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. 2013 Dec 2;8(12):e82259.
doi: 10.1371/journal.pone.0082259. eCollection 2013.

Chikungunya as a cause of acute febrile illness in southern Sri Lanka

Megan E Reller  1 , Ufuoma Akoroda, Ajith Nagahawatte, Vasantha Devasiri, Wasantha Kodikaarachchi, John J Strouse, Robert Chua, Yan'an Hou, Angelia Chow, October M Sessions, Truls Østbye, Duane J Gubler, Christopher W Woods, Champica Bodinayake
Affiliations

Chikungunya as a cause of acute febrile illness in southern Sri Lanka

Megan E Reller et al. PLoS One. .

Abstract

Background: Chikungunya virus (CHIKV) re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK) in patients presenting with acute undifferentiated febrile illness in unstudied rural and semi-urban southern Sri Lanka in 2007.

Methodology/principal findings: We enrolled febrile patients ≥ 2 years of age, collected uniform epidemiologic and clinical data, and obtained serum samples for serology, virus isolation, and real-time reverse-transcriptase PCR (RT-PCR). Serology on paired acute and convalescent samples identified acute chikungunya infection in 3.5% (28/797) patients without acute dengue virus (DENV) infection, 64.3% (18/28) of which were confirmed by viral isolation and/or real-time RT-PCR. No CHIKV/DENV co-infections were detected among 54 patients with confirmed acute DENV. Sequencing of the E1 coding region of six temporally distinct CHIKV isolates (April through October 2007) showed that all isolates posessed the E1-226A residue and were most closely related to Sri Lankan and Indian isolates from the same time period. Except for more frequent and persistent musculoskeletal symptoms, acute chikungunya infections mimicked DENV and other acute febrile illnesses. Only 12/797 (1.5%) patients had serological evidence of past chikungunya infection.

Conclusions/significance: Our findings suggest CHIKV is a prominent cause of non-specific acute febrile illness in southern Sri Lanka.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Age distribution of patients with and without acute chikungunya infection, southern Sri Lanka, 2007.
Figure 2
Figure 2. Distribution of febrile patients with and without acute chikungunya infection by month, southern Sri Lanka, 2007.
Figure 3
Figure 3. Presence of anti-chikungunya IgG by age (years) in febrile patients, southern Sri Lanka, 2007.
Figure 4
Figure 4. Phylogenetic relationship of Sri Lankan chikungunya virus (CHIKV) isolates.
Sequences corresponding to the CHIKV structural genes from the six Sri Lankan isolates were compared to published CHIKV sequences [6,8,10,11,16]. Region of isolation is indicated by text color: West Africa (Red), Asia (Blue), East/South/Central Africa (Green), Reunion Island (Pink) and India/Sri Lanka (Orange). Isolates from the current study are indicated in bold-italics.
Figure 5
Figure 5. Alignment of the amino acid sequence surrounding the chikungunya virus E1-226 region.
Amino acid sequence corresponding to the E1 gene was translated from the nucleotide sequences of the three Sri Lankan isolates and compared the amino acid sequences of the isolates described in Schuffennecker et al 2006, PLoS Med and Kumar et al 2008, JGV [10,11]. Position E1-226 is highlighted (E1-226 corresponds to position 1035 in the polyprotein).
See this image and copyright information in PMC

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