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Inicio Revista Colombiana de Reumatología (English Edition) Impact of emerging arthritogenic arboviruses in Colombia and Latin America
Journal Information
Vol. 23. Issue 3.
Pages 145-147 (July - September 2016)
Vol. 23. Issue 3.
Pages 145-147 (July - September 2016)
DOI: 10.1016/j.rcreue.2016.11.001
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Impact of emerging arthritogenic arboviruses in Colombia and Latin America
Impacto de las arbovirosis artritogénicas emergentes en Colombia y América Latina
Alfonso J. Rodríguez-Moralesa,
Corresponding author

Corresponding author.
, Juan-Manuel Anayab
a Grupo de Investigación Salud Pública e Infección, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira (UTP), Pereira, Risaralda, Colombia
b Centro de Estudio de Enfermedades Autoinmunes (CREA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Tables (1)
Table 1. Main relevant arboviruses in groups A and B.
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During the last two years, Latin America, in general, and Colombia, in particular, have seen the emergence in a significant part of their territory of new viral tropical infectious agents, not previously described in the region, especially of autochthonous transmission by arthropod vectors.1 The viruses that can be transmitted by this way (in addition to other possible routes, usually secondary) are called arboviruses. This term comes from ararthropod boborne, virus transmitted by arthropods (mosquitoes or ticks, mainly). In this denomination are found a wide number of viruses that belong to 4 groups, A, B, C and D, of which the most important are found in the groups A and B (Table 1).

Table 1.

Main relevant arboviruses in groups A and B.

Group A arboviruses 
Barmah forest 
EEEV, complex 
Eastern equine encephalitis (EEEV)a 
Rio Negro 
Salmon pancreas disease 
Semliki forest, complex 
Ross river 
Semliki forest 
VEEV, complex 
Venezuelan equine encephalitis (VEEV)a 
WEEV, complex 
Fort Morgan 
Highlands J 
Western equine encephalitis (WEEV) 
Group B arboviruses 
Dengue, groupa 
Gadgets Gully 
Japanese encephalitis, group 
Japanese encephalitis 
Murray Valley encephalitis 
St. Louis encephalitis 
West Nile virusb 
Kokobera, group 
Modoc, group 
Tick-borne encephalitis, group 
Kyasanur forest disease 
Louping ill 
Omsk hemorrhagic fever 
Phnom Penh bat 
Royal Farm 
Tick-borne encephalitis 
Yellow fever, groupa 

Present in Colombia.


Present in Latin America.

In group A is found the alphavirus genus (Table 1), which includes the chikungunya virus (CHIKV) and the Mayaro virus, both arthritogenic and circulating in Latin America; the first since 2014 in Colombia. Viruses such as the Ross River, Barmah forest, O’nyong-nyong, Sindbis, and Semliki forest, are also arthritogenic alphaviruses, which are not yet present in Latin America, but that could appear in a future time.1,2

In group B are included relevant viruses such as the dengue virus (DENV) and the Zika virus (ZIKV) (Table 1), which also produce rheumatologic manifestations, although with less commitment in extension and in time, in comparison with the alphaviruses.1,2

The clinical manifestations that these arboviruses can produce are similar. When there is a monoinfection, there are some characteristics of higher predominance in them, however, it has been demonstrated that there might be coinfections3,4 that would make more complex the syndromic diagnosis. For this reason it has been proposed to consider them altogether. For example, the ChikDenMaZika syndrome includes simultaneously CHIKV, DENV, Mayaro virus and ZIKV.5 Their clinical similarities appear to be related with their taxonomy and also with their phylogenetics. Indeed, an evolution is evident, as has been recently demonstrated in dengue (where apparently exists a fifth serotype, DENV-5) and in ZIKV (where an oceanic lineage and a Latin American lineage are recently described).6

The CHIKV infection is characterized, mainly, in its acute phase by fever and migratory bilateral severe polyarthralgias that involve especially joints of hands and feet, generating a significant disability. However, a considerable impact has been demonstrated not only in the acute phase of the disease (the first 3 weeks), but beyond in the sub-acute phase (3–12 weeks) and particularly in the chronic phase (from 12 weeks onwards). In Colombia, where the estimates indicate that more than 3 million cases could have been occurred between 2014 and 2015, a proportion close to 50% could be suffering or being at risk of developing the so-called post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR), observed in multiple cohorts in Sucre,7 Tolima8 and Risaralda,9 confirming previous modeling studies10 and a meta-analysis.11 In summary, 56.6% of patients persisted with pCHIK-CIR beyond 12 weeks post-infection.7–9 Therefore, the pCHIK-CIR is a challenge for the Latin American Rheumatology.12

As it happened with the DENV, the CHIKV and the ZIKV came to stay. Although the epidemic phase of CHIKV ended up, an endemic condition is observed. In Colombia, a total of 18,317 cases of CHIKV have been reported during the first 31 weeks of 2016 (until August 6), 3949 in the Valle del Cauca, 2178 in Santander, 1560 in Tolima and 1415 in Risaralda.13 In the American continent also stands out that 247,626 cases have been notified until the week 32 of 2016 (August 12).14

In new preliminary data from 2 cohorts under follow-up, in Risaralda and Tolima, after one year of infection, is known that in the first of them, 45.6% of the subjects still persist with pCHIK-CIR (previous value <1 year: 53.7%), while in the second, 43.1% (previous value <1 year: 44.3%). These figures indicate the true chronic character of the pCHIK-CIR with the possibility of an inflammatory arthropathy which, in some cases, can be erosive and indistinguishable from a seronegative rheumatoid arthritis.15

As if CHIK were not enough, concern has been raised regarding the possible and nearby circulation of the Mayaro virus, an alphavirus that also can produce acute and chronic joint involvement.16 The country should be prepared, both in the primary and the specialized care, to face this new challenge that could supervene even this same year 2016. Mayaro already circulates in Brazil,17 Venezuela,18 Peru19 and Ecuador.20 A possible circulation in Colombia cannot be ruled out.5

For all these reasons, it becomes imperative to increase the research on these emerging arthritogenic arboviruses, where Rheumatology has a particularly important role not only in clinical,21,22 but also epidemiological and basic research, to better understand their implications not only in the acute phase, but also in the chronic, the risk factors associated with chronicity, the immunological mechanisms involved and the possible alternatives not only for palliative treatment but also for possible prevention and cure.

In conclusion, these arboviruses are having a considerable impact in terms of clinical commitment, disability and even costs,23–25 which entails greater reflection by the multiple specialties involved in their management and research, as is the case of Rheumatology, to generate in addition local research which would have a global repercussion, since Colombia is being the scenario of major contributions for Latin America regarding the pCHIK-CIR,26 and it should be also in the future for other emerging arthritogenic arboviruses.

Conflict of interest

The authors declare that they have no conflict of interest.

A.J. Rodríguez-Morales.
Zika: the new arbovirus threat for Latin America.
J Infect Dev Ctries, 9 (2015), pp. 684-685
A.J. Rodríguez-Morales.
No era suficiente con dengue y chikungunya: llegó también Zika.
Arch Med, 11 (2015), pp. e3
W.E. Villamil-Gómez, O. González-Camargo, J. Rodríguez-Ayubi, D. Zapata-Serpa, A.J. Rodríguez-Morales.
Dengue, chikungunya and Zika co-infection in a patient from Colombia.
J Infect Public Health, 9 (2016), pp. 684-686
W.E. Villamil-Gómez, A.J. Rodríguez-Morales, A.M. Uribe-García, E. González-Arismendy, J.E. Castellanos, E.P. Calvo, et al.
Zika, dengue and chikungunya co-infection in a pregnant woman from Colombia.
[Electronic publishing 3 August]
A.E. Paniz-Mondolfi, A.J. Rodríguez-Morales, G. Blohm, M. Márquez, W.E. Villamil-Gómez.
ChikDenMaZika syndrome: the challenge of diagnosing arboviral infections in the midst of concurrent epidemics.
W. Shi, Z. Zhang, C. Ling, M.J. Carr, Y. Tong, G.F. Gao.
Increasing genetic diversity of Zika virus in the Latin American outbreak.
Emerg Microbes Infect, 5 (2016), pp. e68
A.J. Rodríguez-Morales, W. Villamil-Gómez, M. Merlano-Espinosa, L. Simone-Kleber.
Post-chikungunya chronic arthralgia: a first retrospective follow-up study of 39 cases in Colombia.
Clin Rheumatol, 35 (2016), pp. 831-832
A.J. Rodríguez-Morales, C.E. Calvache-Benavides, J. Giraldo-Gómez, N. Hurtado-Hurtado, M.C. Yepes-Echeverri, C.J. García-Loaiza, et al.
Post-chikungunya chronic arthralgia: results from a retrospective follow-up study of 131 cases in Tolima, Colombia.
Travel Med Infect Dis, 14 (2016), pp. 58-59
A.J. Rodríguez-Morales, A.F. Gil-Restrepo, V. Ramírez-Jaramillo, C.P. Montoya-Arias, W.F. Acevedo-Mendoza, J.E. Bedoya-Arias, et al.
Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia [version 2; referees: 3 approved].
F1000Research, 5 (2016), pp. 360
A.J. Rodríguez-Morales, J.A. Cardona-Ospina, W. Villamil-Gómez, A.E. Paniz-Mondolfi.
How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?.
Rheumatol Int, 35 (2015), pp. 2091-2094
A.J. Rodríguez-Morales, J.A. Cardona-Ospina, S.F. Urbano-Garzón, J.S. Hurtado-Zapata.
Prevalence of post-chikungunya chronic inflammatory rheumatism: a systematic review and meta-analysis.
Arthritis Care Res (Hoboken), (2016),
[Electronic publishing 25 March]. Available from:
A.J. Rodríguez-Morales.
Chikungunya y la patología articular crónica: ¿un reto para la reumatología latinoamericana?.
Rev Exp Med, 1 (2015), pp. 38-39
OPS. Número de casos reportados de chikungunya en países o territorios de las Américas 2016 (por semanas). Semana epidemiológica/SE 32. Available from:⟨=es [accessed 12.08.16].
A. Suhrbier, M.C. Jaffar-Bandjee, P. Gasque.
Arthritogenic alphaviruses—an overview.
Nat Rev Rheumatol, 8 (2012), pp. 420-429
M. Muñoz, J.C. Navarro.
Mayaro: a re-emerging arbovirus in Venezuela and Latin America.
O.P. Serra, B.F. Cardoso, A.L. Ribeiro, F.A. Santos, R.D. Slhessarenko.
Mayaro virus and dengue virus 1 and 4 natural infection in culicids from Cuiabá, state of Mato Grosso, Brazil.
Mem Inst Oswaldo Cruz, 111 (2016), pp. 20-29
J.R. Torres, K.L. Russell, C. Vasquez, R. Barrera, R.B. Tesh, R. Salas, et al.
Family cluster of Mayaro fever, Venezuela.
Emerg Infect Dis, 10 (2004), pp. 1304-1306
F.W. Santiago, E.S. Halsey, C. Siles, S. Vilcarromero, C. Guevara, J.A. Silvas, et al.
Long-term arthralgia after Mayaro virus infection correlates with sustained pro-inflammatory cytokine response.
PLoS Negl Trop Dis, 9 (2015), pp. e0004104
R.O. Izurieta, M. Macaluso, D.M. Watts, R.B. Tesh, B. Guerra, L.M. Cruz, et al.
Hunting in the rainforest and Mayaro virus infection: an emerging alphavirus in Ecuador.
J Glob Infect Dis, 3 (2011), pp. 317-323
J.F. Betancur, E.P. Navarro, J.H. Bravo Bonilla, A.D. Cortés, J.D. Vélez, A. Echeverry, et al.
Catastrophic antiphospholipid syndrome triggered by fulminant chikungunya infection in a patient with systemic lupus erythematosus.
Arthritis Rheumatol, 68 (2016), pp. 1044
J. Jaller Raad, A. Segura Rosero, J. Vidal Martínez, A. Parody, R. Jaller Raad, D. Caballero Tovar, et al.
Respuesta inmunitaria de una población del Caribe colombiano infectada con el virus chikungunya.
Rev Colomb Reumatol, 23 (2016), pp. 85-91
J.A. Cardona-Ospina, A.J. Rodríguez-Morales, W. Villamil-Gómez.
Burden of chikungunya in one coastal department of Colombia (Sucre): estimates of disability adjusted life years (DALY) lost in 2014 epidemic.
J Infect Public Health, 8 (2015), pp. 644-646
J.A. Cardona-Ospina, F.A. Diaz-Quijano, A.J. Rodríguez-Morales.
Burden of chikungunya in Latin American countries: estimates of disability adjusted life years (DALY) lost in 2014 epidemic.
Int J Infect Dis, 38 (2015), pp. 60-61
J.A. Cardona-Ospina, W.E. Villamil-Gómez, C.E. Jimenez-Canizales, D.M. Castañeda-Hernández, A.J. Rodríguez-Morales.
Estimating the burden of disease and the economic cost attributable to chikungunya, Colombia, 2014.
Trans R Soc Trop Med Hyg, 109 (2015), pp. 793-802
A.J. Rodríguez-Morales, W.E. Villamil-Gómez, C. Franco-Paredes.
The arboviral burden of disease caused by co-circulation and co-infection of dengue, chikungunya and Zika in the Americas.
Travel Med Infect Dis, 14 (2016), pp. 177-179

Please cite this article as: Rodríguez-Morales AJ, Anaya J-M. Impacto de las arbovirosis artritogénicas emergentes en Colombia y América Latina. Rev Colomb Reumatol. 2016;23:145–147.

Copyright © 2016. Asociación Colombiana de Reumatología
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