Lobkowicz Ludmila, Miranda-Filho Demócrito de Barros, Montarroyos Ulisses Ramos, Martelli Celina Maria Turchi, Barreto de Araújo Thalia Velho, De Souza Wayner Vieira, Bezerra Luciana Caroline Albuquerque, Dhalia Rafael, Marques Ernesto T A, Clemente Nuria Sanchez, Webster Jayne, Vaughan Aisling, Webb Emily L, Brickley Elizabeth B, Alencar Ximenes Ricardo Arraes de
Am J Trop Med Hyg. 2022 Apr 11;106(6):1711-20. doi: 10.4269/ajtmh.21-0449.
Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015-2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable. Between December 2015 and June 2017, we observed evidence of co-circulation with laboratory confirmation of 213 ZIKV mono-infections, 55 CHIKV mono-infections, and 58 sequential ZIKV/CHIKV infections (i.e., cases with evidence of acute ZIKV infection with concomitant serological evidence of recent CHIKV infection). In logistic regressions with adjustment for maternal age, ZIKV mono-infected cases had lower odds than CHIKV mono-infected cases of presenting with arthralgia (aOR, 99% CI: 0.33, 0.15-0.74), arthritis (0.35, 0.14-0.85), fatigue (0.40, 0.17-0.96), and headache (0.44, 0.19-1.90). However, sequential ZIKV/CHIKV infections complicated discrimination, as they did not significantly differ in clinical presentation from CHIKV mono-infections. These findings suggest clinical symptoms alone may be insufficient for differentiating between ZIKV and CHIKV infections during pregnancy and therefore laboratory diagnostics continue to be a valuable tool for tailoring care in the event of arboviral co-circulation.
节肢动物传播病毒的共同流行，尤其是那些具有共同蚊媒的病毒，如寨卡病毒（ZIKV）和基孔肯雅病毒（CHIKV），报告越来越多。寨卡病毒和基孔肯雅病毒之间的准确鉴别诊断具有很高的临床重要性，尤其是在妊娠背景下，但由于专业实验室检测设施的可用性有限，仍然具有挑战性。利用小头畸形流行研究小组前瞻性妊娠队列研究收集的数据，该研究在巴西伯南布哥州累西腓2015 - 2017年寨卡病毒流行的高峰期和消退期对出疹孕妇进行随访，本研究旨在描述寨卡病毒和基孔肯雅病毒感染的地理和时间分布，并调查寨卡病毒和基孔肯雅病毒感染在临床上可区分的程度。在2015年12月至2017年6月期间，我们观察到共同流行的证据，实验室确诊了213例寨卡病毒单一感染、55例基孔肯雅病毒单一感染和58例寨卡病毒/基孔肯雅病毒序贯感染（即有急性寨卡病毒感染证据且伴有近期基孔肯雅病毒感染血清学证据的病例）。在对产妇年龄进行调整的逻辑回归分析中，寨卡病毒单一感染病例出现关节痛（调整后比值比，99%置信区间：0.33，0.15 - 0.74）、关节炎（0.35，0.14 - 0.85）、疲劳（0.40，0.17 - 0.96）和头痛（0.44，0.19 - 1.90）的几率低于基孔肯雅病毒单一感染病例。然而，寨卡病毒/基孔肯雅病毒序贯感染使鉴别变得复杂，因为它们在临床表现上与基孔肯雅病毒单一感染没有显著差异。这些发现表明，仅靠临床症状可能不足以区分妊娠期寨卡病毒和基孔肯雅病毒感染，因此实验室诊断仍然是在虫媒病毒共同流行情况下提供个性化护理的宝贵工具。
