ORIGINAL ARTICLES

Concurrent outbreaks of Chikungunya and Dengue fever in Kandy, Sri Lanka, 2006–07: a comparative analysis of clinical and laboratory features

S A M Kularatne¹, M C Gihan¹, S C Weerasinghe¹, S Gunasena²

¹ Department of Medicine, Faculty of Medicine, Peradeniya University, Peradeniya, Sri Lanka
² Department of Virology, Medical Research Institute, Colombo, Sri Lanka

Correspondence to:
Dr S A M Kularatne, Department of Medicine, Faculty of Medicine, Peradeniya University, Peradeniya, Sri Lanka; samkul{at}sltnet.lk

Objectives: To compare the clinical and laboratory features of confirmed cases of Chikungunya and Dengue fever; to validate the clinical diagnosis based on serology.

Methods: Cases with a clinical diagnosis of Chikungunya and Dengue fever were recruited for seroconfirmation during a concurrent epidemic in 2006–07, at the General Hospital, Peradeniya, Sri Lanka.

Results: Of 54 patients with fever, serology confirmed 21 with Chikungunya infection, 20 with Dengue infection, and three co-infections, with sensitivity of the clinical diagnosis of 92% for Chikungunya fever and 95% for Dengue fever. The mean age of patients with Chikungunya fever was 45 years (range 21–74 years), and patients with Dengue fever was 30 years (range 15–63 years) (p = 0.005). Sixteen (70%) of Chikungunya fever patients were females, while 15 (71%) of those with Dengue fever were males (p = 0.007). Arthralgia was common to both groups (p = 0.155), while headache and a bleeding tendency were observed more in patients with Dengue fever. Twelve (57%) Chikungunya cases had acute arthritis compared with none in the Dengue group (p = 0.001), lasting mean 6 days (range 1–14 days). They developed chronic arthritic disability (range 1–6 months). Leucopenia was common to both Chikungunya and Dengue fever patients. However, thrombocytopenia was more pronounced in the Dengue patients (mean (SD) platelet count 75 (34)x10⁹/l) than in the Chikungunya patients (117 (70)x10⁹/l) (p = 0.001). In the Chikungunya group there was a positive correlation between duration of the illness and the platelet count (r = 0.181, p = 0.194), but the Dengue group showed a negative correlation (r = –0.309, p<0.001).

Conclusion: Most of the clinical and laboratory features of patients with Chikungunya and Dengue fever are similar. Arthritis is the pathgnomonic sign in patients with Chikungunya fever.

Keywords: Chikungunya fever; Dengue fever; chronic arthritic disability; arthritis; Sri Lanka

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