Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014

Rose Langsjoen, Rebecca J. Rubinstein, Tiffany F. Kautz, Albert J. Auguste, Jesse H. Erasmus, Liddy Kiaty-Figueroa, Renessa Gerhardt, David Lin, Kumar L. Hari, Ravi Jain, Nicolas Ruiz, Antonio E. Muruato, Jael Silfa, Franklin Bido, Matthew Dacso, Scott Weaver

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Since emerging in Saint Martin in 2013, chikungunya virus (CHIKV), an alphavirus transmitted by the Aedes aegypti mosquito, has infected approximately two million individuals in the Americas, with over 500,000 reported cases in the Dominican Republic (DR). CHIKV-infected patients typically present with a febrile syndrome including polyarthritis/polyarthralgia, and a macropapular rash, similar to those infected with dengue and Zika viruses, and malaria. Nevertheless, many Dominican cases are unconfirmed due to the unavailability and high cost of laboratory testing and the absence of specific treatment for CHIKV infection. To obtain a more accurate representation of chikungunya fever (CHIKF) clinical signs and symptoms, and confirm the viral lineage responsible for the DR CHIKV outbreak, we tested 194 serum samples for CHIKV RNA and IgM antibodies from patients seen in a hospital in La Romana, DR using quantitative RT-PCR and IgM capture ELISA, and performed retrospective chart reviews. RNA and antibodies were detected in 49% and 24.7% of participants, respectively. Sequencing revealed that the CHIKV strain responsible for the La Romana outbreak belonged to the Asian/American lineage and grouped phylogenetically with recent Mexican and Trinidadian isolates. Our study shows that, while CHIKV-infected individuals were infrequently diagnosed with CHIKF, uninfected patients were never falsely diagnosed with CHIKF. Participants testing positive for CHIKV RNA were more likely to present with arthralgia, although it was reported in just 20.0% of CHIKF+ individuals. High percentages of respiratory (19.6%) signs and symptoms, especially among children, were noted, though it was not possible to determine whether individuals infected with CHIKV were co-infected with other pathogens. These results suggest that CHIKV may have been underdiagnosed during this outbreak, and that CHIKF should be included in differential diagnoses of diverse undifferentiated febrile syndromes in the Americas.

Original languageEnglish (US)
Article numbere0005189
JournalPLoS Neglected Tropical Diseases
Volume10
Issue number12
DOIs
StatePublished - Dec 28 2016

Fingerprint

Chikungunya virus
Dominican Republic
Disease Outbreaks
Arthralgia
RNA
Immunoglobulin M
Respiratory Signs and Symptoms
Fever
Alphavirus
Chikungunya Fever
Dengue Virus
Asian Americans
Antibodies
Aedes
Exanthema
Culicidae
Malaria
Signs and Symptoms
Arthritis
Differential Diagnosis

ASJC Scopus subject areas

  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014. / Langsjoen, Rose; Rubinstein, Rebecca J.; Kautz, Tiffany F.; Auguste, Albert J.; Erasmus, Jesse H.; Kiaty-Figueroa, Liddy; Gerhardt, Renessa; Lin, David; Hari, Kumar L.; Jain, Ravi; Ruiz, Nicolas; Muruato, Antonio E.; Silfa, Jael; Bido, Franklin; Dacso, Matthew; Weaver, Scott.

In: PLoS Neglected Tropical Diseases, Vol. 10, No. 12, e0005189, 28.12.2016.

Research output: Contribution to journalArticle

Langsjoen, R, Rubinstein, RJ, Kautz, TF, Auguste, AJ, Erasmus, JH, Kiaty-Figueroa, L, Gerhardt, R, Lin, D, Hari, KL, Jain, R, Ruiz, N, Muruato, AE, Silfa, J, Bido, F, Dacso, M & Weaver, S 2016, 'Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014', PLoS Neglected Tropical Diseases, vol. 10, no. 12, e0005189. https://doi.org/10.1371/journal.pntd.0005189
Langsjoen, Rose ; Rubinstein, Rebecca J. ; Kautz, Tiffany F. ; Auguste, Albert J. ; Erasmus, Jesse H. ; Kiaty-Figueroa, Liddy ; Gerhardt, Renessa ; Lin, David ; Hari, Kumar L. ; Jain, Ravi ; Ruiz, Nicolas ; Muruato, Antonio E. ; Silfa, Jael ; Bido, Franklin ; Dacso, Matthew ; Weaver, Scott. / Molecular Virologic and Clinical Characteristics of a Chikungunya Fever Outbreak in La Romana, Dominican Republic, 2014. In: PLoS Neglected Tropical Diseases. 2016 ; Vol. 10, No. 12.
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abstract = "Since emerging in Saint Martin in 2013, chikungunya virus (CHIKV), an alphavirus transmitted by the Aedes aegypti mosquito, has infected approximately two million individuals in the Americas, with over 500,000 reported cases in the Dominican Republic (DR). CHIKV-infected patients typically present with a febrile syndrome including polyarthritis/polyarthralgia, and a macropapular rash, similar to those infected with dengue and Zika viruses, and malaria. Nevertheless, many Dominican cases are unconfirmed due to the unavailability and high cost of laboratory testing and the absence of specific treatment for CHIKV infection. To obtain a more accurate representation of chikungunya fever (CHIKF) clinical signs and symptoms, and confirm the viral lineage responsible for the DR CHIKV outbreak, we tested 194 serum samples for CHIKV RNA and IgM antibodies from patients seen in a hospital in La Romana, DR using quantitative RT-PCR and IgM capture ELISA, and performed retrospective chart reviews. RNA and antibodies were detected in 49{\%} and 24.7{\%} of participants, respectively. Sequencing revealed that the CHIKV strain responsible for the La Romana outbreak belonged to the Asian/American lineage and grouped phylogenetically with recent Mexican and Trinidadian isolates. Our study shows that, while CHIKV-infected individuals were infrequently diagnosed with CHIKF, uninfected patients were never falsely diagnosed with CHIKF. Participants testing positive for CHIKV RNA were more likely to present with arthralgia, although it was reported in just 20.0{\%} of CHIKF+ individuals. High percentages of respiratory (19.6{\%}) signs and symptoms, especially among children, were noted, though it was not possible to determine whether individuals infected with CHIKV were co-infected with other pathogens. These results suggest that CHIKV may have been underdiagnosed during this outbreak, and that CHIKF should be included in differential diagnoses of diverse undifferentiated febrile syndromes in the Americas.",
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