Published date: Sep 30 2020

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 15 (2020), Issue No. 3

Pages: 300–312

DOI: 10.18502/sjms.v15i3.6823

Bashir Abdrhman Bashir Mohamedbashirbashir17@hotmail.comPort Sudan Ahlia College

Medical laboratory Consultant Hematology Department

Abubaker El-dirdiri drdardiri@gmail.comPort Sudan Teaching Hospital, Port Sudan, Sudan

Background: Chikungunya has recently been reported by the WHO to account for many cases in Sudan. The infection is extremely symptomatic, with fever, skin rash, and incapacitating arthralgia, which can promote chronic arthritis and rheumatism in older patients. A few studies on chronic pain owing to the Chikungunya virus (CHIKV) infection have been issued. The aim of this study was to outline the laboratory findings and the physical symptom frequency of joint pain of the current Sudanese CHIKV outbreak, and evaluate its impact on the individual.

Methods:  This cross–sectional study included 23 CHIKV-confirmed patients attending a Sudanese single private medical center between March and September 2019. The included patients were checked for rheumatoid factor (RF) value, C-reactive protein (CRP) titer, erythrocyte sedimentation rate (ESR) value, and uric acid (UA) level. Physical scrutiny was conducted and persistent symptoms were registered.

Results: The significant rheumatologic conditions were polyarthralgia (39.1%), polyarthritis (21.7%), arthralgia (17.4%), arthritis (13%), and osteoarthritis (8.8%). Swelling signs were noted in 21.9% of the patients. Joints implicated were knees (59.4%), wrists (56.3%), fingers (50%), shoulders (37.5%), feet (34.4%), ankles (31.3%), spine (18.8%), and elbow (9.4%). CRP, RF, and ESR were significantly increased in patients with persistent joints pain versus nonpersistent joint pain patients (P = 0.000, 0.002, 0.008, respectively). However, the UA was insignificant (P = 0.920).   

Conclusions:  Knee joint pain remarks a significant dilemma post-CHIKV. It is noted that these remarks were linked with the risk of subsequently creating chronic sequelae. Polyarthralgia was the dominant inflammatory sequel post-Chikungunya infection.  

Keywords: CHIKV, arthritis, arthralgia, polyarthralgia, polyarthritis, Sudan

[1] Manimunda, S. P., Vijayachari, P., Uppoor, R., et al. (2010). Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging. Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 104, no. 6, pp. 392 –399.
[2] Gould, L. H., Osman, M. S., Farnon, E. C., et al. (2008). An outbreak of yellow fever with concurrent chikungunya virus transmission in South Kordofan Sudan 2005. Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 102, no. 12, pp. 1247–1254.
[3] Al-Gasseer, N., El Bushra, H. E., Yeneabat, A., et al. (2019). Countrywide outbreak of acute watery diarrhea in Sudan, 2016–2018. EC Emergency Medicine and Critical Care, vol. 3, no. 5, pp. 274–284.
[4] Leparc-Goffart, I., Nougairede, A., Cassadou, S., et al. (2014). Chikungunya in the Americas. Lancet, vol. 383, p. 514.
[5] Weaver, S. C. and Lecuit, M. (2015). Chikungunya virus and the global spread of a mosquito-borne disease. New England Journal of Medicine, vol. 372, pp. 1231–1239.
[6] Powers, A. M. (2015). Risks to the Americas associated with the continued expansion of chikungunya virus. Journal of General Virology, vol. 96, pp. 1–5.
[7] Kwoh, C. K., Maclean, C., Anderson, L. G., et al. (2008). Rheumatoid Arthritis Physician Performance Management Set. National Committee for Clinical Assurance, Physician consortium for Performance Improvement, American College of Rheumatology. Available from: http://www.ama-assn.org/ama1/pub/upload/mm/pcpi/rheumatoid-arthritis.pdf
[8] Ali, A. N., Hui, C. J., Prajapati, S. K., et al. (2018). Knowledge and awareness regarding Chikungunya: a cross-sectional study among healthcare students in a private university, Malaysia. MOJ Bioequivalence & Bioavailability, vol. 5, no. 6, pp. 293‒298.
[9] Charlys da Costa, A., Thézé, J., Komninakis, S., et al. Spread of chikungunya virus east/central/south African genotype in Northeast Brazil. Emerging Infectious Diseases 2017, vol. 23, no. 10, pp. 1742–1744.
[10] Staples, J. E., Breiman, R. F., and Powers, A. M. (2009). Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clinical Infectious Diseases, vol. 49, no. 6, pp. 942–948.
[11] Schilte, C., Staikowsky F, Couderc T, et al. (2013). Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLOS Neglected Tropical Diseases, vol. 7, no. 3, p. e2137.
[12] Chow, A., Her Z, Ong EK, et al. (2011). Persistent arthralgia induced by chikungunya virus infection is associated with interleukin-6 and granulocyte macrophage colony stimulating factor. The Journal of Infectious Diseases, vol. 203, no. 2, pp. 149–157.
[13] Chen, W., Foo SS, Rulli NE, et al. (2014). Arthritogenic alphaviral infection perturbs osteoblast function and triggers pathologic bone loss. Proceedings of the National Academy of Sciences of the United States of America, vol. 111, no. 16, pp. 6040–6045.
[14] Gerardin, P., Fianu, A., Michault, A., et al. (2013). Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study. Arthritis Research & Therapy, vol. 15, p. R9.
[15] Elsinga, J., Gerstenbluth, I., van der Ploeg, S., et al. (2017). Long-term Chikungunya sequelae in Curacao: burden, determinants and a novel classification tool. Journal of Infectious Diseases, vol. 216, pp. 573–581.
[16] Mohd Zim, M. A., Sam, I. C., Omar, S. F., et al. (2013). Chikungunya infection in Malaysia: comparison with dengue infection in adults and predictors of persistent arthralgia. Journal of Clinical Virology, vol. 56, p. 141–145.
[17] Rodriguez-Morales, A. J., Cardona-Ospina, J. A., Fernanda Urbano-Garzon, S., et al. (2016). Prevalence of post-Chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis. Arthritis Care & Research, vol. 68, pp. 1849–1858.
[18] Feldstein, L. R., Rowhani-Rahbar, A., Staples, J. E., et al. (2016). Persistent arthralgia associated with Chikungunya virus outbreak, US Virgin Islands, December 2014-February. Emerging Infectious Diseases, vol. 23, no. 4, pp. 673–676.
[19] Yaseen, H. M., Simon, F., Deparis, X., et al. (2014). Identification of initial severity determinants to predict arthritis after Chikungunya infection in a cohort of French gendarmes. BMC Musculoskeletal Disorders, vol. 15, p. 249.
[20] Fritzell, C., Raude, J., Adde, A., et al. (2016). Knowledge, attitude and practices of vector- borne disease prevention during the emergence of a new arbovirus: implications for the control of Chikungunya virus in French Guiana. PLOS Neglected Tropical Diseases, vol. 10, p. e0005081.
[21] Chang, A. Y., Encinales, L., Porras, A., et al. (2018). Frequency of chronic joint pain following Chikungunya virus infection: a Colombian cohort study. Arthritis & Rheumatology, vol. 70, no. 4, pp. 578–584.
[22] van Aalst, M., Nelen, C. M., Goorhuis, A., et al. (2017). Long-term sequelae of chikungunya virus disease: a systematic review. Travel Medicine and Infectious Disease, vol. 15, pp. 8–22.
[23] Hoarau, J. J., Jaffar Bandjee, M. C., Krejbich Trotot, P., et al. (2010). Persistent chronic inflammation and infection by Chikungunya arthritogenic alphavirus in spite of a robust host immune response. Journal of Immunology, vol. 184, pp. 5914–5927.
[24] Heath, C. J., Lowther, J., Noël, T. P., et al. (2018). The identification of risk factors for chronic Chikungunya arthralgia in Grenada, West Indies: a cross-sectional cohort study. Open Forum Infectious Diseases, vol. 5, no. 1, pp. 1–10.