الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In the recent years, emerging and re-emerging tropical infectious diseases have
been shown to cause high social and economic impact.
Chikungunya virus (CHIKV) is a mosquito-borne pathogen listed by National
Institute of Allergy and Infectious Diseases (NIAID) as a Category C Priority Pathogen
that causes Chikungunya fever (CHIKF). Chikungunya fever (CHIKF) has now emerged
as the next important infection in South-East Asia, the Pacific region and Europe, making
it a major threat that requires immediate attention. It is of concern that the re -emerged
CHIKV has caused considerable morbidity and some fatalities.
In Yemen republic at least 65 deaths have been reported in western coastal
province of Al- Hodeida. The disease is thought to be chikungunya, though some medical
officers dispute it. The disease is locally known as Al-Mukarfess. Chikungunya sprang up
in the area in the last 3 months of 2010.
Historically, dengue was reported in Yemen as early as the 19th century and
imported cases from east Africa (Zanzibar) were documented in 1872 and 1877.
Clinical and epidemiological similarities with dengue fever make CHIKV
diagnosis difficult, which may lead physicians to misdiagnose CHIKV as dengue fever;
therefore, the incidence of CHIKV may actually be higher than currently believed.
Thereby, the aim of the current study was to estimate the prevalence of
Chikungunya and Dengue viruses in AI-Hodeida Governorate in Republic of Yemen and
to identify symptoms associated with infection.
Samples were recruited from six hospital centers (Center of Nephrology,
Maritime College, Al-Rasheed, AI-Thawra, Al-Salakhana and Al-olofi) located in AI-Hodeida, 495 Yemeni Patients presenting with fever (>37.5°C) or at least two
constitutional symptoms, hospitalized in February 2011 or during the year 2012, were
recruited. Serum samples were collected within four days from the date of hospital
admission and then stored and shipped at -80°C. Samples were tested for serological
markers (IgG and IgM by ELISA) and RNA of CHIK and DNE viruse by real time PCR.
The patients’ age ranged from one month to 88 years. The median age was 30,
32.5% of the study groups were female and 67.5% were males. The commonest
symptoms were arthralgia; in 97% of cases, Myalgia in 95% of patients; followed by
fever; in 93% of cases.
In the current study of CHIKV, out of the 450 cases tested by both PCR and ELISA.
Only one case 0.2% was positive for PCR and ELISA IgM; and 25 cases 5.6% were
positive for both IgM & IgG by ELISA; while 21 cases 4.6% were positive by PCR; 14
cases 3.1% were positive for IgM only by ELISA; and 37 cases 8.2% were positive for
IgG only by ELISA. Mean while 352 cases 78.2% were negative by all techniques.
Out of the 450 cases tested for DENV RNA by PCR. Only 9 cases (2.0%) were
positive by PCR and IgM by ELISA and 10 cases (2.2%) were positive by PCR and IgG
by ELISA.
The distribution of cases (from January to June 2011-2012) for Chikungunya and
Dengue virus infection in relation to time. Peaks were observed during the month of
February 33 cases 52% , when the highest number of Chikungunya fever was observed,
while the highest absolute number and proportion of Dengue fever was reported in May
74 cases 56% . A low number of cases were reported 1 and 4(2% and 3%) respectively in
June and January.
In the current study, the commonest symptoms with CHIKF were fever and
arthralgia, which were reported in (99% and 99%) of cases for each of DENF and in
(98% each of DEN fever cases among for each, followed by myalgia and headache (96%
and 89%) in CHIKF cases, (96% and 92% of DEN fever cases respectively).
Gastrointestinal symptoms and Jaundice were less significantly reported among patients
with CHIK fever than those with DEN fever (p<0.01, 0.05).
Clinical and epidemiological similarities between dengue fever and CHIK fever
make diagnosis difficult, which may lead physicians to misdiagnose CHIKV as dengue
fever; therefore, the incidence of CHIKV may actually be inappropriately estimated.
Also, co-infections with CHIKV and DENV occur in areas where these 2 viruses co-circulate. Concurrent infections may result in illness with overlapping signs and symptoms, making diagnosis and treatment difficult for physicians.