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Chikungunya misdiagnosed, unrecognized cause of febrile illness in Tanzania

Issue: January 2012

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PHILADELPHIA — Chikungunya infection was a significant but unrecognized cause of febrile illness in northern Tanzania, according to data presented at the American Society of Tropical Medicine and Hygiene 60th Annual Meeting.

From September 2007 to August 2008, Julian T. Hertz, MD, of Duke University in Durham, N.C., and colleagues gathered acute serum from 870 febrile inpatients at two hospitals in Tanzania to examine the prevalence of chikungunya virus infection in the absence of an outbreak.

Hertz and colleagues performed polymerase chain reaction testing on 80.5% of participants; 7.9% tested positive for acute chikungunya virus infection.

Compared with adults and adolescents, chikungunya was more common among infants and children (OR=1.9; P=.026) and more common during dry (OR=3.2; P=.001) and cold months (OR=3.9; P< .001).

Although hepatomegaly results (OR=2.3; P=.043) and the absence of vomiting (OR=0.49; P=.043) helped to distinguish chikungunya-infected patients from other febrile inpatients, clinical signs and symptoms, hematologic results and radiographic features were not helpful, and chikungunya was commonly misdiagnosed as malaria, according to the abstract.

The researchers said they observed the first-ever case series of patients coinfected with HIV and chikungunya. This was significantly associated with lymphopenia (OR=5.6; P=.017) and severe immunosuppression (OR=10.5; P=.007).

“Further research is needed to fully understand the epidemiology of this and other arboviruses in sub-Saharan Africa in non-epidemic settings,” the researchers wrote.

For more information:

• Hertz J. #435. Presented at: the American Society of Tropical Medicine and Hygiene 60th Annual Meeting; Dec. 4-8, 2011; Philadelphia.

Disclosure: The researchers report no relevant financial disclosures.

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