Evidence of Chikungunya Virus Disease in Pakistan Since 2015 With Patients
Demonstrating Involvement of the Central Nervous System
#MMPMID30042937
Barr KL
; Khan E
; Farooqi JQ
; Imtiaz K
; Prakoso D
; Malik F
; Lednicky JA
; Long MT
Front Public Health
2018[]; 6
(?): 186
PMID30042937
show ga
Several arboviruses are endemic to and co-circulate in Pakistan. In recent years,
Pakistan has observed a rise in arboviral infections. A cross-sectional study for
arboviral diseases, which included screening for Chikungunya virus (CHIKV), was
initiated in 2015 to determine which pathogens were causing disease in patients
presenting to health care services. Exposure to CHIKV was verified via detection
of viral nucleic acids or virus-specific IgM with virus-specific neutralizing
antibodies. Out of 997 enrolled patients presenting with clinical features
suggestive of arboviral disease, 102 patients were positive for CHIKV IgM
antibodies and 60 patients were positive for CHIKV nucleic acids or neutralizing
antibodies. The data presented here show that CHIKV has been circulating in
Pakistan since April of 2015. CHIKV infections were detected in study subjects up
to the conclusion of our enrollment period in July 2017. Syndromic and clinical
data show that arthralgia was associated with CHIKV as was rash, fever greater
than 38°C, and lymphopenia. Neurological symptoms were reported in 49% of CHIKV
suspect patients and in 46.6% of confirmed infections. Acute disseminated
encephalomyelitis was diagnosed in 5% of confirmed infection and various
manifestation of encephalitis diagnosed in an additional 16.6% of patients with
confirmed CHIKV infections. CHIKV-exposed patients were just as likely to present
with neurological symptoms and encephalitis as patients with West Nile Virus
infections but were 4.57 times more likely to have lymphopenia. This proportion
of neurological symptoms may be a complicating factor in countries where WNV
and/or JEV co-circulate with CHIKV.
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