Introduction
Chikungunya virus is an RNA virus that spreads by biting of female Aedes Species, Aedes aegypti or Aedes albopictus. The Chikungunya virus belongs to the Togaviridae family. The word “chikungunya” is an African word that means “that which bends up.” This is because Chikungunya causes extreme pain of the muscles and joints and stoop postures. Sudden onset of fever, nausea, sore throat, severe headache, vomiting, abdomen cramps, severe pain in the muscles and joints, photophobia, and chills are the symptoms of Chikungunya. If left undiagnosed or not provided proper care, Chikungunya can lead to serious health complications.
This article gives an overview of the different health complications that arise due to Chikungunya.
Chikungunya related health complications
- Neurological Complications
The neurological complications of the Chikungunya virus are of two types. The first category consists of the list of those neurological diseases that have been observed more frequently, and the second category contains the list of those neurological diseases that have been observed less frequently. The table below shows the list of neurological disorders caused by the Chikungunya virus in both categories.
| Neurological Complications described more frequently | Neurological Complications described less frequently |
|---|---|
| Myeloneuropathy | Behavioral changes |
| Encephalopathy and encephalitis | Cerebellitis |
| Encephalomyelopathy | Meningism |
| Guillain‐Barré syndrome | Sensorineural hearing loss |
| Neonatal hypotonia | Carpal tunnel syndrome |
| Neuro‐ocular disease (uveitis, retinitis, optic neuritis) | Bilateral total ophthalmoplegia |
| Acute disseminated encephalomyelitis | Third nerve palsy |
| Bickerstaff brainstem encephalitis–Miller Fisher syndrome–Guillain‐Barré syndrome overlap | |
| Stroke | |
| Seizures with or without fever |
A systemic review published in the Reviews in Medical Virology, 2018, mentions that encephalopathy is the most common neurological complication associated with adult and child Chikungunya infection. The review article also stressed that people with any underlying disease like respiratory disorder, hypertension, and cardiac disorder are more vulnerable to neurological complications when infected by the Chikungunya virus.
- Ocular Complications
As mentioned below, the Chikungunya virus has been linked to various ocular complications.
Ocular complications associated with Chikungunya virus
• Conjunctivitis
• Episcleritis
• Non- granulomatous anterior uveitis
• Granulomatous anterior uveitis
• Keratitis
• Retinitis with vitritis
• Bilateral neuroretinitis
• Multifocal choroiditis
• Optic neuritis
• Retrobulbar neuritis
• Exudative retinal detachment
• Panuveitis
A study published in the Ophthalmology Science, 2008, reports the ocular complications associated with the Chikungunya virus. The study involved chikungunya patients who had ocular complications from September 2006 to October 2006. Fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography were performed on all patients. Positive alterations in the eyes were noted and calculated.
The study found the following ocular complications in Chikungunya patients:
• Ocular lesions
• Nodular episcleritis
• Acute iridocyclitis
• Retinitis
Iridocyclitis and retinitis were the most common ocular complications associated with the Chikungunya virus. None of the patients reported cases of permanent blindness. All patients recovered from Chikungunya infection with good vision. - Cardiac Complications
Cardiac complications related to Chikungunya infections across all age groups have been reported in recent years. However, older people and patients with preexisting cardiac diseases are more vulnerable to cardiac complications due to Chikungunya. Cardiac complications due to Chikungunya infection are mainly observed among populations of the Caribbean, India, and parts of South America.
The list of cardiac complications includes:
• Myocarditis
• Hypotension
• Shock and circulatory collapse
• Raynaud disease
• Arrhythmias
• Murmurs
• Dilated cardiomyopathy
• Congestive insufficiency
• Heart failure
The cardiac complications of Chikungunya infection were examined by echocardiography in 32 individuals and published in the European Heart Journal, Cardiovascular Imaging, 2020. The study found atrial fibrillation in two of the individuals. Other kinds of arrhythmia, primarily ventricular extrasystoles, were seen in nine patients. The heart walls of 14 individuals showed concentric remodeling and eccentric LV hypertrophy. In most patients with persistent CHIKV infection, the EF of the LV and SLG were reduced. - Liver Damage resulting in jaundice
Chikungunya has a broad tissue tropism. Tissue tropism is when the host’s cells and tissues support the growth of any virus or bacterium. In addition, there have been reports of atypical presentations and complications of CHIK virus infections involving the nervous system, heart, kidney, and liver, which have resulted in significant consequences and deaths.
A case report describing a severe case of Chikungunya virus infection involving the liver was published in the Medical Journal of Malaysia in 2010. The news is of a non-alcoholic, non-smoker sixty-six-year-old man who got admitted at the hospital due to swelling in his limbs, joint pain, and fever of two days duration. The patient also complained about having chills, vomiting, myalgia, rigors, decreased urine output, and weight loss. Despite providing all necessary medical treatment and care, the patient succumbed to his illness three days after admission to the hospital. The serum sample and post-mortem liver biopsy test detected the presence of the Chikungunya RNA virus. Physicians concluded that although the patient was healthy, his age could have been a risk factor in developing such severe complications. - Renal Complications
The consequence of Chikungunya on renal function, as mentioned by a few studies, includes:
• Albuminuria
• Acute Kidney Injury
• Nephritis
• Hematuria
• Acute tubular necrosis
• Glomerular alterations that involve nephrosclerosis and membranoproliferative lesion
Patients who are already having Diabetes Mellitus, Chronic Kidney Disease, and patients who are on Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARBs) are at higher risk of developing Acute Kidney Injury when infected with Chikungunya virus. - Chikungunya Arthritis
Chikungunya can be acute and chronic. The chronic phase of Chikungunya involves pain in the ankles, knees, hips, wrists, elbows, and metacarpophalangeal joints that can last for weeks, months, and even years. The pattern of joint pain is similar to rheumatoid arthritis, peripheral spondyloarthritis, undifferentiated arthritis, and fibromyalgia. The rheumatic disease that lasts for more than 12 weeks in Chikungunya patients is Chronic Chikungunya Arthritis (CCA).
The symptoms of Chikungunya Arthritis include:
• Morning Stiffness
• Arthralgias
• Inflammatory synovitis
• negative tests for rheumatoid factor and anti-cyclic citrullinated peptide antibodies
• Laboratory diagnosis confirms the presence of serum positive IgM/IgG anti-Chikungunya antibodies.
In research conducted on the Caribbean island of Martinique, 128 individuals diagnosed with Chikungunya arthritis advanced to seronegative rheumatoid arthritis in one year. In the same study, 37% of patients had a flare-up of underlying degenerative arthritis, 35% had a relapse of previously clinically inactive spondyloarthritis, and 7% had fibromyalgia.
Similarly, an observational study from India found participants with chronic polyarthralgia, chronic polyarthritis, and tenosynovitis 15 months after Chikungunya infection.
REFERENCES
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