Londhey Vikram, Agrawal Sachee, Vaidya Nilima, Kini Seema, Shastri J S, Sunil Sujatha
Associate Professor of Medicine.
Assistant Professor of Microbiology.
J Assoc Physicians India. 2016 Mar;64(3):36-40.
There have been various studies from India describing the acute presentation and the long-term sequalae of Chikungunya (CHIKV) infection. However, there are very few studies discussing the Chikungunya-Dengue (DENV) co-infection from Western India. The present project was undertaken to study the clinical features of Dengue and Chikungunya co-infection and compare with Chikungunya mono-infection; correlate the clinical findings with seroprevalence and molecular identification of Dengue and Chikungunya using IgM ELISA and RTPCR.
Three hundred suspected cases of Dengue and/or Chikungunya patients from out patients department and indoor wards, more than 12 years of age suffering from acute febrile illness, joint pains and rash for less than 10 days were included from June 2010 to April 2015. Proven cases of malaria, enteric fever, leptospirosis were excluded from the study. Leptospira IgM, Dengue IgM and PCR, Chikungunya IgM and PCR was done on all 300 samples.
Sero-surveillance of the patients revealed that 59% (177) patients were positive for Dengue IgM alone, while 2% (6) tested positive for Chikungunya IgM alone. 6.7% (20) patients tested positive for Dengue and Chikungunya both. Ninty seven (32.3%) patients were negative for Dengue and Chikungunya. Of the 300 samples, 7% (21) were positive for DENV, 35% (105) were positive for CHIKV, 10% (30) were both DENV and CHIKV positive and 48% (144) were negative for both through RT-PCR.
In our study, the patients of CHIKV mono-infection and DENV + CHIK co-infection had high VAS score, morning stiffness, arthralgias, restriction of joint movements as compared to patients with DENV mono infection. Patients of dengue mono infection had bone pains and myalgias in addition to joint pains; however there was restriction of joint movements in only 13.2% as compared with 100% of mono CHIKV or dual infection. These clinical features can be helpful in distinguishing DENV mono infection as compared to co-infection. The study highlights the diagnostic importance of RT-PCR in CHIKV and DENV co-infection, as 10% cases were identified using RT-PCR as compared to 6.7% cases by IgM antibodies.
印度已有多项研究描述了基孔肯雅热（CHIKV）感染的急性表现和长期后遗症。然而，来自印度西部讨论基孔肯雅热 - 登革热（DENV）合并感染的研究非常少。本项目旨在研究登革热和基孔肯雅热合并感染的临床特征，并与基孔肯雅热单一感染进行比较；将临床发现与使用IgM ELISA和RTPCR对登革热和基孔肯雅热的血清阳性率及分子鉴定结果相关联。
纳入2010年6月至2015年4月期间来自门诊和室内病房的300例疑似登革热和/或基孔肯雅热患者，年龄超过12岁，患有急性发热性疾病、关节疼痛且皮疹持续时间少于10天。已确诊的疟疾、伤寒、钩端螺旋体病病例被排除在研究之外。对所有300份样本进行钩端螺旋体IgM、登革热IgM和PCR、基孔肯雅热IgM和PCR检测。
对患者的血清学监测显示，59%（177例）患者仅登革热IgM呈阳性，而2%（6例）仅基孔肯雅热IgM检测呈阳性。6.7%（20例）患者登革热和基孔肯雅热检测均呈阳性。97例（32.3%）患者登革热和基孔肯雅热检测均为阴性。在300份样本中，7%（21份）DENV呈阳性，35%（105份）CHIKV呈阳性，10%（30份）DENV和CHIKV均呈阳性，48%（144份）两者均为阴性（通过RT-PCR检测）。
在我们的研究中，与登革热单一感染患者相比，基孔肯雅热单一感染和登革热 + 基孔肯雅热合并感染的患者视觉模拟评分（VAS）较高、晨僵、关节痛、关节活动受限。登革热单一感染患者除关节疼痛外还伴有骨痛和肌痛；然而，与基孔肯雅热单一感染或双重感染患者的100%相比，仅有13.2%的登革热单一感染患者存在关节活动受限。这些临床特征有助于区分登革热单一感染与合并感染。该研究强调了RT-PCR在基孔肯雅热和登革热合并感染诊断中的重要性，因为通过RT-PCR鉴定出10%的病例，而通过IgM抗体鉴定出6.7%的病例。
