Chikungunya fever and lymphedema of limbs

Febre chikungunya e linfedema de membros

Beuy Joob Viroj Wiwanitkit About the authors

Dear Editor,

We read the publication on “Secondary lymphedema of limbs and chikungunya fever (CF)” with great interest.11 Marques MA, Milhomens ALM, Vieira JM, Cardoso FR, Guedes HJ No. Secondary lymphedema of limbs and chikungunya fever. J Vasc Bras. 2019;18:e20190015. http://dx.doi.org/10.1590/1677-5449.190015. PMid:31320883.
http://dx.doi.org/10.1590/1677-5449.1900...
Marques et al. described “the case of a patient who developed lymphedema of upper and lower limbs after an episode of CF.11 Marques MA, Milhomens ALM, Vieira JM, Cardoso FR, Guedes HJ No. Secondary lymphedema of limbs and chikungunya fever. J Vasc Bras. 2019;18:e20190015. http://dx.doi.org/10.1590/1677-5449.190015. PMid:31320883.
http://dx.doi.org/10.1590/1677-5449.1900...
” Marques et al. also noted that “the CF outbreak that occurred during 2015 and 2016 resulted in the first cases described in the medical literature of acute and chronic vascular complications secondary to infection by this arbovirus.11 Marques MA, Milhomens ALM, Vieira JM, Cardoso FR, Guedes HJ No. Secondary lymphedema of limbs and chikungunya fever. J Vasc Bras. 2019;18:e20190015. http://dx.doi.org/10.1590/1677-5449.190015. PMid:31320883.
http://dx.doi.org/10.1590/1677-5449.1900...
” In fact, the vascular defect due to CF is rarely mentioned in the literature. Nevertheless, this is not the first report regarding CF and lymphedema. Lymphedema of the limbs in CF is also described in many previous reports from India.22 Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008;47(2):154-9. http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x. PMid:18211486.
http://dx.doi.org/10.1111/j.1365-4632.20...

3 Bandyopadhyay D, Ghosh SK. Mucocutaneous manifestations of Chikungunya fever. Indian J Dermatol. 2010;55(1):64-7. http://dx.doi.org/10.4103/0019-5154.60356. PMid:20418982.
http://dx.doi.org/10.4103/0019-5154.6035...
-44 Rampal, Sharda M, Meena H. Neurological complications in Chikungunya fever. J Assoc Physicians India. 2007;55:765-9. PMid:18290551.

REFERENCES

  • 1
    Marques MA, Milhomens ALM, Vieira JM, Cardoso FR, Guedes HJ No. Secondary lymphedema of limbs and chikungunya fever. J Vasc Bras. 2019;18:e20190015. http://dx.doi.org/10.1590/1677-5449.190015 PMid:31320883.
    » http://dx.doi.org/10.1590/1677-5449.190015
  • 2
    Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008;47(2):154-9. http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x PMid:18211486.
    » http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x
  • 3
    Bandyopadhyay D, Ghosh SK. Mucocutaneous manifestations of Chikungunya fever. Indian J Dermatol. 2010;55(1):64-7. http://dx.doi.org/10.4103/0019-5154.60356 PMid:20418982.
    » http://dx.doi.org/10.4103/0019-5154.60356
  • 4
    Rampal, Sharda M, Meena H. Neurological complications in Chikungunya fever. J Assoc Physicians India. 2007;55:765-9. PMid:18290551.

Publication Dates

  • Publication in this collection
    07 Aug 2020
  • Date of issue
    2020

History

  • Received
    23 July 2019
  • Accepted
    06 Sept 2019
jvbCE20190100

LETTER TO THE EDITOR

Marcos Arêas Marques About the author
Conflicts of interest: No conflicts of interest declared concerning the publication of this article.
Correspondence Marcos Arêas Marques Universidade do Estado do Rio de Janeiro – UERJ, Unidade Docente Assistencial de Angiologia Rua Assunção, 217/704 - Botafogo CEP 22251-030 - Rio de Janeiro (RJ), Brasil Tel.: + 55 (21) 99859-0160 E-mail: mareasmarques@gmail.com
Author information MAM - Angiologist, Unidade Docente Assistencial de Angiologia, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ).
15 July 2020 2020 19 e20190100
Creative Common - by 4.0

RESPONSE LETTER

Dear Editor,

Thank you very much for your comment and for the timely and pertinent correction of the facts. Undoubtedly lymphedema had already been described by several Indian and Pakistani authors 11 Norman FF, Monge-Maillo B, Perez-Molina J-A, et al. Lymphadenopathy in patients with chikungunya virus infection imported from hispaniola: case reports. J Travel Med. 2015;22(4):272-5. http://dx.doi.org/10.1111/jtm.12204. PMid:25828151.
http://dx.doi.org/10.1111/jtm.12204...

2 McCarthy MK, Davenport BJ, Reynoso GV, et al. Chikungunya virus impairs draining lymph node function by inhibiting HEV-mediated lymphocyte recruitment. JCI Insight. 2018;3(13):e121100. http://dx.doi.org/10.1172/jci.insight.121100. PMid:29997290.
http://dx.doi.org/10.1172/jci.insight.12...

3 Iqbal H, Aziz H. Current status of spurt of chikungunya in Pakistan. Clin Microbiol Infect. 2018;24(4):443-4. http://dx.doi.org/10.1016/j.cmi.2017.11.002. PMid:29133156.
http://dx.doi.org/10.1016/j.cmi.2017.11....

4 Mogami R, Vaz JLP, Chagas YFB, et al. Ultrasound of ankles in the diagnosis of complications of chikungunya fever. Radiol Bras. 2017;50(2):71-5. http://dx.doi.org/10.1590/0100-3984.2016.0221. PMid:28428648.
http://dx.doi.org/10.1590/0100-3984.2016...
-55 Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008;47(2):154-9. http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x. PMid:18211486.
http://dx.doi.org/10.1111/j.1365-4632.20...
, some cited in the letter to the editor, because it is an endemic infection in this region of the planet. However, in my article I draw attention to the Chikungunya epidemic in the South American continent, and particularly in Brazil, in the years 2015 and 2016, which drew the attention of many doctors, because until then it was an infection unknown to most professionals of health in Brazil.

In addition, after a new and extensive literature review and search in PubMed associating the term Chikungunya with the terms lymphedema, lymphoscintigraphy, vascular complications, or nuclear medicine66 Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009;49(6):942-8. http://dx.doi.org/10.1086/605496. PMid:19663604.
http://dx.doi.org/10.1086/605496...

7 Khoury VJ, Camilo PR. Chikungunya virus (CHIKV): what can be expected after the acute phase? Reumatol Clin. 2016;12(1):1-3. http://dx.doi.org/10.1016/j.reuma.2015.12.002. PMid:26781826.
http://dx.doi.org/10.1016/j.reuma.2015.1...

8 Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, et al. Post-Chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. Version 1. F1000 Res. 2016;5:360. http://dx.doi.org/10.12688/f1000research.8235.1. PMid:27081477.
http://dx.doi.org/10.12688/f1000research...

9 Ramacciotti E, Agati LB, Aguiar VCR, et al. Zika and Chikungunya virus and risk for venous thromboembolism. Clin Appl Thromb Hemost. 2019;25:1-5. http://dx.doi.org/10.1177/1076029618821184. PMid:30808213.
http://dx.doi.org/10.1177/10760296188211...

10 Ahmed K, Hoque H, Rahman F, et al. Lymphatic involvement in Chikungunya patient in Cardiovascular Practice. University Heart Journal. 2017;13(1):13-6.

11 Bandyopadhyay D, Ghosh SK. Mucocutaneous manifestations of Chikungunya fever. Indian J Dermatol. 2010;55(1):64-7. http://dx.doi.org/10.4103/0019-5154.60356. PMid:20418982.
http://dx.doi.org/10.4103/0019-5154.6035...
-1212 Rampal, Sharda M, Meena H. Neurological complications in Chikungunya fever. J Assoc Physicians India. 2007;55:765-9. PMid:18290551., I found no article associating lymphedema or lymphadenopathy secondary to Chikungunya virus infection and abnormal images of lymphoscintigraphy, as described in my article, including the references cited in the letter to the editor. Finally, and to be fair, the first reports, similar to the case report cited, described in Brazil, were made by researchers from the Federal University of Pernambuco in 2016, which even served as an incentive for my deepening of the subject.

  • Financial support: None.

REFERENCES

  • 1
    Norman FF, Monge-Maillo B, Perez-Molina J-A, et al. Lymphadenopathy in patients with chikungunya virus infection imported from hispaniola: case reports. J Travel Med. 2015;22(4):272-5. http://dx.doi.org/10.1111/jtm.12204 PMid:25828151.
    » http://dx.doi.org/10.1111/jtm.12204
  • 2
    McCarthy MK, Davenport BJ, Reynoso GV, et al. Chikungunya virus impairs draining lymph node function by inhibiting HEV-mediated lymphocyte recruitment. JCI Insight. 2018;3(13):e121100. http://dx.doi.org/10.1172/jci.insight.121100 PMid:29997290.
    » http://dx.doi.org/10.1172/jci.insight.121100
  • 3
    Iqbal H, Aziz H. Current status of spurt of chikungunya in Pakistan. Clin Microbiol Infect. 2018;24(4):443-4. http://dx.doi.org/10.1016/j.cmi.2017.11.002 PMid:29133156.
    » http://dx.doi.org/10.1016/j.cmi.2017.11.002
  • 4
    Mogami R, Vaz JLP, Chagas YFB, et al. Ultrasound of ankles in the diagnosis of complications of chikungunya fever. Radiol Bras. 2017;50(2):71-5. http://dx.doi.org/10.1590/0100-3984.2016.0221 PMid:28428648.
    » http://dx.doi.org/10.1590/0100-3984.2016.0221
  • 5
    Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008;47(2):154-9. http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x PMid:18211486.
    » http://dx.doi.org/10.1111/j.1365-4632.2008.03478.x
  • 6
    Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009;49(6):942-8. http://dx.doi.org/10.1086/605496 PMid:19663604.
    » http://dx.doi.org/10.1086/605496
  • 7
    Khoury VJ, Camilo PR. Chikungunya virus (CHIKV): what can be expected after the acute phase? Reumatol Clin. 2016;12(1):1-3. http://dx.doi.org/10.1016/j.reuma.2015.12.002 PMid:26781826.
    » http://dx.doi.org/10.1016/j.reuma.2015.12.002
  • 8
    Rodriguez-Morales AJ, Gil-Restrepo AF, Ramírez-Jaramillo V, et al. Post-Chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia. Version 1. F1000 Res. 2016;5:360. http://dx.doi.org/10.12688/f1000research.8235.1 PMid:27081477.
    » http://dx.doi.org/10.12688/f1000research.8235.1
  • 9
    Ramacciotti E, Agati LB, Aguiar VCR, et al. Zika and Chikungunya virus and risk for venous thromboembolism. Clin Appl Thromb Hemost. 2019;25:1-5. http://dx.doi.org/10.1177/1076029618821184 PMid:30808213.
    » http://dx.doi.org/10.1177/1076029618821184
  • 10
    Ahmed K, Hoque H, Rahman F, et al. Lymphatic involvement in Chikungunya patient in Cardiovascular Practice. University Heart Journal. 2017;13(1):13-6.
  • 11
    Bandyopadhyay D, Ghosh SK. Mucocutaneous manifestations of Chikungunya fever. Indian J Dermatol. 2010;55(1):64-7. http://dx.doi.org/10.4103/0019-5154.60356 PMid:20418982.
    » http://dx.doi.org/10.4103/0019-5154.60356
  • 12
    Rampal, Sharda M, Meena H. Neurological complications in Chikungunya fever. J Assoc Physicians India. 2007;55:765-9. PMid:18290551.

History

  • Received
    03 Sept 2019
  • Accepted
    03 Sept 2019
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