Date: Mon 27 Jan 2014
From: Denis Malvy <email@example.com> [edited]
A 28-year-old female residing in Chateauboeuf quarter, Fort de France, Martinique, from August 2012 to 28 Dec 2013 experienced an abrupt algo-eruptive fever on 2 Nov 2013 (week 44). Additional symptoms occurred on 4 Nov  with incapacitating joint pain in knees, ankles, toes, wrists, fingers, and the left shoulder.
Fever and extensive cutaneous rash lasted for 4 days, but joint manifestations persisted over time. 10 weeks later, on 10 Jan 2014, she was admitted to our clinics because of persistent long standing severe limiting arthralgia located on similar joints. Laboratory investigation of the condition ruled out dengue virus infection whereas ELISA testing was positive for chikungunya fever specific IgM and IgG.
The serological features were consistent with a recent chikungunya [virus] infection and with the recent clinical history experienced by the patient. Of note, she denied any previous travel in Africa or Asia, nor in any other places in the Caribbean region, especially during the 2 weeks preceding the initial acute phase of sickness. Indeed the patient stayed in Martinique, mainly in Fort de France (mostly Chateauboeuf and Redoute, and sparsely Dillon, Centre-Ville and Sainte-Therese quarters), with sparse, short outings in the Lamentin and Trinite locations.
The spread of chikungunya in the Caribbean had been noticed in mid-October 2013 on St Martin island with the 1st 2 confirmed cases and accounts for the 1st known outbreak of chikungunya virus in the western hemisphere. Subsequently, 3 locally-acquired cases from Martinique have been noticed during week 50 2013 (mid-December). Thus, the case above, laboratory-confirmed from late serum sample analysis, is ascertained to be the 1st documented indigenous case of chikungunya occurring in Martinique.
The case has been reported to the regional health agency and local and national health authorities have been informed.
Dr Denis Malvy, Dr Marie-Catherine Receveur, Dr Matthieu Mechain
Travel clinics and Division of Tropical Medicine - Clinical
Department of Infectious and Tropical Medicine
University Hospital Center
Dr Isabelle Leparc-Goffart, Dr Christine Prat, Dr Olivier Flusin
Arbovirus National Reference Center
IRBA (Biomedical Research Institute of the French Armed Forces)
[ProMED-mail thanks Dr Denis Malvy and colleagues for this 1st hand report of the index case on Martinique.