Chikungunya infection - An emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases
Chikungunya infection - An emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases
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DOI：
10.1097/md/0b013e31806010a5
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发表时间：
2007-05-01
期刊：
影响因子：
1.6
通讯作者：
Tolou, Hugues
中科院分区：
文献类型：
--
作者：
Simon, Fabrice;Parola, Philippe;Tolou, Hugues
2005-2006年在印度洋岛屿，包括科摩罗、马约特、毛里求斯、塞舌尔，特别是留尼汪岛，出现了大规模的基孔肯雅病毒（CHIKV）爆发，其中77万居民中有35%在6个月内感染。最近，已在马达加斯加和印度记录了该病毒的传播，其中CHIKV正在迅速传播。感染CHIKV的游客已经从这些岛屿返回非流行地区的家中。我们对从印度洋岛屿返回的旅行者中输入到法国马赛的CHIKV感染的临床方面进行了为期14个月的前瞻性观察研究。共有47名患者被诊断为输入性CHIKV感染，经血清学、逆转录-聚合酶链反应和/或病毒培养证实。在疾病的早期阶段（发病后10天内），47名患者中有45名出现发热。25例病例在第一周出现皮疹。所有患者均患有关节炎。最常受影响的关节是手指、手腕、脚趾和脚踝。8例患者在急性期住院治疗，其中2例严重危及生命。共有38名患者在第10天后仍有症状，患有慢性外周风湿病，其特征为严重的关节疼痛和多发性腱鞘炎，行走和日常活动能力明显受限。3名患者在此阶段因严重持续性残疾住院。随访显示，尽管对症治疗，主要是止痛药和止痛药，关节疼痛和僵硬改善缓慢。在本系列中，我们描述了疾病的两个阶段。最初是严重的发热和发疹性多关节炎，随后是可持续数月的致残性周围风湿病。我们指出，在第二阶段的可能性暂时性外周血管疾病和短期皮质类固醇的偶尔受益。由于CHIKV可以在世界各地传播，所有医生都应该做好遇到这种虫媒病毒感染的准备。
A large chikungunya virus (CHIKV) outbreak emerged in 2005-2006 in the Indian Ocean islands, including Comoros, Mayotte, Mauritius, the Seychelles, and particularly in Reunion Island where 35% of 770,000 inhabitants were infected in 6 months. More recently, circulation of the virus has been documented in Madagascar and in India where CHIKV is spreading rapidly. CHIKV-infected visitors have returned home to nonendemic regions from these islands. We conducted a 14-month prospective observational study on the clinical aspects of CHIKV infection imported to Marseilles, France, in travelers returning from the Indian Ocean islands. A total of 47 patients have been diagnosed with imported CHIKV infection confirmed by serology, reverse transcription-polymerase chain reaction, and/or viral culture. At the early stage of the disease (within 10 days of the disease onset), fever was present in 45 of 47 patients. A rash was present in the first week in 25 cases. All patients suffered with arthritis. The most frequently affected joints were fingers, wrists, toes, and ankles. Eight patients were hospitalized during the acute stage, including 2 severe life-threatening cases. A total of 38 patients remained symptomatic after the tenth day with chronic peripheral rheumatism, characterized by severe joint pain and multiple tenosynovitis, with a dramatically limited ability to ambulate and carry out activities in daily life. Three patients were hospitalized at this stage for severe persistent handicap. Follow-up demonstrated slow improvement in joint pain and stiffness despite symptomatic treatment, mainly antiinflammatory and analgesic drugs. In the current series we describe 2 stages of the disease. an initial severe febrile and eruptive polyarthritis, followed by disabling peripheral rheumatism that can persist for months. We point out the possibility of transitory peripheral vascular disorders during the second stage and the occasional benefit of short-term corticosteroids. As CHIKV could spread throughout the world, all physicians should be prepared to encounter this arboviral infection.