An outbreak of chikungunya in southern Thailand from 2008 to 2009 caused by African strains with A226V mutation
An outbreak of chikungunya in southern Thailand from 2008 to 2009 caused by African strains with A226V mutation
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DOI：
10.1016/j.ijid.2010.01.001
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发表时间：
2010-09-01
影响因子：
8.4
通讯作者：
Poovorawan, Yong
中科院分区：
文献类型：
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作者：
Rianthavorn, Pornpimol;Prianantathavorn, Kesmanee;Poovorawan, Yong
目的：为阐明2008 - 2009年泰国南部基孔肯雅病毒（CHIKV）引起的基孔肯雅热（CHIK fever）的临床和分子特征，采用ELISA法检测332例急性发热患者的381份血清中抗CHIKV IgM抗体。这些血清的分子分析进行了半巢式逆转录聚合酶链反应（RT-PCR），然后直接测序和系统发育分析。结果：179例患者被诊断为CHIK热的分子分析和/或抗CHIKV IgM抗体检测。诊断为CHIK热的患者明显比对照组年龄大（平均年龄38.8 ± 19岁对28.7 ± 18岁，p <0.0001），并且比对照组更常出现关节痛。100%的血清通过RT-PCR呈阳性，而如果血清是在发热的前4天内获得的，则通过ELISA进行的抗CHIKV IgM抗体的血清学检测中仅10%呈阳性。与此相反，CHIKV特异性IgM抗体的ELISA发现在100%的患者，而15%的患者是阳性的RT-PCR，如果血清获得超过9天后发烧。如果患者在发热的前4天内出现，则应进行CHIKV的RT-PCR。发烧至少9天后出现的患者应进行IgM抗体检测。基于系统发育分析，CHIKV分离株属于非洲基因型，携带E1 A226V突变，表明2004 - 2009年CHIKV暴发的单一起源。结论：新的CHIKV突变可能会改变CHIK热的流行病学表现。CHIK热的早期诊断对于防止进一步大规模爆发至关重要。(C)2010年国际传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To elucidate clinical and molecular characteristics of chikungunya fever (CHIK fever) from the 2008-2009 outbreak caused by chikungunya virus (CHIKV) in southern Thailand.Methods: Three hundred and eighty-one sera from 332 patients with acute febrile illness were tested for anti-CHIKV IgM antibody by ELISA. A molecular analysis of these sera was performed using a semi-nested reverse transcriptase polymerase chain reaction (RT-PCR), followed by direct sequencing and phylogenetic analysis.Results: One hundred and seventy-nine patients were diagnosed with CHIK fever by molecular analysis and/or anti-CHIKV IgM antibody detection. Patients diagnosed with CHIK fever were significantly older than controls (mean age 38.8 +/- 19 vs. 28.7 +/- 18 years, p < 0.0001) and presented with arthralgia more often than controls. One hundred percent of the sera were positive by RT-PCR, whereas only 10% were positive in serological tests for anti-CHIKV IgM antibody by ELISA if the serum was obtained during the first 4 days of fever. In contrast, CHIKV-specific IgM antibody by ELISA was found in 100% of patients, whereas 15% of patients were positive by RT-PCR if the serum was obtained more than 9 days after the onset of fever. RT-PCR for CHIKV should be performed if the patients present within the first 4 days of fever. Patients presenting after at least 9 days of fever should be tested for IgM antibody. Based on phylogenetic analysis, the CHIKV strains isolated belong to African genotypes harboring the E1 A226V mutation, indicating a single origin of the 2004-2009 CHIKV outbreaks.Conclusions: The novel CHIKV mutation could potentially modify the epidemiological presentation of CHIK fever. Early diagnosis of CHIK fever is essential for preventing further massive outbreaks. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.