Persisting arthralgias after a stay in Brazil: an unfamiliar infectious risk for visitors to the 2014 FIFA World Cup
Slegers, C.A.D., Keuter, M., Ven, A.V. van der, Mast, Q. de
Voorzitter(s): prof.dr. J.W. de Fijter, Leiden & dr. P.J. de Vries, Hilversum
Locatie(s): Zaal 0.5
Categorie(ën):
Introduction
With the upcoming 2014 FIFA World Cup and the 2016 Olympic Games in Brazil, physicians may be confronted with rare imported infections that are indigenous to Brazil. Our case reports a traveler with a rare dengue-like viral infection after a stay in the Amazon region.
Case Description
A 52-year old Caucasian female biologist presented at our policlinic one week after return from a four weeks visit to the Amazon area (Caxiuana) of Brazil. In the last week of her stay she experienced acute high grade fever, headache and polyarthralgia of the hands, wrists, elbows and ankles. In the following days she complained of nausea, vomiting and a non-pruritic rash mainly on her arms and upper legs which lasted for approximately one week. The fever disappeared after two days. Severe, debilitating polyarthralgia persisted and restricted her in her daily activities. Her Brazilian colleague, who accompanied her, had the same symptoms. During her stay she had multiple mosquito bites and a tick bite after the first week. She had no relevant medical history. On physical examination she was afebrile and except for mild diffuse swelling of the fingers without evident arthritis, no abnormalities were found. Laboratory results showed a normal blood count, Erythrocyte Sedimentation Rate and C-Reactive Protein. Renal function and liver tests were normal.Serological examination for dengue was negative. Given the persisting arthralgias, Chikungunya was considered but this alphavirus is rare in Brazil. Mayaro virus disease is another mosquito-borne alphavirus endemic in forested areas of tropical South America. Serology for Mayaro virus was positive for IgM and IgG, while serology for Chikungunya was negative. A Non Steroidal Anti-Inflammatory Drug was started for the persisting polyarthralgia, which gradually disappeared in the course of weeks.
Conclusion
We describe a patient with persisting polyarthralgia due to an acute Mayaro virus infection. Persisting arthralgias are characteristic for alphavirus infections, of which Chikungunya is the most well known. Mayaro virus is not well known outside endemic areas and should be in the differential diagnosis of any dengue-like illness in travelers to South America, especially if persisting arthralgias are present. With increasing international travel and large groups of travelers expected to visit Brazil for the upcoming sports events, physicians may increasingly be confronted with this rare viral infection.