title: Chikungunya fever in travelers: clinical presentation and course.
abstract: BACKGROUND
  An outbreak of chikungunya virus infection emerged in the southwest Indian Ocean islands in 2005, spread out to India, and resulted in an ongoing outbreak that has involved >1.5 million patients, including travelers who have visited these areas.
  
  
  METHODS
  Our study investigated 69 travelers who developed signs and symptoms compatible with chikungunya fever after returning home from countries involved in the epidemic. Twenty cases of infection that were confirmed by serological analysis, polymerase chain reaction, and/or cell culture were investigated.
  
  
  RESULTS
  All patients experienced flulike symptoms with fever and joint pain. No serious complications were observed, but 69% of the patients had persistent arthralgia for >2 months, and 13% had it for >6 months. Viral RNA could be detected in blood samples using reverse-transcriptase polymerase chain reaction in 4 of 4 patients who presented to a health care facility during their first week of illness, and the virus was successfully isolated from blood samples obtained from 2 of these patients. Chikungunya virus-specific immunoglobulin M and/or immunoglobulin G antibodies were detected in all patients. However, initial testing of serum samples yielded negative results for 3 of 5 patients during the first week.
  
  
  CONCLUSIONS
  Chikungunya fever must be considered in travelers who develop fever and arthritis after traveling to areas affected by an ongoing epidemic. Related arthritis mainly affects smaller joints and often persists for extended periods. Serological testing may have negative results during the first week of the disease; diagnosis using polymerase chain reaction appears to be more reliable during this time. Travelers to areas of epidemicity should be informed of the risk of infection and of adequate preventive measures, such as protection against mosquitos.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, University Munich, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Taubitz
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
authors.forename: Anette
authors.initials: A
authors.lastname: Kapaun
authors.forename: Martin
authors.initials: M
authors.lastname: Pfeffer
authors.forename: Christian
authors.initials: C
authors.lastname: Drosten
authors.forename: Gerhard
authors.initials: G
authors.lastname: Dobler
authors.forename: Gerd D
authors.initials: GD
authors.lastname: Burchard
authors.forename: Thomas
authors.initials: T
authors.lastname: Löscher
mesh_terms: D000293:Adolescent; D000328:Adult; D018354:Alphavirus Infections / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D018771:Arthralgia / Q000209:etiology*; D002646:Chikungunya virus; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014195:Travel
chemical_list: D002738:Chloroquine