Abstract
Background
Imported cases of arbovirus infections associated with persistent arthralgia in travelers returning from endemic areas are often misdiagnosed due to overlapping clinical presentations and lack of widely available diagnostic testing. Identifying differences in joint involvement between arboviruses that cause persistent arthralgia may facilitate an earlier diagnosis. The purpose of this study was to determine if such distinct joint involvement has been reported in published literature for arbovirus-associated persistent arthralgia.
Methods
Chikungunya (CHIKV), Ross River Virus (RRV), Sindbis Virus (SINV) and Mayaro Virus (MAYV) were selected for their association with persistent arthralgia. Candidate manuscripts were identified using the PubMed database and search terms included virus names as well as terms associated with persistent arthralgia. Inclusion criteria consisted of 1) patient data on persistent arthralgia and 2) description of joint involvement. Joint involvement data was manually extracted and compared between viruses using a Fisher’s exact test. Pairwise post-hoc comparisons were then conducted using Fisher’s exact test and a Bonferroni correction was applied.
Results
Data from 1,833 patients were extracted from 57 manuscripts that met inclusion criteria (RRV = 194, SINV = 87, CHIKV = 1,526, MAYV = 26). Reported involvement of hands, wrists, elbows, shoulders, ankles and knees were recorded (Table 1). Distribution of joint involvement was then calculated for each virus (Figure 1). The difference in distribution of joint pain between the four arboviruses was statistically significant (P = 0.004). Comparisons revealed RRV and CHIKV are distinguishable from each other (P = 0.004).
Table 1. Reported Joint Involvement
Figure 1. Distribution of Joint Involvement
Conclusion
These findings suggest that differences in distribution in joint involvement may exist between patients with persistent arthralgia following arbovirus infection. Future studies aimed at more clearly elucidating these differences are warranted and may help develop a more rapid and accurate diagnostic algorithm that could improve patient care.
Disclosures
All Authors: No reported disclosures