Dataset Information

Fatal Outcome of Chikungunya Virus Infection in Brazil.

ABSTRACT:

Background

Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused approximately 2.1 million cases and >600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological, and viral genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil.

Methods

Sera, cerebrospinal fluid (CSF), and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue virus (DENV), and Zika virus (ZIKV). Clinical, epidemiological, and death reports were obtained for patients with confirmed CHIKV infection. Logistic regression analysis was undertaken to identify independent factors associated with risk of death during CHIKV infection. Phylogenetic analysis was conducted using whole genomes from a subset of cases.

Results

Sixty-eight fatal cases had CHIKV infection confirmed by reverse-transcription quantitative polymerase chain reaction (52.9%), viral antigen (41.1%), and/or specific immunoglobulin M (63.2%). Co-detection of CHIKV with DENV was found in 22% of fatal cases, ZIKV in 2.9%, and DENV and ZIKV in 1.5%. A total of 39 CHIKV deaths presented with neurological signs and symptoms, and CHIKV-RNA was found in the CSF of 92.3% of these patients. Fatal outcomes were associated with irreversible multiple organ dysfunction syndrome. Patients with diabetes appear to die at a higher frequency during the subacute phase. Genetic analysis showed circulation of 2 CHIKV East-Central-South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome.

Conclusions

The investigation of the largest cross-sectional cohort of CHIKV deaths to date reveals that CHIKV-ECSA strains can cause death in individuals from both risk and nonrisk groups, including young adults.

SUBMITTER: de Lima STS

PROVIDER: S-EPMC8492446 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Fatal Outcome of Chikungunya Virus Infection in Brazil.

de Lima Shirlene Telmos Silva STS de Souza William Marciel WM Cavalcante John Washington JW da Silva Candido Darlan D Fumagalli Marcilio Jorge MJ Carrera Jean-Paul JP Simões Mello Leda Maria LM De Carvalho Araújo Fernanda Montenegro FM Cavalcante Ramalho Izabel Letícia IL de Almeida Barreto Francisca Kalline FK de Melo Braga Deborah Nunes DN Simião Adriana Rocha AR Miranda da Silva Mayara Jane MJ Alves Barbosa Oliveira Rhaquel de Morais RM Lima Clayton Pereira Silva CPS de Sousa Lins Camila C Barata Rafael Ribeiro RR Pereira Melo Marcelo Nunes MN Caldas de Souza Michel Platini MP Franco Luciano Monteiro LM Fernandes Távora Fábio Rocha FR Queiroz Lemos Daniele Rocha DR de Alencar Carlos Henrique Morais CHM de Jesus Ronaldo R de Souza Fonseca Vagner V Dutra Leonardo Hermes LH de Abreu André Luiz AL Lima Araújo Emerson Luiz EL Ribas Freitas André Ricardo AR Vianez Júnior João Lídio da Silva Gonçalves JLDSG Pybus Oliver G OG Figueiredo Luiz Tadeu Moraes LTM Faria Nuno Rodrigues NR Nunes Márcio Roberto Teixeira MRT Cavalcanti Luciano Pamplona de Góes LPG Miyajima Fabio F

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20211001 7

<h4>Background</h4>Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused approximately 2.1 million cases and >600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological, and viral genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil.<h4>Methods</h4>Sera, cerebrospinal fluid (CSF), and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue virus (DENV), and Zika ...[more]

PMID: 32766829

Similar Datasets

Project description:BackgroundSince 2015, the arthropod-borne viruses (arboviruses) Zika and chikungunya have spread across the Americas causing outbreaks, accompanied by increases in immune-mediated and infectious neurological disease. The spectrum of neurological manifestations linked to these viruses, and the importance of dual infection, are not known fully. We aimed to investigate whether neurological presentations differed according to the infecting arbovirus, and whether patients with dual infection had a different disease spectrum or severity.MethodsWe report a prospective observational study done during epidemics of Zika and chikungunya viruses in Recife, Pernambuco, a dengue-endemic area of Brazil. We recruited adults aged 18 years or older referred to Hospital da Restauração, a secondary-level and tertiary-level hospital, with suspected acute neurological disease and a history of suspected arboviral infection. We looked for evidence of Zika, chikungunya, or dengue infection by viral RNA or specific IgM antibodies in serum or CSF. We grouped patients according to their arbovirus laboratory diagnosis and then compared demographic and clinical characteristics.FindingsBetween Dec 4, 2014, and Dec 4, 2016, 1410 patients were admitted to the hospital neurology service; 201 (14%) had symptoms consistent with arbovirus infection and sufficient samples for diagnostic testing and were included in the study. The median age was 48 years (IQR 34-60), and 106 (53%) were women. 148 (74%) of 201 patients had laboratory evidence of arboviral infection. 98 (49%) of them had a single viral infection (41 [20%] had Zika, 55 [27%] had chikungunya, and two [1%] had dengue infection), whereas 50 (25%) had evidence of dual infection, mostly with Zika and chikungunya viruses (46 [23%] patients). Patients positive for arbovirus infection presented with a broad range of CNS and peripheral nervous system (PNS) disease. Chikungunya infection was more often associated with CNS disease (26 [47%] of 55 patients with chikungunya infection vs six [15%] of 41 with Zika infection; p=0·0008), especially myelitis (12 [22%] patients). Zika infection was more often associated with PNS disease (26 [63%] of 41 patients with Zika infection vs nine [16%] of 55 with chikungunya infection; p≤0·0001), particularly Guillain-Barré syndrome (25 [61%] patients). Patients with Guillain-Barré syndrome who had Zika and chikungunya dual infection had more aggressive disease, requiring intensive care support and longer hospital stays, than those with mono-infection (median 24 days [IQR 20-30] vs 17 days [10-20]; p=0·0028). Eight (17%) of 46 patients with Zika and chikungunya dual infection had a stroke or transient ischaemic attack, compared with five (6%) of 96 patients with Zika or chikungunya mono-infection (p=0·047).InterpretationThere is a wide and overlapping spectrum of neurological manifestations caused by Zika or chikungunya mono-infection and by dual infections. The possible increased risk of acute cerebrovascular disease in patients with dual infection merits further investigation.FundingFundação do Amparo a Ciência e Tecnologia de Pernambuco (FACEPE), EU's Horizon 2020 research and innovation programme, National Institute for Health Research.TranslationsFor the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Dataset Information

Fatal Outcome of Chikungunya Virus Infection in Brazil.

Background

Methods

Results

Conclusions

Publications

Fatal Outcome of Chikungunya Virus Infection in Brazil.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets