Table 2. Clinical and diagnostic characteristics of confirmed and probable chikungunya cases among returning travellers from Myanmar, 2019 (n = 18).
| Case | Clinical acute symptoms | Outcome | Need of hospitalisation (country) | Clinical status as at 20 Oct 2019 | Chikungunya diagnostic method | Day of diagnosis in 2019 (time from onset of illness) |
Other arboviral diagnostic test results |
|---|---|---|---|---|---|---|---|
| 1 | Fever, rash, arthralgias (fingers, wrists, ankles, knees) | Persistent arthralgias needing NSAIDs | No | Unknown | IgM+ (N Health Myanmar Co., Ltd, Yangon, Myanmar) | 08 Jul (6 days) |
Dengue: IgM−/IgG−; NS1− Zika: NS1− |
| 2 | Fever, rash, arthralgia (wrists, ankles), retro-orbital pain, conjunctival hyperaemia | Persistent arthralgias needing NSAIDs | No | Improvement of arthralgias | IgM+; PCR+ (NovaLisa, NovaTec, Dietzenbach, Germany) | 13 Aug (6 days) |
Dengue: PCR−; IgM− Zika: PCR−; IgM− |
| 3 | Fever, rash, arthralgia, myalgia, conjunctivitis | Persistent incapacitating arthralgias needing NSAIDs | No | Mild and improving arthralgia, no more NSAIDs needed | RT-PCR+ (RealStar chikungunya RT-PCR, Altona diagnostics, Hamburg, Germany) | 14 Aug (1 day) |
Dengue: PCR− Zika: PCR− |
| 4 | Fever, arthralgia, deep asthenia, profuse sweating | Persistent arthralgias needing NSAIDs and CT (prednisone) | Yes (Italy) | Unknown | IgM+/IgG+ (Euroimmun, Luebeck, Germany) | 14 Aug (9 days) |
Unknown |
| 5 | Fever, rash, arthralgia (fingers, wrists, knees), ankle swelling, conjunctival hyperaemia | Persistent arthralgias needing NSAIDs | Yes (United States) | Improving existing arthritis and arthralgia | IgM+/IgG+ (NovaLisa, NovaTec ) | 21 Aug (20 days) |
Dengue: IgM−/IgG− Zika: IgM− |
| 6 | Fever, ankles oedema | Persistent and recurrent arthralgias needing NSAIDs; fatigue, headache | No | Persisting moderate arthralgia, still needing NSAIDs | IgM+/IgG+ (Euroimmun) | 03 Sep (12 days) |
Dengue: IgM− Zika: IgM− |
| 7 | Fever, rash, chills, myalgias, symmetric arthralgias (knees, ankles, wrists, hands) | Improving with NSAIDs | No | Improving | IgM+/IgG+ (Arup Laboratories, Utah, United States) | 04 Sep (41 days) |
Not tested |
| 8 | Fever, rash, arthralgias (ankles, wrists, feet, interphalangeal joints in hands, bilateral) | Persistent arthralgias needing NSAIDs and CT | No | Improved | IgM+ (Euroimmun) | 09 Sep (10 days) |
Dengue: IgM−/IgG− Zika: IgM ambiguous/IgG− |
| 9 | Fever, rash, arthralgia | Persistent arthralgias needing NSAIDs and CT | No | Improved | IgM+ (Chemiluminescence Virclia UNILABS, Madrid, Spain) | 13 Sep (21 days) |
Dengue: IgM−/ IgG− Zika: IgM−/ IgG− |
| 10 | Fever, rash, arthralgia, diarrhoea, paraesthesia lower limbs, swelling upper and lower limbs, lymphadenopathy | Persistent arthralgias needing NSAIDs | No | Persistent arthralgia | IgM+/IgG−; PCR+ (ChLIA Alifax, Polverada, Italy) | 13 Sep (7 days) |
Dengue: RDT− Zika: PCR−; IgM−/ IgG− |
| 11 | Fever, rash, arthralgia, diarrhoea | Persistent arthralgias needing NSAID | No | Persistent arthralgia | IgM+/IgG-; PCR+ (ChLIA Alifax) | 13 Sep (6 days) |
Dengue: RDT− Zika: PCR−; IgM−/IgG− |
| 12 | Fever, pruritus, rash, head and limbs felt swollen | Persistent arthralgias needing paracetamol | No | Little light headed when exercise | RT-PCR+ (in house RT-PCR: [24]) | 23 Sep (4 days) |
Dengue NS1−; RT−PCR− Zika: not tested |
| 13 | Fever, nausea, arthralgias, ankle oedema | Persistent incapacitating arthralgias and ankle oedema needing NSAIDs and CT | No | Persistent incapacitating arthralgias and ankle oedema needing NSAIDs and corticosteroids | IgG+ (Euroimmun) | 07 Oct (8 months) |
Dengue: NS1−; IgM−, IgG+ (multiple exposures before, IIFT+ with low titre) Zika: not tested |
| 14 | Fever, rash, arthralgia | Not needing any treatment | No | Mild ankles arthralgias | IgG+ (Euroimmun) | 07 Oct (8 months) |
Dengue: NS1−; IgM−/IgG– Zika: not tested |
| 15 | Fever, rash, arthralgias (wrists, right elbow, metacarpophalangeal joints), general malaise and nausea | Persistent arthralgias needing NSAIDs | Yes (Myanmar) | Improve | IgM+/IgG+ (NovaLisa, NovaTec) | 14 Oct (74 days) |
Dengue: NS1− Zika: not tested |
| 16 | Fever, rash, arthralgia | Persistent arthralgias needing NSAIDs | No | Persistent arthralgias | IgM+/IgG+ (Euroimmun) | 16 Oct (60 days) |
Not tested |
| 17 | Fever, rash, arthralgias (hands, ankles) | No drugs needed | No but presented to local outpatient clinic where no testing for CHIK was done. | Mild arthralgias in fingers and ankles | RT-PCR+; IgM+/IgG– (Fast Track Diagnostics. Ltd, Esch-sur-Alzette, Luxembourg) | 21 Oct (7 days) |
Zika: PCR–; IgM–/IgG– Dengue: PCR−; NS1– |
| 18 | Fever, arthralgia | Improving arthralgia, NSAIDs no more needed | Yes (France) | Moderate persisting arthralgias | RT-PCR+ (RealStar chikungunya RT-PCR, Altona diagnostics); IgM+/IgG– (Euroimmun) | 02 Nov (4 days) |
Dengue: PCR–; IgM– Zika: PCR–; IgM– |
CT: corticosteroids; IIFT: indirect immunofluorescence test; Ig: immunoglobulin; NSAID: non-steroidal anti-inflammatory drug; NS1: nonstructural 1 protein antigen; RDT: rapid diagnostic test; RT-PCR: real time PCR.