The Asian mosquito (tiger) carrying the arthritis

Rome – Chikungunya: “what bends”. It is the name of a viral and dangerous disease, often mistaken for rheumatoid arthritis due to debilitating symptoms in the joints, which leads to the typical curved posture. This virus – first isolated in Tanzania in the early 1950s – is transmitted by the Aedes group mosquito, in particular by the Aedes aegypti in tropical countries or by the Aedes albopictus (the tiger mosquito) in temperate areas such as those of the Mediterranean basin.

“The manifestations of the disease – explains Vincenzo Bruzzese, Past President of the Italian Society of Rheumatology Gastro – are often confused and treated as rheumatoid arthritis, but it is necessary to investigate more thoroughly for a correct differential diagnosis. In this case – continues Bruzzese – asking the patient if he has just returned from a trip or resides in countries where the mosquito is present and investigate the onset of fever, is a good start, to improve the process of early detection and intervene quickly. This is the appeal that comes from the 5th Congress of the Italian Society of Rheumatology Gastro.

CLIMATE AND GLOBALIZATION – Due to climate change and frequent travel to Asia and tropical countries – Chikungunya virus fever (CHIKV) has become a frequent enemy, but still little known in the West. The outbreaks of CHIKV affect a large number of people in a short period of time, producing not only acute cases, but up to 40% of cases also a large number of chronic cases.

In Italy and Europe, in the last decade, there has been an increase in the reporting of “imported” and autochthonous cases of arbovirosis (including Chikungunya virus fever) that are widespread throughout the world. After the first episode that occurred in 2007 in Ravenna, in Italy there were two new outbreaks – linked together – of CHIKV in Lazio and Calabria in 2017, with about 500 cases.

IN THE WORLD – In 2005 an epidemic was already described in the Reunion Islands, involving 34% of the population and in the Kenyan island of Lamu, 75% of the inhabitants affected. India was also affected: in 2006, about 1.4 million suspected cases of Chikungunya were reported.

THE PHASES OF MALACE – “The disease can have a biphasic course,” explains Dr. Emanuele Nicastri, Director of the Complex Operating Unit of High Intensity Infectious Diseases of the National Institute for Infectious Diseases L. Spallanzani in Rome, in his report to the 5th Congress of the Italian Society of Gastro Rheumatology. “From the incubation – continues Nicastri – which has a window period ranging from 2 to 14 days, Chikungunya virus fever manifests itself with high fever often over 39 °, skin rashes that are highlighted after about 3 days from the beginning of the fever and can become itchy and symptoms typical of polyarthritis. Other signs are strong migraines, conjunctivitis, myalgia, swelling of peripheral lymph nodes, gastrointestinal symptoms and widespread neuropathies that give fatigue and exhaustion. The second phase is the chronic phase which, after an initial improvement after the acute phase, can last for months and is particularly disabling. It is characterized by widespread joint pain, morning joint stiffness, pain, swelling of the affected parts and persistent fatigue.

Up to 40% of cases, in fact, the symptoms stabilize resulting in polyarthritis, first manifesting as small swellings of the distal joints, until the patient is immobilized due to pain and lack of muscle strength.

SOMIGLIANCES WITH REUMATED ARTRIT – Studies conducted on the pathogenesis of the disease bring chronic Chikungunya closer to rheumatoid arthritis – RA – with which it also shares many clinical features. The mechanism of CHIKV inducing persistent arthritis remains under investigation, however at present, there is agreement that Chikungunya and RA have many common immuno-cellular and cytokine pathways involved in their development. Vaccines or antiviral drugs against CHIKV are not yet available. The treatment of the acute phase is symptomatic, while in the chronic phases several anti-rheumatic drugs have been used, which modify the course of the disease with variable outcome.

THE SURVEILLANCE PLAN – A surveillance plan for arbovirosis promoted by the Ministry of Health has been in place in Italy since 2008, including the Zika virus since 2016, and has recently been updated.

The “Plan for surveillance and response to arbovirosis transmitted by invasive mosquitoes (Aedes sp.) with particular reference to the Chikungunya, Dengue and Zika viruses – 2018 (Circular of 18 May 2018)” outlines as its main objective the reduction of the risk of native transmission of Chikungunya, Dengue and Zika viruses on the national territory through the immediate notification of the suspected case.

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