Emergence and Clinical Insights into the Pathology of Chikungunya Virus Infection

Authors and Disclosures

Marie Christine Jaffar-Bandjee¹, Duksha Ramful¹, Bernard Alex Gauzere¹, Jean Jacques Hoarau¹, Pascale Krejbich-Trotot¹, Stephanie Robin¹, Anne Ribera¹, Jimmy Selambarom¹ and Philippe Gasque<sup>†1

1</sup>Groupe de recherche immunopathologie et maladies infectieuses (GRI), Université de la Réunion et CHR Félix Guyon, Plateau technique du CYROI, 2 rue Maxime Rivière, 97470 Sainte-Clotilde, Reunion, France

^†Author for correspondence
Tel: +262 262 938 836 Fax: +262 262 938 801 gasque@univ-reunion.fr; gasquep@hotmail.com

Sidebar

Key Issues

• Chikungunya, a tropical disease in poorer countries, is now becoming a major global health issue given the worldwide distribution of its mosquito vector (Aedes albopictusand, to a less extent, Aedes aegypti).

• The disease is highly symptomatic and characterized by a Dengue-like episode (fever and rash) and a unique incapacity to walk, accompanied by myalgia and neurological symptoms.

• Rare cases of mother-to-child transmission, encephalitis, hepatitis and cardiomyopathies have been described that required intensive care. Deaths linked to Chikungunya virus infection were estimated at 0.1% in La Réunion.

• Chronic pain is of nociceptive but also neuropathic nature. Salicylates and other NSAIDs used in adults should be avoided in neonates as they may precipitate bleeding manifestations.

• Severe arthralgia can persist for months, particularly in elderly patients, and evolve to rheumatisms.

• Classical disease-modifying anti-rheumatic drug therapy with methotrexate, sulfasalazine, leflunomide or hydroxychloroquine was used successfully. In case of inadequate response to methotrexate, treatment was successful with TNF-α blockers.

• Other treatments (anti-malaria drugs) proved to be inadequate.

• The design of a safe and efficient recombinant vaccine is in progress and has been shown to be protective in mouse and nonhuman primate models of Chikungunya.

• The development of polyvalent immunoglobulins purified from human plasma samples of convalescent Chikungunya patients could benefit infected viremic mothers and newborns.