{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:47:28Z","timestamp":1783457248918,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP19fm0108003"],"award-info":[{"award-number":["JP19fm0108003"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["20wm0225010h0101"],"award-info":[{"award-number":["20wm0225010h0101"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The Chikungunya virus is a re-emerging mosquito-borne alphavirus. Outbreaks are unpredictable and explosive in nature. Fever, arthralgia, and rash are common symptoms during the acute phase. Diagnostic tests are required to differentiate chikungunya virus from other co-circulating arboviruses, as symptoms can overlap, causing a dilemma for clinicians. Arthritis is observed during the sub-acute and chronic phases, which can flare up, resulting in increased morbidity that adversely affects the activities of daily living. During the 2019 chikungunya epidemic in Thailand, cases surged in Bangkok in the last quarter of the year. Here, we demonstrate the chronic sequelae of post-chikungunya arthritis in one of our patients one year after the initial infection. An inflammatory process involving edema, erythema, and tenderness to palpation of her fingers\u2019 flexor surfaces was observed, with positive chikungunya IgG and negative IgM tests and antigen. The condition produced stiffness in the patient\u2019s fingers and limited their range of motion, adversely affecting daily living activities. Resolution of symptoms was observed with a short course of an anti-inflammatory agent. More research is required to determine whether sanctuaries enable chikungunya virus to evade the host immune response and remain latent, flaring up months later and triggering an inflammatory response that causes post-chikungunya arthritis.<\/jats:p>","DOI":"10.3390\/tropicalmed6020052","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T21:35:13Z","timestamp":1618522513000},"page":"52","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Post\u2013Chikungunya Virus Infection Musculoskeletal Disorders: Syndromic Sequelae after an Outbreak"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4812-6334","authenticated-orcid":false,"given":"Hisham A.","family":"Imad","sequence":"first","affiliation":[{"name":"Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"},{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-2765","authenticated-orcid":false,"given":"Wasin","family":"Matsee","sequence":"additional","affiliation":[{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajikapon","family":"Kludkleeb","sequence":"additional","affiliation":[{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punyisa","family":"Asawapaithulsert","sequence":"additional","affiliation":[{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6739-0144","authenticated-orcid":false,"given":"Juthamas","family":"Phadungsombat","sequence":"additional","affiliation":[{"name":"Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-0980","authenticated-orcid":false,"given":"Emi E.","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keita","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"},{"name":"Point of Care Testing Products Business Unit, TANAKA Kikinzoku Kogyo, Hiratsuka 254-0076, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pornsawan","family":"Leaungwutiwong","sequence":"additional","affiliation":[{"name":"Tropical Medicine Diagnostic Reference Laboratory, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Watcharapong","family":"Piyaphanee","sequence":"additional","affiliation":[{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5896-1961","authenticated-orcid":false,"given":"Weerapong","family":"Phumratanaprapin","sequence":"additional","affiliation":[{"name":"Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-8331","authenticated-orcid":false,"given":"Tatsuo","family":"Shioda","sequence":"additional","affiliation":[{"name":"Mahidol-Osaka Center for Infectious Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"},{"name":"Department of Viral Infections, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hotez, P.J., Aksoy, S., Brindley, P.J., and Kamhawi, S. (2020). What constitutes a neglected tropical disease?. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008001"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.hgmx.2016.09.011","article-title":"Clinical and differential diagnosis: Dengue, chikungunya and Zika","volume":"81","year":"2018","journal-title":"Rev. M\u00e9dica Hosp. Gen. M\u00e9xico"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Imad, H., Phadungsombat, J., Nakayama, E., Kludkleeb, S., Matsee, W., Ponam, T., Suzuki, K., Leaungwutiwong, P., Piyaphanee, W., and Phumratanaprapin, W. (2021). Chikungunya Manifestations and Viremia in Patients WhoPresented to the Fever Clinic at Bangkok Hospital for Tropical Diseases during the 2019 Outbreak in Thailand. Trop. Med. Infect. Dis., 6.","DOI":"10.3390\/tropicalmed6010012"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"943","DOI":"10.4269\/ajtmh.19-0487","article-title":"Cytokine Expression in Dengue Fever and Dengue Hemorrhagic Fever Patients with Bleeding and Severe Hepatitis","volume":"102","author":"Imad","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.tmaid.2018.05.010","article-title":"Fever, rash, and red eyes in Thailand: A diagnostic challenge","volume":"24","author":"Imad","year":"2018","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/0035-9203(55)90080-8","article-title":"An epidemic of virus disease in Southern Province, Tanganyika territory, in 1952\u20131953","volume":"49","author":"Robinson","year":"1955","journal-title":"Trans. R Soc. Trop. Med. Hyg."},{"key":"ref_7","unstructured":"Jupp, P.G., and Mcintosh, B.M. (1988). The Arbovirus: Epidemiology and Ecology, CRC Press."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Phadungsombat, J., Imad, H., Rahman, M., Nakayama, E.E., Kludkleeb, S., Ponam, T., Rahim, R., Hasan, A., Poltep, K., and Yamanaka, A. (2020). A Novel Sub-Lineage of Chikungunya Virus East\/Central\/South African Genotype Indian Ocean Lineage Caused Sequential Outbreaks in Bangladesh and Thailand. Viruses, 12.","DOI":"10.3390\/v12111319"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1111\/j.1537-2995.2012.03960.x","article-title":"Viremic profiles in asymptomatic and symptomatic chikungunya fever: A blood transfusion threat?","volume":"53","author":"Appassakij","year":"2013","journal-title":"Transfusion"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.medmal.2015.05.007","article-title":"French guidelines for the management of chikungunya (acute and persistent presentations)","volume":"45","author":"Simon","year":"2015","journal-title":"M\u00e9decine Mal. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1093\/rheumatology\/kes015","article-title":"Impaired quality of life after chikungunya virus infection: A 2-year follow-up study","volume":"51","author":"Couturier","year":"2012","journal-title":"Rheumatology"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Schilte, C., Staikovsky, F., Couderc, T., Madec, Y., Carpentier, F., Kassab, S., Albert, M.L., Lecuit, M., and Michault, A. (2013). Chikungunya virus-associated long-term arthralgia: A 36-month prospective longitudinal study. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/annotation\/850ee20f-2641-46ac-b0c6-ef4ae79b6de6"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.tmaid.2017.01.004","article-title":"Long-term sequelae of chikungunya virus disease: A systematic review","volume":"15","author":"Nelen","year":"2017","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1093\/trstmh\/try063","article-title":"Chikungunya chronic disease: A systematic review and meta-analysis","volume":"112","author":"Paixao","year":"2018","journal-title":"Trans. R Soc. Trop. Med. Hyg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1445-5994.1978.tb04783.x","article-title":"Viral Arthritis and the Possible Role of Viruses in Rheumatoid Arthritis","volume":"8","author":"Clarris","year":"1978","journal-title":"Aust. N. Z. J. Med."},{"key":"ref_16","first-page":"130","article-title":"Rheumatoid arthritic syndrome after chikungunya fever","volume":"56","author":"Fourie","year":"1979","journal-title":"South Afr. Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1089\/vim.2010.0123","article-title":"Role of proinflammatory cytokines and chemokines in chronic arthropathy in CHIKV infection","volume":"24","author":"Chaaitanya","year":"2011","journal-title":"Viral Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1002\/art.39027","article-title":"Brief Report: Chikungunya Viral Arthritis in the United States: A Mimic of Seronegative Rheumatoid Arthritis","volume":"67","author":"Miner","year":"2015","journal-title":"Arthritis Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jbspin.2009.08.005","article-title":"A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years","volume":"76","author":"Bouquillard","year":"2009","journal-title":"Jt. Bone Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12985-020-01364-4","article-title":"Promising application of monoclonal antibody against chikungunya virus E1-antigen across genotypes in immunochromatographic rapid diagnostic tests","volume":"17","author":"Suzuki","year":"2020","journal-title":"Virol. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1128\/JCM.02744-14","article-title":"Neutralization Activity of Patient Sera Collected during the 2008-2009 Chikungunya Outbreak in Thailand","volume":"53","author":"Kishishita","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31584\/jhsmr.201939","article-title":"Cutaneous Manifestations in Chikungunya Disease","volume":"37","author":"Aiempanakit","year":"2019","journal-title":"J. Health Sci. Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/s41584-019-0276-9","article-title":"Rheumatic manifestations of chikungunya: Emerging concepts and interventions","volume":"15","author":"Suhrbier","year":"2019","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"530","DOI":"10.3201\/eid2103.141397","article-title":"Post-Chikungunya Rheumatoid Arthritis, Saint Martin","volume":"21","author":"Foissac","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.tmaid.2015.09.001","article-title":"Post-chikungunya chronic arthralgia: Results from a retrospective follow-up study of 131 cases in Tolima, Colombia","volume":"14","year":"2016","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.jbspin.2018.03.019","article-title":"Incidence of articular pain and arthritis after chikungunya fever in the Americas: A systematic review of the literature and meta-analysis","volume":"85","author":"Edington","year":"2018","journal-title":"Jt. Bone Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jinf.2012.04.005","article-title":"Long-term chikungunya infection clinical manifestations after an outbreak in Italy: A prognostic cohort study","volume":"65","author":"Moro","year":"2012","journal-title":"J. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.cmi.2015.02.024","article-title":"Chikungunya infection: Self-reported rheumatic morbidity and impaired quality of life persist 6 years later","volume":"21","author":"Marimoutou","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1017\/S0950268818000031","article-title":"Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: The TELECHIK cohort study on Reunion island","volume":"146","author":"Duvignaud","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_30","first-page":"12","article-title":"Clinical features of acute chikungunya virus infection in children and adults during an outbreak in the Maldives","volume":"6","author":"Imad","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1978","DOI":"10.1002\/rmv.1978","article-title":"The neurological complications of chikungunya virus: A systematic review","volume":"28","author":"Mehta","year":"2018","journal-title":"Rev. Med. Virol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"13878","DOI":"10.1128\/JVI.02666-13","article-title":"Chronic Joint Disease Caused by Persistent Chikungunya Virus Infection Is Controlled by the Adaptive Immune Response","volume":"87","author":"Hawman","year":"2013","journal-title":"J. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5914","DOI":"10.4049\/jimmunol.0900255","article-title":"Persistent chronic inflammation and infection by Chikungunya arthritogenic alphavirus in spite of a robust host immune response","volume":"184","author":"Hoarau","year":"2010","journal-title":"J. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/art.40383","article-title":"Chikungunya Arthritis Mechanisms in the Americas: A Cross-Sectional Analysis of Chikungunya Arthritis Patients Twenty-Two Months After Infection Demonstrating No Detectable Viral Persistence in Synovial Fluid","volume":"70","author":"Chang","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Prow, N.A., Tang, B., Gardner, J., Le, T.T., Taylor, A., Poo, Y.S., Nakayama, E., Hirata, T.D., Nakaya, H.I., and Slonchak, A. (2017). Lower temperatures reduce type I interferon activity and promote alphaviral arthritis. PLoS Pathog., 13.","DOI":"10.1371\/journal.ppat.1006788"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Malvy, D., Ezzedine, K., Mamani-Matsuda, M., Autran, B., Tolou, H., Receveur, M.-C., Pistone, T., Rambert, J., Moynet, D., and Mossalayi, D. (2009). Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies. BMC Infect. Dis., 9.","DOI":"10.1186\/1471-2334-9-200"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.patbio.2007.07.002","article-title":"Molecular and serological diagnosis of Chikungunya virus infection","volume":"55","author":"Grivard","year":"2007","journal-title":"Pathol. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Javelle, E., Ribera, A., Degasne, I., Ga\u00fczere, B.-A., Marimoutou, C., and Simon, F. (2015). Specific Management of Post-Chikungunya Rheumatic Disorders: A Retrospective Study of 159 Cases in Reunion Island from 2006-2012. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003603"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1038\/nrrheum.2012.64","article-title":"Arthritogenic alphaviruses\u2014An overview","volume":"8","author":"Suhrbier","year":"2012","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1080\/20477724.2017.1355431","article-title":"O\u2019nyong-nyong fever: A neglected mosquito-borne viral disease","volume":"111","author":"Rezza","year":"2017","journal-title":"Pathog. Glob. Health"}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/6\/2\/52\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:48:27Z","timestamp":1760161707000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/6\/2\/52"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,15]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["tropicalmed6020052"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed6020052","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202103.0680.v1","asserted-by":"object"}]},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,15]]}}}