G Model
ARTICLE IN PRESS
JCV 3018 1–3
Journal of Clinical Virology xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case Report
1
Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup?
2
3
4 5 6 7 8 9
Q1
C.A.D. Slegers a,∗ , M. Keuter a , S. Günther b , J. Schmidt-Chanasit b,c , A.J. van der Ven a , Q. de Mast a a
Radboud University Medical Center, Department of Internal Medicine, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Bernard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht Strasse 74, 20359 Hamburg, Germany c German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, Hamburg, Inhoffenstraße 7, 38124 Braunschweig, Germany b
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11 25
a r t i c l e
i n f o
a b s t r a c t
12 13 14 15 16
Article history: Received 18 March 2014 Received in revised form 8 April 2014 Accepted 23 April 2014
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Keywords: Mayaro virus Alphavirus Traveler Arthralgia Brazil 2014 FIFA World Cup
26
1. Why is this case important
18 19 20 21 22 23
The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquitoborne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed.
34
The upcoming 2014 FIFA World Cup is expected to attract more than half a million soccer fans. These fans will be at a significant risk for contracting dengue, as was recently highlighted by Hay [1]. However, other less known viral infections may also pose a threat for visitors, especially with some of the host cities being located in the Amazon basin. We present a case of a traveler who presented with a rare dengue-like viral infection, which she acquired during a stay in the Amazon.
35
2. Case description
27 28 29 30 31 32 33
36 37 38 39 40 41 42 43
A 52-year-old Caucasian female biologist presented to our outpatient department with complaints of persistent arthralgia after a febrile illness. She had returned one week earlier from a four weeks visit to the Amazon basin in Brazil in May 2013. Together with a Brazilian colleague, she had performed scientific research in the tropical rainforests near Caxiuana. In the last week of her stay, she developed high grade fever lasting 2 days, together with headache, nausea and vomiting, a non pruritic rash
∗ Corresponding author. Tel.: +31 24 361 8819; fax: +31 24 354 1734. E-mail address: [email protected] (C.A.D. Slegers).
© 2014 Published by Elsevier B.V.
mainly located on her arms and upper legs and polyarthralgia of the hands, wrists, elbows and ankles. The rash and the other complaints disappeared after approximately one week, but she remained having incapacitating polyarthralgia. Her Brazilian colleague suffered from a similar illness. During her stay she had multiple mosquito bites and a tick bite after the first week. She had no significant medical history and she did not take regular medication. On physical examination 15 days after disease onset, she was afebrile and except for mild diffuse swelling of the fingers without evident arthritis, no abnormalities were found. Laboratory examination that same day showed normal results of a complete blood count, erythrocyte sedimentation rate, C-reactive protein, renal function and liver enzymes. Anti-dengue-IgM and IgG were negative. Due to her travel to the Amazon basin and the persisting arthralgia, an infection with MAYV was considered. Serologic testing for mosquito-borne alphaviruses using the indirect immunofluorescence test (IIFT), according to Friedrich-Jänicke et al. [2], demonstrated an acute MAYV infection (Table 1). The virus neutralization test (VNT), according to Theilacker et al. [3], confirmed the presence of MAYV-specific antibodies (titer 1:640). Testing for MAYV RNA by real-time RT-PCR according to Friedrich-Jänicke et al. [2], was performed with the same serum sample and revealed a negative result. The polyarthralgia was treated by a Non Steroidal Anti-Inflammatory Drug (NSAID) and gradually disappeared in the course of weeks.
http://dx.doi.org/10.1016/j.jcv.2014.04.020 1386-6532/© 2014 Published by Elsevier B.V.
Please cite this article in press as: Slegers CAD, et al. Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup? J Clin Virol (2014), http://dx.doi.org/10.1016/j.jcv.2014.04.020
44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68
G Model JCV 3018 1–3
ARTICLE IN PRESS C.A.D. Slegers et al. / Journal of Clinical Virology xxx (2014) xxx–xxx
2
Table 1 Alphavirus serology results (indirect immunofluorescence assays) after four weeks visit to the Amazon basin in Brazil.
69
70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113
114
115 116 117 118
Virus
IgM
IgG
Mayaro virus Sindbis virus Chikungunya virus Eastern equine encephalitis virus Semliki forest virus Venezuelan equine encephalitis virus Western equine encephalitis virus Barmah forest virus
1:640 1:20
ARTICLE IN PRESS
JCV 3018 1–3
Journal of Clinical Virology xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case Report
1
Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup?
2
3
4 5 6 7 8 9
Q1
C.A.D. Slegers a,∗ , M. Keuter a , S. Günther b , J. Schmidt-Chanasit b,c , A.J. van der Ven a , Q. de Mast a a
Radboud University Medical Center, Department of Internal Medicine, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Bernard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Bernhard-Nocht Strasse 74, 20359 Hamburg, Germany c German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, Hamburg, Inhoffenstraße 7, 38124 Braunschweig, Germany b
10
11 25
a r t i c l e
i n f o
a b s t r a c t
12 13 14 15 16
Article history: Received 18 March 2014 Received in revised form 8 April 2014 Accepted 23 April 2014
17
24
Keywords: Mayaro virus Alphavirus Traveler Arthralgia Brazil 2014 FIFA World Cup
26
1. Why is this case important
18 19 20 21 22 23
The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquitoborne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed.
34
The upcoming 2014 FIFA World Cup is expected to attract more than half a million soccer fans. These fans will be at a significant risk for contracting dengue, as was recently highlighted by Hay [1]. However, other less known viral infections may also pose a threat for visitors, especially with some of the host cities being located in the Amazon basin. We present a case of a traveler who presented with a rare dengue-like viral infection, which she acquired during a stay in the Amazon.
35
2. Case description
27 28 29 30 31 32 33
36 37 38 39 40 41 42 43
A 52-year-old Caucasian female biologist presented to our outpatient department with complaints of persistent arthralgia after a febrile illness. She had returned one week earlier from a four weeks visit to the Amazon basin in Brazil in May 2013. Together with a Brazilian colleague, she had performed scientific research in the tropical rainforests near Caxiuana. In the last week of her stay, she developed high grade fever lasting 2 days, together with headache, nausea and vomiting, a non pruritic rash
∗ Corresponding author. Tel.: +31 24 361 8819; fax: +31 24 354 1734. E-mail address: [email protected] (C.A.D. Slegers).
© 2014 Published by Elsevier B.V.
mainly located on her arms and upper legs and polyarthralgia of the hands, wrists, elbows and ankles. The rash and the other complaints disappeared after approximately one week, but she remained having incapacitating polyarthralgia. Her Brazilian colleague suffered from a similar illness. During her stay she had multiple mosquito bites and a tick bite after the first week. She had no significant medical history and she did not take regular medication. On physical examination 15 days after disease onset, she was afebrile and except for mild diffuse swelling of the fingers without evident arthritis, no abnormalities were found. Laboratory examination that same day showed normal results of a complete blood count, erythrocyte sedimentation rate, C-reactive protein, renal function and liver enzymes. Anti-dengue-IgM and IgG were negative. Due to her travel to the Amazon basin and the persisting arthralgia, an infection with MAYV was considered. Serologic testing for mosquito-borne alphaviruses using the indirect immunofluorescence test (IIFT), according to Friedrich-Jänicke et al. [2], demonstrated an acute MAYV infection (Table 1). The virus neutralization test (VNT), according to Theilacker et al. [3], confirmed the presence of MAYV-specific antibodies (titer 1:640). Testing for MAYV RNA by real-time RT-PCR according to Friedrich-Jänicke et al. [2], was performed with the same serum sample and revealed a negative result. The polyarthralgia was treated by a Non Steroidal Anti-Inflammatory Drug (NSAID) and gradually disappeared in the course of weeks.
http://dx.doi.org/10.1016/j.jcv.2014.04.020 1386-6532/© 2014 Published by Elsevier B.V.
Please cite this article in press as: Slegers CAD, et al. Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup? J Clin Virol (2014), http://dx.doi.org/10.1016/j.jcv.2014.04.020
44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68
G Model JCV 3018 1–3
ARTICLE IN PRESS C.A.D. Slegers et al. / Journal of Clinical Virology xxx (2014) xxx–xxx
2
Table 1 Alphavirus serology results (indirect immunofluorescence assays) after four weeks visit to the Amazon basin in Brazil.
69
70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113
114
115 116 117 118
Virus
IgM
IgG
Mayaro virus Sindbis virus Chikungunya virus Eastern equine encephalitis virus Semliki forest virus Venezuelan equine encephalitis virus Western equine encephalitis virus Barmah forest virus
1:640 1:20
