Acute Clinical Features and Persistence of Joint Pain in Probable Cases of Chikungunya Fever in Eritrea

Background: Chikungunya fever is a mosquito-borne viral illness that has re-emerged as an important global concern. Persistent arthralgia following chikungunya fever is common and requires advanced pharmacological interventions as pain does not respond well to analgesics. Objective: The study aimed to describe the acute clinical features of probable cases of chikungunya fever and risk factors associated with the persistence of joint pain. Methods: A prospective, descriptive cohort study was conducted on probable cases of chikungunya fever from October 2018 to March 2019 in the Tesseney subzone of Eritrea. Results: A total of 203 probable cases of chikungunya fever were enrolled, majority being males (68%) with a mean age of 39.2 years. The acute phase symptoms include the triad of polyarthralgia (97%), fever (96.1%), and skin rash (56.7%). Commonly affected joint sites were the wrist (59.4%) and interphalangeal joints of the hands (56.9%). Fever had a mean duration of 4.1 ± 3 days, while headache had a mean duration of 3.8 ± 3 days. Skin rash was maculopapular, which was pruritic in (85.2%) and the common involved sites were the hands (71%) and trunk (46.5%). Complete blood count during acute phase includes lymphocytosis (64.5%) and granulocytopenia (43.3%). Joint pain persisted at three months in 52.1% of cases and at six months in 21.7%. Age > 41 (p = 0.001, OR: 1.588; 95% CI: 0.935– 2.695) and having the O-type blood group (p = 0.033, OR: 0.704; 95% CI: 0.448– 1.105) were found to be associated with the persistence of joint pain. Conclusion: Our study indicates polyarthralgia, fever, and skin rash as a triad of symptoms during the acute phase. Persistent arthralgia was a frequent long-term complication of chikungunya fever in which increasing age was identified to be a significant risk factor. Keywords: chikungunya fever, clinical features, persistent joint pain, Eritrea