Molecular Characterisation of Chikungunya Virus Infections in Trinidad and Comparison of Clinical and Laboratory Features with Dengue and Other Acute Febrile Cases.
Molecular Characterisation of Chikungunya Virus Infections in Trinidad and Comparison of Clinical and Laboratory Features with Dengue and Other Acute Febrile Cases.
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DOI：
10.1371/journal.pntd.0004199
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发表时间：
2015-11
影响因子：
3.8
通讯作者：
Carrington CV
中科院分区：
文献类型：
--
作者：
Sahadeo N;Mohammed H;Allicock OM;Auguste AJ;Widen SG;Badal K;Pulchan K;Foster JE;Weaver SC;Carrington CV
基孔肯雅病毒（CHIKV）的本地传播于2014年7月在特立尼达和托巴哥（T&T）首次记录，随后发生大规模流行。在最初的表现中，很难区分基孔肯雅热（CHIKF）与其他急性未分化发热性疾病（AUFI），包括危及生命的登革热。我们在T&T的一家大医院对158名疑似登革热（DF）和CHIKF的患者进行了登革热病毒（DENV）和CHIKV感染的特征和比较，并对从8名个体中回收的CHIKV基因组序列进行了系统发育分析。使用Pearson χ2和student t检验比较具有和不具有PCR证实的CHIKV的患者的特征，并且使用逻辑回归确定调整的优势比（aOR）和95%置信区间（CI）。然后，我们使用Mann-Whitney U，Pearson χ2和Fisher精确检验比较了RT-qPCR证实的CHIKV和DENV感染者的体征和症状。在158人中，有8人（6%）RT-qPCR证实的DENV和30人（22%）RT-qPCR证实的CHIKV感染。系统发育分析表明，CHIKV毒株属于亚洲基因型，与2013/14年美洲爆发初期分离的英属维尔京群岛毒株关系最密切。与CHIKV RT-qPCR阴性的人相比，RT-qPCR阳性的人更容易出现关节疼痛。（aOR：4.52 [95%CI：1.28-16.00]），在疾病后期接受访谈的可能性较小（发热后天数-aOR：0.56 [0.40-0.78]），白色血细胞计数较低（aOR：0.83 [0.71-0.96]）。在38例RT-qPCR证实的CHIKV或DENV患者中，症状表现无显著差异。然而，当分析中包括具有近期DENV或CHIKV感染的血清学证据的个体时，CHIKF与包括DF在内的其他AUFI之间的临床表现存在关键差异，其可用于在临床环境中对患者进行分类以进行适当护理。基孔肯雅病毒（CHIKV）最近在美洲出现，并引起基孔肯雅热（CHIKF）的大流行。虽然通常不危及生命，但CHIKF是一种使人衰弱的慢性疾病，导致严重的发病率和经济损失。很难将CHIKF与其他引起急性发热的病毒性疾病（包括登革热（DF））区分开来，这是一个重要的考虑因素，因为DF可能危及生命，早期识别和治疗病例是降低死亡率的关键。在这项研究中，我们调查了特立尼达和托巴哥（T&T）一家大医院的疑似DF或CHIKF患者，并确定了区分这两种疾病的体征和症状。我们还恢复了CHIKV的完整基因组序列，并表明T&T中的病原菌株是美洲爆发初期首次从英属维尔京群岛分离的菌株的密切相关后代。
Local transmission of Chikungunya virus (CHIKV) was first documented in Trinidad and Tobago (T&T) in July 2014 preceding a large epidemic. At initial presentation, it is difficult to distinguish chikungunya fever (CHIKF) from other acute undifferentiated febrile illnesses (AUFIs), including life-threatening dengue disease. We characterised and compared dengue virus (DENV) and CHIKV infections in 158 patients presenting with suspected dengue fever (DF) and CHIKF at a major hospital in T&T, and performed phylogenetic analyses on CHIKV genomic sequences recovered from 8 individuals. The characteristics of patients with and without PCR-confirmed CHIKV were compared using Pearson’s χ2 and student’s t-tests, and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression. We then compared signs and symptoms of people with RT-qPCR-confirmed CHIKV and DENV infections using the Mann-Whitney U, Pearson’s χ2 and Fisher’s exact tests. Among the 158 persons there were 8 (6%) RT-qPCR-confirmed DENV and 30 (22%) RT-qPCR-confirmed CHIKV infections. Phylogenetic analyses showed that the CHIKV strains belonged to the Asian genotype and were most closely related to a British Virgin Islands strain isolated at the beginning of the 2013/14 outbreak in the Americas. Compared to persons who were RT-qPCR-negative for CHIKV, RT-qPCR-positive individuals were significantly more likely to have joint pain (aOR: 4.52 [95% CI: 1.28–16.00]), less likely to be interviewed at a later stage of illness (days post onset of fever—aOR: 0.56 [0.40–0.78]) and had a lower white blood cell count (aOR: 0.83 [0.71–0.96]). Among the 38 patients with RT-qPCR-confirmed CHIKV or DENV, there were no significant differences in symptomatic presentation. However when individuals with serological evidence of recent DENV or CHIKV infection were included in the analyses, there were key differences in clinical presentation between CHIKF and other AUFIs including DF, which can be used to triage patients for appropriate care in the clinical setting. Chikungunya virus (CHIKV) recently emerged in the Americas and caused a major epidemic of chikungunya fever (CHIKF). While not usually life threatening, CHIKF is a debilitating and often chronic illness resulting in major morbidity and economic losses. It is difficult to distinguish CHIKF from other viral illnesses that cause acute fevers including dengue fever (DF), an important consideration since DF can be life-threatening and early identification and treatment of cases is key to reducing mortality. In this study we investigated individuals presenting to a major hospital in Trinidad and Tobago (T&T) with suspected DF or CHIKF, and identified signs and symptoms that distinguish these two illnesses. We also recovered complete genome sequences for CHIKV and show that the etiologic strain in T&T is a closely related descendent of the strain first isolated from the British Virgin Islands at the beginning of the outbreak in the Americas.