Unité des Maladies Virales Emergentes, Centre International de Recherches Médicales de Franceville-CIRMF, Franceville, Gabon.
PLoS Negl Trop Dis. 2012;6(2):e1517. doi: 10.1371/journal.pntd.0001517. Epub 2012 Feb 14.
Chikungunya virus (CHIKV) has caused multiple outbreaks in tropical and temperate areas worldwide, but the clinical and biological features of this disease are poorly described, particularly in Africa. We report a prospective study of clinical and biological features during an outbreak that occurred in Franceville, Gabon in 2010.
METHODOLOGY/PRINCIPAL FINDINGS: We collected, in suspect cases (individuals presenting with at least one of the following symptoms or signs: fever, arthralgias, myalgias, headaches, rash, fatigue, nausea, vomiting, diarrhea, bleeding, or jaundice), blood samples, demographic and clinical characteristics and outcome. Hematological and biochemical tests, blood smears for malaria parasites and quantitative PCR for CHIKV then dengue virus were performed. CHIKV+ patients with concomitant malaria and/or dengue were excluded from the study. From May to July 2010, data on 270 laboratory-confirmed CHIK patients were recorded. Fever and arthralgias were reported by respectively 85% and 90% of patients, while myalgias, rash and hemorrhage were noted in 73%, 42% and 2% of patients. The patients were grouped into 4 clinical categories depending on the existence of fever and/or joint pain. On this basis, mixed forms accounted for 78.5% of cases, arthralgic forms 12.6%, febrile forms 6.7% and unusual forms (without fever and arthralgias) 2.2%. No cases of organ failure or death were reported. Elevated liver enzyme and creatinine levels, anemia and lymphocytopenia were the predominant biological abnormalities, and lymphocytopenia was more severe in patients with high viral loads (p = 0.01).
CONCLUSIONS/SIGNIFICANCE: During CHIK epidemics, some patients may not have classical symptoms. The existence of unusual forms and the absence of severe forms of CHIK call for surveillance to detect any change in pathogenicity.
基孔肯雅病毒（CHIKV）已在全球热带和温带地区引发了多次疫情，但该疾病的临床和生物学特征描述甚少，尤其是在非洲。我们报告了 2010 年在加蓬弗朗维尔暴发疫情期间进行的一项关于临床和生物学特征的前瞻性研究。
方法/主要发现：我们收集了疑似病例（出现以下至少一种症状或体征的个体：发热、关节痛、肌痛、头痛、皮疹、乏力、恶心、呕吐、腹泻、出血或黄疸）的血液样本、人口统计学和临床特征以及结局。进行了血液学和生化学检查、疟疾寄生虫血涂片检查以及定量 PCR 检测 CHIKV 和登革热病毒。将同时患有疟疾和/或登革热的 CHIKV+患者排除在研究之外。2010 年 5 月至 7 月，共记录了 270 例实验室确诊的 CHIK 患者的数据。发热和关节痛分别见于 85%和 90%的患者，而肌痛、皮疹和出血分别见于 73%、42%和 2%的患者。根据是否存在发热和/或关节痛，将患者分为 4 个临床类别。在此基础上，混合型占 78.5%，关节痛型占 12.6%，发热型占 6.7%，非典型型（无发热和关节痛）占 2.2%。无器官衰竭或死亡病例报告。肝酶和肌酐水平升高、贫血和淋巴细胞减少是主要的生物学异常，高病毒载量患者的淋巴细胞减少更严重（p=0.01）。
结论/意义：在 CHIK 流行期间，一些患者可能没有典型症状。非典型病例的存在和 CHIK 无严重症状的情况提示需要进行监测，以发现任何致病性变化。
