Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: the TELECHIK cohort study on Reunion island

Abstract

Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.

Keywords: Alphavirus; chikungunya; chronic fatigue; cohort study; rheumatic disease.

Fig. 1.

Flowchart of the population, TELECHIK cohort study, Reunion island, November 2007–May 2008. ^†64 asymptomatic subjects and eight symptomatic subjects presenting neither rheumatic musculoskeletal pain nor fatigue at the onset of disease. ^‡50 children, 15 adults with absent contact or relocated, 13 subjects with absence of overt temporality in the clinical course of the post-chikungunya disease.

Fig. 2.

Relationships between the three main post-chikungunya syndromes reported among infected subjects aged 15 years and over who declared symptoms at the onset of infection, TELECHIK cohort study, Reunion island, November 2007–May 2008. The percentage in the left upper corner (light pink) accounts for the subjects who recovered. The percentage in the right upper corner (light blue frame) accounts for the ensemble of all long-lasting post-chikungunya disease manifestations. Percentages into the Venn diagram accounts for the proportions of the three long-lasting post-infective syndromes of interest: long-lasting rheumatic musculoskeletal pain (yellow circle and left bottom frame), idiopathic chronic fatigue (green light circle and right bottom frame) and chronic fatigue syndrome-like illness (dark green bottom circle). In light blue are other manifestations remaining to be specified, as sleep disorders (n = 23), memory troubles (n = 20), blurred vision (n = 15), depression (n = 12), attention difficulties (n = 6), hearing difficulties (n = 4) and mood disturbance (n = 3).