title: Clinical, Serological, and Virological Analysis of 572 Chikungunya Patients From 2010 to 2013 in India.
abstract: Chikungunya fever (CHIK) is a major public health concern in India. Characterized by acute fever with joint pain and swelling, most patients recover from this self-limiting illness in 7-10 days, with cessation of joint pain post-acute episode. However, in some patients, joint pain persists, lasting for months or even years. The precise correlates to the chronic phase of this debilitating illness and/or this remarkable heterogeneity in disease manifestation are poorly understood.
  
  
  
  We evaluated 572 chikungunya patients from India who were recruited on the basis of positive real-time polymerase chain reaction and/or CHIK virus immunoglobulin (IgM) after receiving consent. Arthralgic conditions were monitored using visual analog score (VAS) 12 weeks after onset of fever in 130 patients. Initial viral load, IgG, and initial neutralization response were assayed and correlated with clinical and VAS information in 40 patients.
  
  
  
  Our extensive screening revealed that patients with higher initial viral loads during the acute phase of illness had poor prognosis at the post-acute phase with more restricted joint movement and higher VAS. Additionally, patients who showed early seroconversion to neutralizing IgG responses had better prognosis, as many of these patients did not manifest restricted joint movements at the post-acute phase.
  
  
  
  Our study sheds light on chikungunya disease with respect to disease progression and assesses clinical, virological, and serological parameters of chikungunya disease severity. Importantly, it reveals that initial high viral load and neutralizing IgG response may function in a seemingly contrasting manner to negatively or positively dictate disease outcome.
authors.affiliation: Vector Borne Diseases Group.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Jain
authors.affiliation: ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology.
authors.forename: Kaustuv
authors.initials: K
authors.lastname: Nayak
authors.affiliation: Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Tanwar
authors.affiliation: Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Rajni
authors.initials: R
authors.lastname: Gaind
authors.affiliation: Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Microbiology, BYL Nair Ch. Hospital & T. N. Medical College, Mumbai.
authors.forename: J S
authors.initials: JS
authors.lastname: Shastri
authors.affiliation: International Center for Genetic Engineering and Biotechnology, New Delhi, India.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Bhatnagar
authors.affiliation: ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology.|Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Murali Krishna
authors.initials: MK
authors.lastname: Kaja
authors.affiliation: ICGEB-Emory Vaccine Center, International Center for Genetic Engineering and Biotechnology.
authors.forename: Anmol
authors.initials: A
authors.lastname: Chandele
authors.affiliation: Vector Borne Diseases Group.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Sunil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D065632:Chikungunya Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology* / Q000821:virology; D002646:Chikungunya virus / Q000235:genetics / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D019562:Viral Load; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
keywords: Chikungunya; India; neutralizing antibodies; viral load