A study on Chikungunya virus infection in north India
Abstract number: P991
Agarwal J., Srivastava S., Malik S., Singh K.P., Singh M.
Objectives: Since re emergence of chikungunya virus (CKV) infection in Indian subcontinent in 2005, it has become a major public health threat.
Methods: Clinically suspected cases (as per NICD, New Delhi, India) visiting outpatient or inpatient Departments of Pediatrics, Medicine and Rheumatology and referred to Microbiology Department for diagnosis of CKV were prospectively enrolled after obtaining written consent. Detailed clinical history and examination findings were recorded in a pre designed questionnaire from 248 such patients during September 2009 to May 2010. Results of hematological and other investigations were extracted from medical records. IgM ELISA for CKV was done using IgM antibody capture ELISA (NIV, Pune, India). Reverse Transcriptase PCR for CKV was performed on 53 randomly selected samples. Tests for Malaria antigen, IgM against Dengue, Japanese encephalitis (JE) virus and typhoid were done as per referring clinician's request.
Results: 12.1% (30/248; 21 true positives; 9 borderline cases) patients were positive for CKV IgM and 17/53 were RT-PCR positive (14/45 IgM negative; 1/2 IgM positive; 2/6 borderline IgM positive). Overall CKV infection was present in 44/248 suspected patients. Mean duration of fever was 6.68 + 1.83 days. Frequent clinical features were fever (100%); arthralgia (95%); headache (85%); rash (57%); aphthous ulcers (36.5%); arthritis (25%); lymphadenopathy (16%) and hemorrhagic manifestation (15.9%). Involvement of elbow, wrist and hip joint, pain and redness in eyes and photophobia had significant association (p < 0.05) with CKV positiviy. Clinical presentation was different in adults and pediatric age groups. Neurological involvement with encephalitis and seizures was present in 7 cases and was more common in young children. 16/44 cases had co-infection by dengue virus, 4 with JE virus and 3 had concurrent malaria. Mortality rate amongst CKV infected was 4.5% (2/248, both children).
Conclusions: In absence of pathognomonic features, clinical overlap with other infections prevalent in this part of the world; clinical diagnosis becomes difficult. Unusual features like encephalitis were present in significant proportion. Considerable number of patients had co-infection with other pathogens hence even if patient is diagnosed with other more prevalent infections, CKV should be tested for. Both, serology and molecular diagnosis should be used in conjunction for better case detection.
|Session name:||Abstracts of 21st ECCMID / 27th ICC|
|Location:||Milan, Italy, 7 - 10 May 2011|
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