Post-chikungunya chronic disease and its impact on quality of life, depression, anxiety, fatigue and sleep quality: results from a 2-year follow-up comparative study of 62 patients in La Virginia, Risaralda, Colombia

Background: There are limited studies in Latin America regarding the chronic consequences of Chikungunya virus (CHIK) infection, known as post-CHIK chronic disease (pCHIK-CD), and its impact, not just on organic but also mental conditions. We assessed the longest follow-up cohort of pCHIK-CD in Latin America, at La Virginia municipality, Risaralda, a new endemic area of CHIK in Colombia.

Methods: We conducted a follow-up cohort ambispective study in Colombia of 62 patients diagnosed with CHIK that persisted with pCHIK-CD after >2 years (Feb.2015-Dec.2017), initially serologically confirmed. Cases were followed-up and assessed with the validated instruments: quality of life (QoL) 36-item short-form health survey (SF-36), Zung Self-Rating Depression Scale (SDS) Zung Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI) (licensed) and Fatigue Severity Scale (FSS).

Results: We compared 43 patients with persistent disease (pCHIK-CD+) and 19 controls (pCHIK-CD-). Mean age 44.1 y-old, 69% female. Differences in SF-36 median scores between both groups were pCHIK-CD- 83.2% and pCHIK-CD+ 51.4% (p<0.0001), in six dimensions (physical functioning [89.5%/62.1%], role physical [89.5%/39.0%], bodily pain [88.2%/44.4%], general health [77.7%/51.4%], vitality [79.5%/506%] and health transition [68.4%/40.7%]), differences were significant (p<0.05). Depression and anxiety symptoms were significantly higher among those with pCHIK-CD+, 48.8%:21.1% (p=0.04) and 97.7%:84.2% (p=0.047). Moderate-to-severe scores at SDS and SAS showed marked difference in those pCHIK-CD+ (p=0.039). At the PSQI we found significant differences at wake-up time for pCHIK-CD+ (early, p=0.0069), sleep less time (p=0.0121), and with more somnolence (p=0.006). FSS were significantly higher in those with pCHIK-CD+, 55.2:37.5 (p=0.0213).

Conclusion: According to our results, after 2 years CHIK patients persisted with chronic disease, including impairment in QoL, depression, anxiety, sleep quality and fatigue. These results support previous case reports from La Reunion (France) and Colombia, but show new impacts on mental health in a long-term follow-up for a significant proportion of those infected with CHIK. These findings have significant implications in areas affected by chikungunya epidemics, as well later endemic areas with chronic disease.