Goupil Brad A, Mores Christopher N
Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, Louisiana, United States of America.
Department of Pathobiological Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, Louisiana, United States of America; Virology and Emerging Infections, US Naval Medical Research Unit No. 6, Lima Pampa, Peru.
Open Rheumatol J. 2016 Nov 30;10:129-140. doi: 10.2174/1874312901610010129. eCollection 2016.
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that circulates predominantly in tropical and subtropical regions, potentially affecting over 1 billion people. Recently, an outbreak began in the western hemisphere and has resulted in over 1.8 million reported suspected cases. Infection often results in severe fever, rash and debilitating polyarthralgia lasting weeks to months. Additionally, the current literature reports that CHIKV can result in a severe chronic arthralgia and/or arthritis that can last months to years following the initial infection.
The purpose of this review is to evaluate the literature and summarize the current state of knowledge regarding CHIKV-associated disease, including clinical presentation, diagnosis, risk factors for development of severe disease, treatment, and pathogenesis in human patients. Additionally, recommendations are presented regarding avenues for clinical research to help further elucidate the pathogenesis of joint disease associated with CHIKV infection.
While there is an association between initial CHIKV infection and acute disease, a causal relationship with development of chronic arthralgia has not been established at this time. Potential causes of chronic CHIKV-induced arthritis have been postulated, including viral persistence, induction of autoimmune disease, and exacerbation of pre-existing joint disease. While there are numerous reports of chronic CHIKV-associated arthralgia and/or arthritis, there is currently no evidence of a definitive link between initial infection and development of chronic disease. Additional, prospective clinical research on CHIKV-associated disease is necessary to further determine the potential role of virus and development of chronic joint disease.
基孔肯雅病毒（CHIKV）是一种由蚊子传播的甲病毒，主要在热带和亚热带地区传播，可能影响超过10亿人。最近，西半球爆发了疫情，报告的疑似病例超过180万例。感染通常会导致严重发热、皮疹和使人衰弱的多关节痛，持续数周甚至数月。此外，目前的文献报道，基孔肯雅病毒可导致严重的慢性关节痛和/或关节炎，在初次感染后可持续数月至数年。
本综述的目的是评估文献，并总结关于基孔肯雅病毒相关疾病的现有知识状态，包括临床表现、诊断、重症疾病发生的危险因素、治疗以及人类患者的发病机制。此外，还提出了关于临床研究途径的建议，以帮助进一步阐明与基孔肯雅病毒感染相关的关节疾病的发病机制。
虽然初次感染基孔肯雅病毒与急性疾病之间存在关联，但目前尚未确定其与慢性关节痛的发生存在因果关系。已推测慢性基孔肯雅病毒诱发关节炎的潜在原因，包括病毒持续存在、自身免疫性疾病的诱导以及既往存在的关节疾病的加重。虽然有许多关于慢性基孔肯雅病毒相关关节痛和/或关节炎的报道，但目前没有证据表明初次感染与慢性疾病的发生之间存在明确联系。需要对基孔肯雅病毒相关疾病进行更多的前瞻性临床研究，以进一步确定病毒的潜在作用以及慢性关节疾病的发展情况。
