@article{PAR00010195,
  title = {{C}hikungunya fever : a clinical and virological investigation of outpatients on {R}eunion {I}sland, {S}outh-{W}est {I}ndian {O}cean},
  author = {{T}hiberville, {S}. {D}. and {B}oisson, {V}. and {G}audart, {J}. and {S}imon, {F}. and {F}lahault, {A}. and {D}e {L}amballerie, {X}avier},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {C}hikungunya virus ({CHIKV}) is responsible for acute febrile polyarthralgia and, in a proportion of cases, severe complications including chronic arthritis. {CHIKV} has spread recently in {E}ast {A}frica, {S}outh-{W}est {I}ndian {O}cean, {S}outh-{A}sia and autochthonous cases have been reported in {E}urope. {A}lthough almost all patients are outpatients, medical investigations mainly focused on hospitalised patients. {M}ethodology/{P}rincipal {F}indings: {H}ere, we detail clinico-biological characteristics of {C}hikungunya ({CHIK}) outpatients in {R}eunion {I}sland (2006). 76 outpatients with febrile arthralgia diagnosed within less than 48 hours were included by general practitioners during the {C}ura{C}hik clinical trial. {CHIK} was confirmed in 54 patients and excluded in 22. {A} detailed clinical and biological follow-up was organised, that included analysis of viral intrahost diversity and telephone survey until day 300. {T}he evolution of acute {CHIK} included 2 stages: the 'viral stage' (day 1-day 4) was associated with rapid decrease of viraemia and improvement of clinical presentation; the 'convalescent stage' (day 5-day 14) was associated with no detectable viraemia but a slower clinical improvement. {W}omen and elderly had a significantly higher number of arthralgia at inclusion and at day 300. {B}ased on the study clinico-biological dataset, scores for {CHIK} diagnosis in patients with recent febrile acute polyarthralgia were elaborated using arthralgia on hands and wrists, a minor or absent myalgia and the presence of lymphopenia (<1{G}/{L}) as major orientation criteria. {F}inally, we observed that {CHIKV} intra-host genetic diversity increased over time and that a higher viral amino-acid complexity at the acute stage was associated with increased number of arthralgia and intensity of sequelae at day 300. {C}onclusions/{S}ignificance: {T}his study provided a detailed picture of clinico-biological {CHIK} evolution at the acute phase of the disease, allowed the elaboration of scores to assist {CHIK} diagnosis and investigated for the first time the impact of viral intra-host genetic diversity on the disease course.},
  keywords = {{REUNION}},
  booktitle = {},
  journal = {{P}los {N}eglected {T}ropical {D}iseases},
  volume = {7},
  numero = {1},
  pages = {e2004},
  ISSN = {1935-2735},
  year = {2013},
  DOI = {10.1371/journal.pntd.0002004},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00010195},
}