title: Hyperferritinemia is a potential marker of chronic chikungunya: A retrospective study on the Island of Curaçao during the 2014-2015 outbreak.
abstract: Recently Chikungunya virus (CHIKV) outbreaks have been reported in the Carribean. There is no data regarding the outbreak in Curaçao. In addition, to date there is no biomarker that could be used to predict chronic infection.
  
  
  
  To characterize the first CHIKV outbreak in Curaçao and to identify potential biomarkers for chronic infection.
  
  
  
  A serological test and quantitative polymerase chain reaction (qPCR) were used on samples collected in Curaçao to confirm infection. Subsequently, six samples with high viral load were selected for phylogenetic analysis. Furthermore we investigated the association of macrophage-related biomarkers during CHIKV infection with chronic arthralgia/arthritis.
  
  
  
  116 patients in Curacao were diagnosed with CHIKV infection based on ELISA and 77% were tested positive for CHIKV by qPCR. Phylogenetic analysis showed that an Asian genotype was the cause of the outbreak. Elevated levels of ferritin and CRP were significantly associated with viraemia. In addition, elevated ferritin levels were significantly associated with chronic arthralgia.
  
  
  
  The results showed that the presence of an Asian genotype of CHIKV in Curaçao for the first time. Moreover, we found an association between ferritin levels with chronic arthralgia.
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Fatih
authors.initials: F
authors.lastname: Anfasa
authors.affiliation: Curaçao BioMedical Health Research Institute, Curaçao; Medical Laboratory Services, Curaçao.
authors.forename: Lisette
authors.initials: L
authors.lastname: Provacia
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Corine
authors.initials: C
authors.lastname: GeurtsvanKessel
authors.affiliation: Medical Laboratory Services, Curaçao.
authors.forename: Robert
authors.initials: R
authors.lastname: Wever
authors.affiliation: Curaçao BioMedical Health Research Institute, Curaçao; Epidemiology & Research Unit, Ministry of Health, Environment & Nature, Curaçao.
authors.forename: Izzy
authors.initials: I
authors.lastname: Gerstenbluth
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands; Artemis One Health Research Institute, Utrecht, The Netherlands; Center for Infection Medicine and Zoonoses Research (RIZ), University of Veterinary Medicine, Hannover, Germany.
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands; Artemis One Health Research Institute, Utrecht, The Netherlands. Electronic address: b.martina@erasmusmc.nl.
authors.forename: Byron E E
authors.initials: BE
authors.lastname: Martina
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D065632:Chikungunya Fever / Q000473:pathology*; D002646:Chikungunya virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D002908:Chronic Disease / Q000453:epidemiology*; D000073096:Curacao / Q000453:epidemiology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005293:Ferritins / Q000097:blood*; D005838:Genotype; D006801:Humans; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D015415:Biomarkers; D005293:Ferritins
keywords: Chikungunya virus; Chronic arthralgia; Curaçao; Ferritin; Neopterin