Fatal Outcome of Chikungunya Virus Infection in Brazil

• Autor(a) principal: Lima, Shirlene Telmos Silva de
• Data de Publicação: 2020
• Outros Autores: Souza, William Marciel de, Cavalcante, John Washington, Candido, Darlan da Silva, Fumagalli, Marcilio Jorge, Carrera, Jean-Paul, Mello, Leda Maria Simões, Araújo, Fernanda Montenegro de Carvalho, Ramalho, Izabel Letícia Cavalcante, Barreto, Francisca Kalline de Almeida, Braga, Deborah Nunes de Melo, Simião, Adriana Rocha, Silva, Mayara Jane Miranda da, Oliveira, Rhaquel de Morais Alves Barbosa, Lima, Clayton Pereira Silva, Lins, Camila de Sousa, Barata, Rafael Ribeiro, Melo, Marcelo Nunes Pereira, Souza, Michel Platini Caldas de, Franco, Luciano Monteiro, Távora, Fábio Rocha Fernandes, Lemos, Daniele Rocha Queiroz, Alencar, Carlos Henrique Morais de, Jesus, Ronaldo de, Fonseca, Vagner de Souza, Dutra, Leonardo Hermes, Abreu, André Luiz de, Araújo, Emerson Luiz Lima, Freitas, André Ricardo Ribas, Vianez Júnior, João Lídio da Silva Gonçalves, Pybus, Oliver G., Figueiredo, Luiz Tadeu Moraes, Faria, Nuno Rodrigues, Nunes, Márcio Roberto Teixeira, Cavalcanti, Luciano Pamplona de Góes, Miyajima, Fabio
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.oxfordjournals.org/our_journals/cid/; http://www.repositorio.ufc.br/handle/riufc/54680
• topic: Vírus Chikungunya; Chikungunya virus; Alphavirus; Arbovirus

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.