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. 2023 Apr 3;8(4):213.
doi: 10.3390/tropicalmed8040213.

Clinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available

Juan C Rueda  1   2 , Ingris Peláez-Ballestas  3 , Jose-Ignacio Angarita  2 , Ana M Santos  2 , Carlos Pinzon  4 , Eugenia-Lucia Saldarriaga  2 , Jorge M Rueda  5 , Elias Forero  6 , Diego L Saaibi  7 , Paula X Pavía  8 , Marta Juliana Mantilla  2   9 , Gustavo Rodríguez-Salas  2   9 , Juan Camilo Santacruz  2   9 , Igor Rueda  2   9 , Mario H Cardiel  10 , John Londono  2   9
Affiliations

Clinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available

Juan C Rueda et al. Trop Med Infect Dis. .

Abstract

Background: Chikungunya virus (CHIKV) diagnosis has become a challenge for primary care physicians in areas where the Zika virus and/or Dengue virus are present. Case definitions for the three arboviral infections overlap.

Methods: A cross-sectional analysis was carried out. A bivariate analysis was made using confirmed CHIKV infection as the outcome. Variables with significant statistical association were included in an agreement consensus. Agreed variables were analyzed in a multiple regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine a cut-off value and performance.

Results: 295 patients with confirmed CHIKV infection were included. A screening tool was created using symmetric arthritis (4 points), fatigue (3 points), rash (2 points), and ankle joint pain (1 point). The ROC curve identified a cut-off value, and a score ≥ 5.5 was considered positive for identifying CHIKV patients with a sensibility of 64.4% and a specificity of 87.4%, positive predictive value of 85.5%, negative predictive value of 67.7%, area under the curve of 0.72, and an accuracy of 75%.

Conclusion: We developed a screening tool for CHIKV diagnosis using only clinical symptoms as well as proposed an algorithm to aid the primary care physician.

Keywords: Chikungunya virus; Colombia; arbovirus infections; clinical decision making; diagnosis.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
World distribution of DENV, CHIKV and ZIKAV. DENV: Dengue virus; CHIKV: Chikungunya virus; ZIKAV: Zika virus [7,8,9].
Figure 2
Figure 2
Common symptoms in arboviral infection (DENV, CHIKV and ZIKAV). Shown are the common symptoms in DENV, CHIKV and ZIKAV. In panel (A) are the percentages and statistical significance (p < 0.05) of each symptom between DENV-CHIKV (*), DENV-ZIKAV (†) and CHIKV-ZIKAV (‡). In panel (B) are depicted the shared and single statistically significant symptoms between CHIKV, DENV and ZIKAV. See supplementary Tables S1 and S2 for references. DENV: Dengue virus; CHIKV: Chikungunya virus; ZIKAV: Zika virus.
Figure 3
Figure 3
Profile of the study population. COPCORD: Community Oriented Program for Control of Rheumatic Diseases; CHIKV: Chikungunya virus.
Figure 4
Figure 4
Clinical characteristics of the study population. CHIKV: Chikungunya virus.
Figure 5
Figure 5
ROC curve of the screening score for CHIKV infection. ROC: Receiver operating characteristic; CHIKV: Chikungunya virus.
Figure 6
Figure 6
ROC curves of multiple diagnostic and screening tools in CHIKV, DENV and ZIKAV. ROC: Receiver operating characteristic; CHIKV: Chikungunya virus, DENV: Dengue virus; ZIKAV: Zika virus.
Figure 7
Figure 7
Proposed algorithm for clinical approach of CHIKV, ZIKAV and DENV. DENV: Dengue virus; CHIKV: Chikungunya virus; ZIKAV: Zika virus.
See this image and copyright information in PMC

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