Chikungunya Confused With Dengue In Malaysia :Clinical, Serological And Molecular Perspective

摘要

This study was to observe clinical, serolgical and molecular diagnosis of chikungunya viral fever patients and its comparison with dengue viral fever. For that 49 serologically negative dengue patients but clinically dengue like symptomms were included. Clinical investigation was carried out recording different profiles of hospitalized patients. Serology was performed using the Onsite? Chikungunya IgM Combo rapid test and molecular test RT-PCR was performed to detect the virus in the patients sera. It was observed that out of them 19 (38.7 %) were serologically confirmed chikungunya infection. Interestingly molecular detection of the patients sera did not show the presence chikungunya virus but detected dengue virus from 9 patients’s sera. Classical clinical features of chikungunya virus infected patients were recorded to differentiate chikungunya from dengue, which were fever, arthralgia, myalgia and rash. Detection of chikungunya IgM in these cohort means that this virus is circulating throughout the year although not as many as dengue. Laboratory confirmation is important to differentiate chikungunya fever from dengue fever. This study adds some information in local data and hopefully can help the clinicians to clinically and laboratory diagnosis and management of chikungunya infection in outbreak and non-outbreak setting. Serology was proven to be useful in confirming chikungunya infection. Introduction Chikungunya virus (CHIKV) infection has attracted so much attention since 2005. During that time it caused chikungunya fever with epidemics reported in Asia and Africa.Chikungunya is a crippling disease caused by the virus belong to the family Togaviridae(Chakkaravarthy et al, 2011). It is an arbovirus that shares the same vector with dengue virus. Thus, in dengue-endemic region, chikungunya is also a significant cause of viral fever causing outbreaks associted with severe morbidity. Clinically the virus causes high grade fever, chills and rigors associated with severe arthralgia and myalgia(Venkatesan et al, 2010) In Asia, urban mosquito sp, Aedes aegypti are primary vectors(El-Badry and Al-Ali, 2010)in comparison to forest-dwelling Aedes spp. seen in Africa. These spp are urban and peridomestic, anthropophilic mosquitoes that maintain close associations with humans and thus, are likely responsible for regional large outbreaks (Powers and Logue 2007).Since April 2008, nationwide outbreak has affected Malaysia with 4165 cases in 2008. In 2009, the Ministry of Health in Malaysia reported over 5430 cases of chikungunya fever. The most affected areas were the northern provinces of Sarawak, Kedah, followed by Kelantan, Selangor, and Perak. Chikungunya viral activity continued in the year 2010, with an additional 325 cases reported in the first 5 weeks (MOH, 2010). The symptoms of CHIKV infection are quite similar to those caused by many other infectious agents in the endemic areas. One particular difficulty in identifying CHIKV infection is its overlapping distribution with dengue viruses. It has been postulated that many cases of dengue virus infection are misdiagnosed and that the incidence of CHIKV infection is much higher than reported (Carey 1971). As a result management of patients with CHIKV infection has not been taken care of focusing appropriate causal agent. Through study has not been undertaken to determine the clear picture of CHIKV infection and its comparison with dengue in respect of clinical and serological and molecular investigation. Though, clinical and laboratory diagnosis are important for overall management and control of the disease.Therefore, the present study was undertaken to diagnose chikungunya infection by clinical, serological and molecular method in clinically suspected dengue patients presented to University Kebangsaan Malaysia Medical Centre (UKMMC). Material and Methods Study area: This study was conducted during January 2009 to January 2010 at Universiti Kebangsaan Malaysia Medical Centre (UK