Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup?

doi:10.1016/j.jcv.2014.04.020

Journal of Clinical Virology

Volume 60, Issue 3, July 2014, Pages 317-319

https://doi.org/10.1016/j.jcv.2014.04.020 Get rights and content

Highlights

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We report a traveler with an acute Mayaro virus infection.
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Persistent arthralgia is a common complication of this mosquito borne alphavirus infection.
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Travelers to the tropical forests of South America are at risk for Mayaro virus infections.

Abstract

The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquito-borne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed.

Section snippets

Why is this case important

The upcoming 2014 FIFA World Cup is expected to attract more than half a million soccer fans. These fans will be at a significant risk for contracting dengue, as was recently highlighted by Hay [1]. However, other less known viral infections may also pose a threat for visitors, especially with some of the host cities being located in the Amazon basin. We present a case of a traveler who presented with a rare dengue-like viral infection, which she acquired during a stay in the Amazon.

Case description

A 52-year-old Caucasian female biologist presented to our outpatient department with complaints of persistent arthralgia after a febrile illness. She had returned one week earlier from a four weeks visit to the Amazon basin in Brazil in May 2013. Together with a Brazilian colleague, she had performed scientific research in the tropical rainforests near Caxiuana. In the last week of her stay, she developed high grade fever lasting 2 days, together with headache, nausea and vomiting, a non

Other similar and contrasting cases in literature

MAYV was first isolated in 1954 from the blood of a febrile worker in the forest at Cat's Hill, Mayaro County, southeastern Trinidad [4]. Since then, individual cases, and small outbreaks have been reported in people living in tropical forests in Brazil, Peru, Bolivia, Venezuela, Colombia, Surinam and French Guiana [4], [5], [6], [7], [8].

To the best of our knowledge, only eight cases of MAYV infection in travelers have so far been reported. Tesh et al. [6], described a 48-year-old

Discussion

MAYV is a zoonotic arthropod-borne virus (arbovirus), member of the family Togaviridae and the genus Alphavirus. The presumed principal vectors are forest-dwelling Haemagogus mosquitoes with non-human primates being the most likely reservoirs [12]. The transmission cycle of MAYV resembles the sylvatic cycle of yellow fever and this explains why most human MAYV infections occur either as sporadic cases or as small local outbreaks [12], [13]. The incubation period is approximately 1–2 weeks,

Funding

No funding was received from any institution or organization.

Competing of interest

None.

Ethical approval

Not required.

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Prolonged polyarthralgia in a German traveller with Mayaro virus infection without inflammatory correlates
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There are more references available in the full text version of this article.

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Hepatoprotective, antioxidant, anti-inflammatory, and antiviral activities of silymarin against mayaro virus infection
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Infection caused by Mayaro virus (MAYV) is responsible for causing acute nonspecific fever, in which the majority of patients develop incapacitating and persistent arthritis/arthralgia. Mayaro fever is a neglected and underreported disease without treatment or vaccine, which has gained attention in recent years after the competence of Aedes aegypti to transmit MAYV was observed in the laboratory, coupled with the fact that cases are being increasingly reported outside of endemic forest areas, calling attention to the potential of an urban cycle arising in the near future. Thus, to mitigate the lack of information about the pathological aspects of MAYV, we previously described the involvement of oxidative stress in MAYV infection in cultured cells and in a non-lethal mouse model. Additionally, we showed that silymarin, a natural compound, attenuated MAYV-induced oxidative stress and inhibited MAYV replication in cells. The antioxidant and anti-MAYV effects prompted us to determine whether silymarin could also reduce oxidative stress and MAYV replication after infection in an immunocompetent animal model. We show that infected mice exhibited reduced weight gain, hepatomegaly, splenomegaly, anaemia, thrombocytopenia, leukopenia, increased liver transaminases, increased pro-inflammatory cytokines and liver inflammation, increased oxidative damage biomarkers, and reduced antioxidant enzyme activity. However, in animals infected and treated with silymarin, all these parameters were reversed or significantly improved, and the detection of viral load in the liver, spleen, brain, thigh muscle, and footpad was significantly reduced. This work reinforces the potent hepatoprotective, antioxidant, anti-inflammatory, and antiviral effects of silymarin against MAYV infection, demonstrating its potential against Mayaro fever disease.
Arthritogenic alphaviruses: epidemiological and clinical perspective on emerging arboviruses
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Mosquito-borne viruses, or arboviruses, have been part of the infectious disease landscape for centuries, and are often, but not exclusively, endemic to equatorial and subtropical regions of the world. The past two decades saw the re-emergence of arthritogenic alphaviruses, a genus of arboviruses that includes several members that cause severe arthritic disease. Recent outbreaks further highlight the substantial public health burden caused by these viruses. Arthritogenic alphaviruses are often reported in the context of focused outbreaks in specific regions (eg, Caribbean, southeast Asia, and Indian Ocean) and cause debilitating acute disease that can extend to chronic manifestations for years after infection. These viruses are classified among several antigenic complexes, span a range of hosts and mosquito vectors, and can be distributed along specific geographical locations. In this Review, we highlight key features of alphaviruses that are known to cause arthritic disease in humans and outline the present findings pertaining to classification, immunogenicity, pathogenesis, and experimental approaches aimed at limiting disease manifestations. Although the most prominent alphavirus outbreaks in the past 15 years featured chikungunya virus, and a large body of work has been dedicated to understanding chikungunya disease mechanisms, this Review will instead focus on other arthritogenic alphaviruses that have been identified globally and provide a comprehensive appraisal of present and future research directions.
The role of natural and nature-based compounds against Chikungunya and Mayaro alphaviruses and their vectors
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Citation Excerpt :
A small portion of infected individuals can present swelling of the small joints of hands and feet. After the acute phase, long-term arthralgia starts and may persist for several weeks or months [63,64]. In a previous study, 54% of patients developed the chronic phase of the disease up to 12 months in which the arthralgia generally affected the hands, wrists, elbows, feet, and knees [65].
Chikungunya and Mayaro viruses are Alphaviruses belonging to the Togaviridae family, which are mainly transmitted by the bite of Aedes aegypti (or Ae. albopictus) and Haemagogus spp. mosquitoes. Currently, there are no specific drugs capable of treating or preventing these infectious diseases. In this sense, the development of researches addressed to the identification and design of new active compounds is essential, considering the lack of chemotherapeutic agents. Considering this context, natural products represent a great alternative resource for searching and identifying new potential antiviral agents. In this chapter, a great overview of the historical, epidemiological, and structural aspects of Chikungunya and Mayaro viruses is discussed, including the most important targets from these Alphaviruses. Besides, we report an update on the medicinal chemistry of Chikungunya virus inhibitors from natural and inspired by nature inhibitors, focusing on flavonoid, coumarin, terpene, lignan and their derivatives. Also, a deep overview of Mayaro virus inhibitors is given, including compounds from flavonoid and terpene classes. Moreover, compounds from alkaloid, terpene, phenolic compounds, and hydrocarbon classes with larvicidal and/or repellent activity against Ae. aegypti and Ae. albopictus larvae are discussed in detail.
GloPID-R report on chikungunya, o'nyong-nyong and Mayaro virus, part 3: Epidemiological distribution of Mayaro virus
2019, Antiviral Research
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DENV- patients were tested with an enzyme immunoassay on infected cultured cells (EIA-ICC) (Costa et al., 2017). Imported case- The Netherlands ex Brazil, 2013 (Slegers et al., 2014). After a travel in Pará state, northern Brazil, the patient tested positive for anti-MAYV IgM and IgG by IFT; the result was confirmed by VNT.
Will Mayaro virus be responsible for the next outbreak of an arthropod-borne virus in Brazil?
2017, Brazilian Journal of Infectious Diseases
Citation Excerpt :
The symptoms of MAYV infection are often an exanthematous rash, fever, myalgia, retro-orbital pain, headache, diarrhea, and arthralgia, the latter may persist for months or even years.7 There are several reports on the literature of persistent or recurrent arthralgia resulting from MAYV infection,8–10 which could be a result of an inefficient neutralizing antibody response against this virus associated with the continuous expression of some pro-inflammatory immune cytokines.11 However, there is a need for more studies evaluating the broad spectrum of the clinical manifestations of the acute phase of the disease, including unusual presentations, if present, as well as the possible chronic clinical manifestations, and also, the viral and immunological parameters involved in the causation of each form of this disease.
Mayaro virus is an alphavirus from the Togaviridae family and is transmitted mainly by Hemagogus mosquitoes. This virus circulates in high-density tropical forests or rural areas of Central and South America causing a disease characterized by high-grade fever, maculopapular skin rash and marked arthralgia that, in some patients, can persist for long periods after infection and may be misinterpreted as chikungunya. Although only a few outbreaks involving this virus have been reported, in the last years the number of Mayaro virus infections has increased in the central and northern regions of Brazil. In this review, we describe the reported prevalence of this infection over the years and discuss the circumstances that can contribute to the establishment of an urban mayaro virus epidemic in Brazil and the problems encountered with the specific diagnosis, especially the antigenic cross-reactivity of this pathogen with other viruses of the same family.
Mayaro virus: a forest virus primed for a trip to the city?
2016, Microbes and Infection
Citation Excerpt :
MAYVD occurs abruptly with a three to five day spiking fever, a nonpruritic maculopapular rash that may appear on the legs and arms within a week after onset and may spread to the trunk, neck and face. Dizziness, chills, headache (sometimes severe and frontal), myalgia, retro-orbital pain, photophobia, inguinal lymphadenopathy, myalgia, epigastric pain, vomiting and diarrhoea are also reported and arthralgia which can affect ankles, wrists, fingers, elbows and toes and less often, other joints, sometimes prior to fever can be severe [9,21,19,22–27]. MAYVD can include a four day viraemia that reaches approximately 105 plaque-forming units (PFU)/ml of whole blood [19].
Mayaro virus (MAYV) is an emerging arthropod-borne virus (arbovirus).
Infection by MAYV can produce Mayaro virus disease (MAYVD) which is usually a clinically diagnosed, acute, febrile illness associated with prolonged and painful joint inflammation and swelling. MAYVD may be clinically indistinguishable from dengue, chikungunya fever, malaria, rabies, measles or other arboviral diseases. The full spectrum of disease, sequelae, routes of infection, virus shedding and any rarer means of transmission remain undefined.
MAYVD cases in humans have so far been localised to Central and South America, particularly regions in and around the Amazon basin.
MAYV usually circulates in a sylvan cycle of forest mosquitoes and vertebrates, however it has also been found in more urban locations alongside anthropophilic (preferring humans) insect vectors. If transmission via anthropophilic mosquitoes becomes more efficient following viral change, or existing vectors change their habitat and biting habits, the risk of urban establishment and further spread into non-forested areas will grow. Surveillance, testing and vector control remain key to monitoring and preventing global spread and establishment. The possibility of MAYV becoming further urbanized is worthy of note, consideration and action to ensure MAYV does not spread beyond the forests and establish in the world's cities.

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Case ReportPersisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup?

Highlights

Abstract

Section snippets

Why is this case important

Case description

Other similar and contrasting cases in literature

Discussion

Funding

Competing of interest

Ethical approval

J Infect

Football fever could be a dose of dengue

Nature

Genome analysis of Mayaro virus imported to Germany from French Guiana by traveler

Emerg Infect Dis

Prolonged polyarthralgia in a German traveller with Mayaro virus infection without inflammatory correlates

BMC Infect Dis

Mayaro virus: a new human disease agent: II. Isolation from blood of patients in Trinidad, B.W.I.

Am J Trop Med Hyg

Mayaro Fever in the City of Manaus, Brazil, 2007–2008

Vector-Borne Zoonot

Mayaro virus disease: an emerging mosquito-borne zoonosis in tropical South America

Clin Infect Dis

Mayaro Fever Virus, Brazilian Amazon

Emerg Infect Dis

Case Report
Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: Is there a risk for attendants to the 2014 FIFA World Cup?