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Case Reports
. 2006 Oct;12(10):1493-9.
doi: 10.3201/eid1210.060610.

Novel chikungunya virus variant in travelers returning from Indian Ocean islands

Philippe Parola  1 , Xavier de Lamballerie, Jacques Jourdan, Clarisse Rovery, Véronique Vaillant, Philippe Minodier, Philippe Brouqui, Antoine Flahault, Didier Raoult, Rémi N Charrel
Affiliations
Case Reports

Novel chikungunya virus variant in travelers returning from Indian Ocean islands

Philippe Parola et al. Emerg Infect Dis. 2006 Oct.

Abstract

Chikungunya virus (CHIKV) emerged in Indian Ocean islands in 2005 and is causing an ongoing outbreak that involves >260,000 patients, including travelers returning home from these islands. We investigated cases in 4 patients returning from Mayotte and Reunion Islands with CHIKV infection and a nurse infected in metropolitan France after direct contact with the blood of a traveler. Four patients had tenosynovitis and pain at wrist pressure, and 1 had life-threatening manifestations. Four CHIKV strains were isolated, including 1 from the patient with the autochthonous case. The complete genomic sequence identified a new CHIKV variant emerging from the East/ central African evolutionary lineage. Aedes albopictus, the implicated vector of CHIKV in Indian Ocean islands, has dispersed worldwide in recent decades. High viral loads in patients returning from Indian Ocean islands to countries where Ae. albopictus is prevalent may be a source of epidemics.

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Figures

Figure 1
Figure 1
Evolution of viral load and blood cell counts in a 73-year-old man who had returned from Reunion during the acute phase of chikungunya virus (CHIKV) infection. PMN, polymorphonuclear leukocytes.
Figure 2
Figure 2
Clinical findings in patients. A) Bone scintigraphy of the wrists and hands showing an intense focus of technetium-99m–labeled methylene diphosphonate tracer uptake, particularly on the left side in the left metacarpophalangeal, wrist, and the first distal interphalangeal joints in a 73-year-old man who returned from Reunion with a severe viremic chikungunya virus (CHIKV) infection. B) Conjunctivitis in a 31-year-old woman who returned from Mayotte, French Comoros, with a severe viremic CHIKV infection.
Figure 3
Figure 3
Phylogenetic analysis of chikungunya virus (CHIKV) isolates based on a 1,044-nucleotide (nt) fragment between nt 10243 and 11286 (numbered after strain Ross [accession no. AF490259]) in the E1 gene. Distances and groupings between the 3 Indian Ocean isolates and 18 isolates previously characterized (23) were determined by the Jukes-Cantor algorithm and neighbor-joining method with the MEGA software program (25). Bootstrap values >75% are indicated and correspond to 500 replications. The main evolutionary lineages, East/Central African (brown), eastern/southern Africa (red), West African (blue), and Asian (yellow), are indicated. The Indian Ocean sublineage is indicated in orange. Boldface indicates sequence determined in this study.
Figure 4
Figure 4
Estimated global distribution of Aedes albopictus (areas enclosed in dotted lines) and distribution of chikungunya virus (stars) from western Africa to southeastern Asia, including the Indian Ocean variant responsible for the 2006 outbreak. The color of the stars reflects the main evolutionary lineages shown in Figure 3. Ae. albopictus photograph courtesy of James Gathany, Centers for Disease Control and Prevention.
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