Persisting Mixed Cryoglobulinemia in Chikungunya Infection

Case Western Reserve University School of Medicine, United States of America
PLoS Neglected Tropical Diseases (Impact Factor: 4.49). 02/2009; 3(2):e374. DOI: 10.1371/journal.pntd.0000374
Source: PubMed

ABSTRACT Chikungunya virus (CHIKV), an arbovirus, is responsible for a two-stage disabling disease, consisting of an acute febrile polyarthritis for the first 10 days, frequently followed by chronic rheumatisms, sometimes lasting for years. Up to now, the pathophysiology of the chronic stage has been elusive. Considering the existence of occasional peripheral vascular disorders and some unexpected seronegativity during the chronic stage of the disease, we hypothesized the role of cryoglobulins.
From April 2005 to May 2007, all travelers with suspected CHIKV infection were prospectively recorded in our hospital department. Demographic, clinical and laboratory findings (anti-CHIKV IgM and IgG, cryoglobulin) were registered at the first consultation or hospitalization and during follow-up.
Among the 66 travelers with clinical suspicion of CHIKV infection, 51 presented anti-CHIKV IgM. There were 45 positive with the serological assay tested at room temperature, and six more, which first tested negative when sera were kept at 4 degrees C until analysis, became positive after a 2-hour incubation of the sera at 37 degrees C. Forty-eight of the 51 CHIKV-seropositive patients were screened for cryoglobulinemia; 94% were positive at least once during their follow-up. Over 90% of the CHIKV-infected patients had concomitant arthralgias and cryoglobulinemia. Cryoglobulin prevalence and level drop with time as patients recover, spontaneously or after short-term corticotherapy. In some patients cryoglobulins remained positive after 1 year.
Prevalence of mixed cryoglobulinemia was high in CHIKV-infected travelers with long-lasting symptoms. No significant association between cryoglobulinemia and clinical manifestations could be evidenced. The exact prognostic value of cryoglobulin levels has yet to be determined. Responsibility of cryoglobulinemia was suspected in unexpected false negativity of serological assays at room temperature, leading us to recommend performing serology on pre-warmed sera.

Download full-text


Available from: Marc Morillon, Jul 04, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chikungunya fever is an acute illness caused by the arbovirus Chikungunya virus. The virus is transmitted primarily in a sylvatic cycle involving the Aedes mosquitoes. Since 2005, a Chikungunya fever outbreak of unprecedented magnitude occurred on several Indian Ocean islands. Since then, the disease has spread to many parts of the world due to imported cases among travellers returning from epidemic areas. Chikungunya virus causes a wide spectrum of illness including fever, a characteristic rash, disabling joint symptoms which can sometimes become severe that lasts months. This review summarises on this history of Chikungunya fever, host specificity, the characteristics of Chikungunya virus, clinical features of disease and current control measures. It focuses on how the re-emergence of an old changed the outlook of managing arboviral diseases in the present social and public health context.
    Microbes and Infection 09/2009; 11(14-15):1165-76. DOI:10.1016/j.micinf.2009.09.004 · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2005-2006, a major epidemic of CHIKV infection occurred in the Islands of the south-western Indian Ocean, and longstanding manifestations seemed to be more frequent than described before. To describe the frequency and related factors of late clinical manifestations of CHIKV infection among imported cases living in Aquitaine area, France. All patients recruited through the travel clinic and tropical medicine unit of the University Hospital Centre of Bordeaux with possible CHIKV infection were prospectively recorded, and confirmed cases of CHIKV infection were interviewed 2 years after infection. Factors associated with the persistence of symptoms were determined by multivariate logistic regression. Among the 29 cases followed, 17 still suffered from arthralgia 2 years after infection, and most of them had never recovered from the initial phase of the condition. The risk of persistent arthralgia tended to be higher among subjects with low educational level, subjects infected in the Reunion Island, and when initial phase lasted 30 days or more and was characterised by a severe pain. Consistent with previous studies, our findings showed worsened late manifestations among patients returning from Indian Ocean area. Persistence of symptoms tended to be linked with clinical burden during the acute phase, which can be informative for early recognition and management of patients at risk for developing persistent rheumatic symptoms. Cryoglobulins failed to be identified in seronegative patients with invalidating dengue-like syndrome.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 12/2009; 47(1):85-8. DOI:10.1016/j.jcv.2009.11.014 · 3.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The actuality in clinical dermatology is, to our opinion, dominated by the emergent or reemergent infections (arboviruses, poxviruses, mycobacteria, leishmania, staphylococcus, papillomaviruses, bedbugs...) and their involvement in certain diseases (atopia, psoriasis), tumours or syndromes with dermatologic signs (IRIS). The cutaneous adverse side effects of the targeted chemotherapies and biotherapies are consequently better surrounded. Some rare new anatomoclinical entities are identified but "classics" (Lipschütz ulcer, pityriasis rosea, deep dissecting hematoma, puffy hand syndrome, disseminata alopecia areata) are rediscovered and better represented thanks to help, sometimes, by new techniques.
    Annales de Dermatologie et de Vénéréologie 12/2009; 136 Suppl 7:S393-406. · 0.67 Impact Factor