In the latest Case Record of the Massachusetts General Hospital, a 27-year-old woman was seen in the emergency department of this hospital during the summer because of fever, arthralgias, and a rash. Three days before the onset of illness, she had returned from a vacation in the Caribbean. A diagnostic test was performed.
When considering possible exposures in a returning traveler, it is important to consider the location of travel, food or water consumed, history of insect bites, contact with animals, use of medications or recreational drugs, and sexual contacts.
- Describe the arthralgias associated with Parvovius B19 infection in adults.
Approximately 60% of adults with parvovirus B19 infection have symmetric, polyarticular arthralgias; this infection is more common among women than men, frequently affects the proximal interphalangeal and metacarpophalangeal joints, and has been reported to involve the knees, wrists, and ankles.
- What diseases are common in persons who travel to the Caribbean or Central America?
Of patients who seek medical attention for travel-related diseases after spending time in the Caribbean or Central America, 17.7% present with fever. No specific diagnosis is made in 40% of cases of fever in persons returning from international travel; when a diagnosis is made, the most common cause is dengue, and malaria, typhoid, and hepatitis A are other common causes. Within the Caribbean, malaria has been reported only in Haiti and the Dominican Republic. Leptospirosis is important to consider in any patient returning from the Caribbean, since this illness can be missed on routine testing.”
Morning Report Questions
Q: What clinical findings help distinguish between chikungunya virus infection and dengue?
A: The clinical presentations of dengue and chikungunya virus infection overlap considerably. The incubation periods of both viral diseases are short. Both diseases are typically manifested by fevers and myalgias. Headache, rash, nausea, and vomiting are also commonly associated with both diseases. Abnormal laboratory findings, especially thrombocytopenia, are typically more pronounced in patients with severe dengue than in those with chikungunya virus infection. Hemorrhagic manifestations are more common in patients with dengue than in those with chikungunya virus infection. Symmetric polyarthralgia involving the small and medium joints is the hallmark of chikungunya virus infection and is less commonly reported in patients with dengue.”
Q: What diagnostic tests are available for chikungunya virus infection?
A: Several diagnostic tests are available for chikungunya virus infection. Enzyme-linked immunosorbent assay can aid in the diagnosis, and depending on the timing of the patient’s presentation, detection of viral nucleic acids may also be possible. High-level viremia is detectable within a week after illness onset; IgM antibodies are typically present within 5 to 7 days after illness onset and persist for several months, and shortly thereafter, IgG antibodies are present and persist for life.