrahman Ahmad Elfulaty, Department of Medicine, Ahmadu Bello University, Zaria for providing technical input for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sam IC, Kümmerer BM, Chan YF, Roques P, Drosten C, AbuBakar S. Updates on Chikungunya epidemiology, clinical disease, and diagnostics. Vector Borne Zoonotic Dis 2015;15:223-30.  Back to cited text no. 1
    
2.
Moore DL, Reddy S, Akinkugbe FM, Lee VH, David-West TS, Causey OR et al. An epidemic of Chikungunya fever at Ibadan, Nigeria, 1969. Ann Trop Med Parasitol 1974;68:59-68.  Back to cited text no. 2
    
3.
Baba M, Logue CH, Oderinde B, Abdulmaleek H, Williams J, Lewis J et al. Evidence of arbovirus co-infection in suspected febrile malaria and typhoid patients in Nigeria. J Infect Dev Ctries 2013;7:51-9.  Back to cited text no. 3
    
4.
Raut CG, Rao NM, Sinha DP, Hanumaiah H, Manjunatha MJ. Chikungunya, dengue, and malaria co-infection after travel to Nigeria, India. Emerg Infect Dis 2015;21:908.  Back to cited text no. 4
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5.
Lee VJ, Chow A, Zheng X, Carrasco LR, Cook AR, Lye DC et al. Simple clinical and laboratory predictors of Chikungunya versus dengue infections in adults. PLoS Negl Trop Dis 2012;6:e1786.  Back to cited text no. 5
    




 

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