RESUMO
Long COVID presents with diverse symptoms after COVID-19. Different clusters of symptoms have been reported; however, their persistence beyond 2 years after COVID-19 remains unclear. In this cohort study, we prospectively evaluated individuals with previous severe COVID-19 presenting with long COVID at a two-year follow-up. We characterized the included patients and performed a cluster analysis of symptoms through multiple correspondence analysis and hierarchical clustering. A total of 199 patients with long COVID were included. The median age was 58 years (48-69), 56% were male, and the median follow-up time since the COVID-19 diagnosis was 26 months (IQR: 25, 27). Three symptom clusters were identified: Cluster 1 is characterized by fatigue, myalgia/arthralgia, a low prevalence of symptoms, and a lack of specific symptoms; Cluster 2 is defined by a high prevalence of fatigue, myalgia/arthralgia, and cardiorespiratory symptoms, including palpitations, shortness of breath, cough, and chest pain; and Cluster 3 is demonstrated a high prevalence of ageusia, anosmia, fatigue, and cardiorespiratory symptoms. Our study reinforces the concept of symptom clustering in long COVID, providing evidence that these clusters may persist beyond two years after a COVID-19 diagnosis. This highlights the chronic and debilitating nature of long COVID and the importance of developing strategies to mitigate symptoms in these patients.
Assuntos
Artralgia , COVID-19 , Fadiga , Mialgia , Síndrome de COVID-19 Pós-Aguda , Sistema de Registros , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/complicações , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Fadiga/etiologia , Mialgia/etiologia , Mialgia/fisiopatologia , Artralgia/virologia , Artralgia/etiologia , Estudos Prospectivos , Prevalência , Análise por Conglomerados , Ageusia/epidemiologia , Ageusia/etiologia , Ageusia/virologia , Anosmia/epidemiologia , Anosmia/etiologia , Dispneia/fisiopatologia , Dispneia/virologia , Dispneia/etiologia , Seguimentos , Tosse , Fatores de Tempo , Estudos de CoortesRESUMO
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that recently re-emerged in many parts of the world causing large-scale outbreaks. CHIKV infection presents as a febrile illness known as chikungunya fever (CHIKF). Infection is self-limited and characterized mainly by severe joint pain and myalgia that can last for weeks or months; however, severe disease presentation can also occur in a minor proportion of infections. Among the atypical CHIKV manifestations that have been described, severe arthralgia and neurological complications, such as encephalitis, meningitis, and Guillain-Barré Syndrome, are now reported in many outbreaks. Moreover, death cases were also reported, placing CHIKV as a relevant public health disease. Virus evolution, globalization, and climate change may have contributed to CHIKV spread. In addition to this, the lack of preventive vaccines and approved antiviral treatments is turning CHIKV into a major global health threat. In this review, we discuss the current knowledge about CHIKV pathogenesis, with a focus on atypical disease manifestations, such as persistent arthralgia and neurologic disease presentation. We also bring an up-to-date review of the current CHIKV vaccine development. Altogether, these topics highlight some of the most recent advances in our understanding of CHIKV pathogenesis and also provide important insights into the current development and clinical trials of CHIKV potential vaccine candidates.
Assuntos
Febre de Chikungunya , Vírus Chikungunya , Artralgia/virologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/patologia , Febre de Chikungunya/prevenção & controle , Vírus Chikungunya/genética , Vírus Chikungunya/imunologia , Humanos , Desenvolvimento de Vacinas , Vacinas ViraisRESUMO
OBJECTIVES: To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. METHODS: From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. RESULTS: Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95-2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01-1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48-1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/µL for those with and without chronic arthralgia, respectively; P = 0.75). CONCLUSIONS: These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
Assuntos
Artralgia/epidemiologia , Febre de Chikungunya/epidemiologia , Vírus Chikungunya/imunologia , Dor Crônica/epidemiologia , Adolescente , Adulto , Artralgia/etiologia , Artralgia/virologia , Brasil/epidemiologia , Febre de Chikungunya/complicações , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Criança , Pré-Escolar , Dor Crônica/etiologia , Dor Crônica/virologia , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Adulto JovemRESUMO
Dengue, chikungunya and Zika viruses share similar disease features, rendering them difficult to distinguish clinically. Incapacitating arthralgia/arthritis is a specific manifestation associated with chikungunya virus infection. However, the profile of arthralgia/arthritis in Zika virus (ZIKV) cases has not been well characterized. Articles were extracted from PubMed and Scopus databases reporting original data from patients with arthralgia/arthritis, according to the Cochrane Collaboration. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 137 articles reporting ZIKV-associated joint symptoms were reviewed. Arthralgia was more frequently reported (n = 124 from case studies, n = 1779 from population-based studies) than arthritis (n = 7 and n = 121, respectively). Arthralgia was resolved in <1 week in 54%, and within 1-2 weeks in 40% of cases. The meta-analysis of cases in population-based studies identified a pooled prevalence of 53.55% for arthralgia. The pooled prevalence of arthralgia/arthritis during outbreaks depended on the geographic location, with a higher joint symptom burden observed in the Americas compared to South East Asia (Brazil: 60.79%; Puerto Rico: 68.89% and South East Asia: 26.46%). We conclude that non-specific constitutional arthralgia is the most common joint manifestation during ZIKV infection, being present in nearly half of cases but resolving by two weeks in >90% of these. We found no evidence of chronic rheumatic manifestations following ZIKV infection.
Assuntos
Artralgia/epidemiologia , Artrite/epidemiologia , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/virologia , Artrite/virologia , Brasil/epidemiologia , Surtos de Doenças , Feminino , Humanos , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem , Zika virus , Infecção por Zika virus/patologiaRESUMO
Chikungunya fever is a major public health issue in India. Re-emergence of chikungunya virus (CHIKV) in West Bengal was detected after 32 years in 2006. After 2010, this infection was in apparent decline, but in 2016 a massive outbreak affected the country. Present study was carried out to understand CHIKV infection dynamics during recent outbreaks in West Bengal, Eastern India and its implication on disease manifestations. Blood was collected from 641 symptomatic patients. Patients' sera were serologically diagnosed to detect presence of anti-chikungunya-IgM antibodies. Viral RNA was extracted; presence of CHIKV genome and its respective viral load was determined by real time quantitative reverse transcription-PCR (real-time qRT-PCR). Statistical analysis was performed using EPI INFO software. CHIKV infection was detected in 24.64% of symptomatic patients. Middle-aged patients (31-40 years) were predominantly affected; clinically, both arthralgia and joint-swelling were significantly prevalent among CHIKV-infected patients. Myalgia, joint-swelling, and arthralgic manifestation were found in significantly higher frequency among patients with high chikungunya viral load (> 10,000 copies/ml). Thus, this study clearly indicated the re-emergence of CHIKV in Eastern India. Significant presence of myalgia, joint swelling, and arthralgia among chikungunya patients with high viral load implied association of disease severity with viral load; requiring vigilance for proper management of infected patients as this disease is highly morbid in nature. However, in addition to chikungunya virus, other viral, bacterial, and protozoal infections also occur during post-monsoon season in India, having overlapping symptoms. Hence, continuous monitoring of these infections is required for better clinical management of patients.
Assuntos
Anticorpos Antivirais/sangue , Febre de Chikungunya/epidemiologia , Adolescente , Adulto , Idoso , Artralgia/virologia , Febre de Chikungunya/sangue , Febre de Chikungunya/imunologia , Vírus Chikungunya/genética , Vírus Chikungunya/isolamento & purificação , Criança , Surtos de Doenças/estatística & dados numéricos , Feminino , Genótipo , Geografia , Humanos , Imunoglobulina M/sangue , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/virologia , Saúde Pública , RNA Viral/isolamento & purificação , Sorogrupo , Índice de Gravidade de Doença , Carga Viral , Adulto JovemRESUMO
Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.
Assuntos
Febre de Chikungunya/diagnóstico , Doença Relacionada a Viagens , Artralgia/virologia , Vírus Chikungunya/genética , El Salvador , Doenças Endêmicas , Exantema/patologia , Exantema/virologia , Patologia Legal , Humanos , Los Angeles , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Reação em Cadeia da Polimerase , Edema Pulmonar/patologia , Edema Pulmonar/virologiaRESUMO
Fifty-two febrile patients living in Barquisimeto, Venezuela, were screened for arbovirus infection by virus culture during an outbreak of what was thought to be Zika virus infection. We report identification of Mayaro virus (MAYV) on culture of plasma from one patient, an 18-year-old woman with acute febrile illness, arthralgias, and psoriasiform rash. The strain was sequenced and was found to be most closely related to a 1999 strain from French Guiana, which, in turn, was related to two 2014 strains from Haiti. By contrast, previously reported outbreak-related MAYV strains from a sylvatic area approximately 80 miles from where the case patient lived were most closely related to Peruvian isolates. The two strain groups show evidence of having diverged genetically approximately 100 years ago.
Assuntos
Infecções por Alphavirus/diagnóstico , Alphavirus/isolamento & purificação , Artralgia/virologia , Exantema/virologia , Febre/virologia , Doença Aguda , Adolescente , Alphavirus/genética , Infecções por Alphavirus/virologia , Surtos de Doenças , Doenças Endêmicas , Feminino , Humanos , Filogenia , Análise de Sequência de DNA , VenezuelaRESUMO
BACKGROUND: Brazil presented an alarming number of newborns with microcephaly in the years 2015 and 2016. The investigation of the cases raised the suspicion of the association of these cases with maternal infections by the zika virus. Also, in 2015, there was an epidemic of zika virus infection in Brazil, reinforcing this hypothesis. OBJECTIVE: The objective of this study was to identify factors associated with the diagnosis of microcephaly in newborns, including zika virus infection. METHODS: We conducted a case-control study. The cases were defined as children who received clinical and imaging diagnosis of microcephaly, born after October 2015 in Ceará, Brazil, which recorded the highest number of microcephaly cases in Brazil during the outbreak. The cases were identified in medical records of public and private maternity hospitals and in child development stimulation clinics tracked until June 2017. Epidemiological, clinical, and socioeconomic variables were collected, visiting their homes and confirming data from their medical records. Controls were children without microcephaly identified in the vicinity of the residence of each case. Logistic regression models were used to control confounding. FINDINGS: We evaluated 58 cases and 116 controls. The odds of having a baby with microcephaly was 14 times higher among mothers who had zika virus infection (p < 0.001), after multivariate analysis. Arboviruses infections symptoms, as fever (p = 0.220), skin change (p < 0.001), and joint pain (p = 0.002) also demonstrated an association with microcephaly. CONCLUSIONS: Maternal infection zika virus was associated with a diagnosis of microcephaly. Our study contributes to the investigation of the epidemiological factors associated with the diagnosis of microcephaly.
Assuntos
Microcefalia/epidemiologia , Infecção por Zika virus/epidemiologia , Artralgia/epidemiologia , Artralgia/virologia , Brasil/epidemiologia , Estudos de Casos e Controles , Exantema/epidemiologia , Exantema/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Lactente , Masculino , Microcefalia/diagnóstico por imagem , Microcefalia/virologia , Infecção por Zika virus/complicaçõesRESUMO
Chikungunya virus (CHIKV) causes a febrile disease associated with chronic arthralgia, which may progress to neurological impairment. Chikungunya fever (CF) is an ongoing public health problem in tropical and subtropical regions of the world, where control of the CHIKV vector, Aedes mosquitos, has failed. As there is no vaccine or specific treatment for CHIKV, patients receive only palliative care to alleviate pain and arthralgia. Thus, drug repurposing is necessary to identify antivirals against CHIKV. CHIKV RNA polymerase is similar to the orthologue enzyme of other positive-sense RNA viruses, such as members of the Flaviviridae family. Among the Flaviviridae, not only is hepatitis C virus RNA polymerase susceptible to sofosbuvir, a clinically approved nucleotide analogue, but so is dengue, Zika, and yellow fever virus replication. Here, we found that sofosbuvir was three times more selective in inhibiting CHIKV production in human hepatoma cells than ribavirin, a pan-antiviral drug. Although CHIKV replication in human induced pluripotent stem cell-derived astrocytes was less susceptible to sofosbuvir than were hepatoma cells, sofosbuvir nevertheless impaired virus production and cell death in a multiplicity of infection-dependent manner. Sofosbuvir also exhibited antiviral activity in vivo by preventing CHIKV-induced paw edema in adult mice at a dose of 20 mg/kg of body weight/day and prevented mortality in a neonate mouse model at 40- and 80-mg/kg/day doses. Our data demonstrate that a prototypic alphavirus, CHIKV, is also susceptible to sofosbuvir. As sofosbuvir is a clinically approved drug, our findings could pave the way to it becoming a therapeutic option against CF.
Assuntos
Antivirais/uso terapêutico , Febre de Chikungunya/tratamento farmacológico , Vírus Chikungunya/efeitos dos fármacos , Vírus Chikungunya/patogenicidade , Sofosbuvir/uso terapêutico , Replicação Viral/efeitos dos fármacos , Animais , Animais Recém-Nascidos , Artralgia/tratamento farmacológico , Artralgia/virologia , Febre de Chikungunya/virologia , Humanos , Masculino , CamundongosRESUMO
OBJECTIVE: Describe the clinical-epidemiological profile of hospitalized elderly patients with arbovirus. METHOD: A documentary retrospective population-based descriptive study that used a quantitative approach with hospitalized elderly patients diagnosed with arbovirus was conducted in a teaching hospital. Data were collected from medical records and investigation forms. RESULTS: Thirty-three elderly patients participated in this study. A prevalence of dengue was observed, with fever, myalgia, and arthralgia. Arterial hypertension and diabetes were the comorbidities. Statistically significant correlations were obtained between arbovirus and schooling, employment situation, marital status, test results, and use of analgesics; and between the site of arthralgia and Chikungunya. CONCLUSION: The results support nursing care to hospitalized elderly patients with arbovirus, allowing the development of a proper and humanized care plan.