Fatal Outcome of Chikungunya Virus Infection in Brazil

Shirlene Telmos Silva de Lima; William Marciel de Souza; John Washington Cavalcante; Darlan da Silva Candido; Marcilio Jorge Fumagalli; Jean Paul Carrera; Leda Maria Simões Mello; Fernanda Montenegro de Carvalho Araújo; Izabel Letícia Cavalcante Ramalho; Francisca Kalline de Almeida Barreto; Deborah Nunes de Melo Braga; Adriana Rocha Simião; Mayara Jane Miranda da Silva; Rhaquel de Morais Alves Barbosa Oliveira; Clayton Pereira Silva Lima; Camila de Sousa Lins; Rafael Ribeiro Barata; Marcelo Nunes Pereira Melo; Michel Platini Caldas de Souza; Luciano Monteiro Franco; Fábio Rocha Fernandes Távora; Daniele Rocha Queiroz Lemos; Carlos Henrique Morais de Alencar; Ronaldo de Jesus; Vagner de Souza Fonseca; Leonardo Hermes Dutra; André Luiz de Abreu; Emerson Luiz Lima Araújo; André Ricardo Ribas Freitas; João Lídio da Silva Gonçalves Vianez; Oliver G. Pybus; Luiz Tadeu Moraes Figueiredo; Nuno Rodrigues Faria; Márcio Roberto Teixeira Nunes; Luciano Pamplona de Góes Cavalcanti; Fabio Miyajima

doi:10.1093/cid/ciaa1038

Fatal Outcome of Chikungunya Virus Infection in Brazil

Shirlene Telmos Silva de Lima, William Marciel de Souza, John Washington Cavalcante, Darlan da Silva Candido, Marcilio Jorge Fumagalli, Jean Paul Carrera, Leda Maria Simões Mello, Fernanda Montenegro de Carvalho Araújo, Izabel Letícia Cavalcante Ramalho, Francisca Kalline de Almeida Barreto, Deborah Nunes de Melo Braga, Adriana Rocha Simião, Mayara Jane Miranda da Silva, Rhaquel de Morais Alves Barbosa Oliveira, Clayton Pereira Silva Lima, Camila de Sousa Lins, Rafael Ribeiro Barata, Marcelo Nunes Pereira Melo, Michel Platini Caldas de Souza, Luciano Monteiro FrancoFábio Rocha Fernandes Távora, Daniele Rocha Queiroz Lemos, Carlos Henrique Morais de Alencar, Ronaldo de Jesus, Vagner de Souza Fonseca, Leonardo Hermes Dutra, André Luiz de Abreu, Emerson Luiz Lima Araújo, André Ricardo Ribas Freitas, João Lídio da Silva Gonçalves Vianez, Oliver G. Pybus, Luiz Tadeu Moraes Figueiredo, Nuno Rodrigues Faria, Márcio Roberto Teixeira Nunes, Luciano Pamplona de Góes Cavalcanti, Fabio Miyajima

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	E2436-E2443
Journal	Clinical Infectious Diseases
Volume	73
Issue number	7
DOIs	https://doi.org/10.1093/cid/ciaa1038
State	Published - Oct 1 2021
Externally published	Yes

Keywords

Alphavirus
arbovirus
arthritogenic
chikungunya virus
fatal cases

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

Access to Document

10.1093/cid/ciaa1038

Cite this

de Lima, S. T. S., de Souza, W. M., Cavalcante, J. W., da Silva Candido, D., Fumagalli, M. J., Carrera, J. P., Mello, L. M. S., de Carvalho Araújo, F. M., Ramalho, I. L. C., de Almeida Barreto, F. K., de Melo Braga, D. N., Simião, A. R., da Silva, M. J. M., de Morais Alves Barbosa Oliveira, R., Lima, C. P. S., de Sousa Lins, C., Barata, R. R., Melo, M. N. P., de Souza, M. P. C., ... Miyajima, F. (2021). Fatal Outcome of Chikungunya Virus Infection in Brazil. Clinical Infectious Diseases, 73(7), E2436-E2443. https://doi.org/10.1093/cid/ciaa1038

de Lima, STS, de Souza, WM, Cavalcante, JW, da Silva Candido, D, Fumagalli, MJ, Carrera, JP, Mello, LMS, de Carvalho Araújo, FM, Ramalho, ILC, de Almeida Barreto, FK, de Melo Braga, DN, Simião, AR, da Silva, MJM, de Morais Alves Barbosa Oliveira, R, Lima, CPS, de Sousa Lins, C, Barata, RR, Melo, MNP, de Souza, MPC, Franco, LM, Távora, FRF, Lemos, DRQ, de Alencar, CHM, de Jesus, R, de Souza Fonseca, V, Dutra, LH, de Abreu, AL, Araújo, ELL, Freitas, ARR, da Silva Gonçalves Vianez, JL, Pybus, OG, Figueiredo, LTM, Faria, NR, Nunes, MRT, de Góes Cavalcanti, LP & Miyajima, F 2021, 'Fatal Outcome of Chikungunya Virus Infection in Brazil', Clinical Infectious Diseases, vol. 73, no. 7, pp. E2436-E2443. https://doi.org/10.1093/cid/ciaa1038

@article{0e2d66064661410ca6be190a250431e1,

title = "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 Cear{\'a} 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 Cear{\'a} 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.",

keywords = "Alphavirus, arbovirus, arthritogenic, chikungunya virus, fatal cases",

author = "{de Lima}, {Shirlene Telmos Silva} and {de Souza}, {William Marciel} and Cavalcante, {John Washington} and {da Silva Candido}, Darlan and Fumagalli, {Marcilio Jorge} and Carrera, {Jean Paul} and Mello, {Leda Maria Sim{\~o}es} and {de Carvalho Ara{\'u}jo}, {Fernanda Montenegro} and Ramalho, {Izabel Let{\'i}cia Cavalcante} and {de Almeida Barreto}, {Francisca Kalline} and {de Melo Braga}, {Deborah Nunes} and Simi{\~a}o, {Adriana Rocha} and {da Silva}, {Mayara Jane Miranda} and {de Morais Alves Barbosa Oliveira}, Rhaquel and Lima, {Clayton Pereira Silva} and {de Sousa Lins}, Camila and Barata, {Rafael Ribeiro} and Melo, {Marcelo Nunes Pereira} and {de Souza}, {Michel Platini Caldas} and Franco, {Luciano Monteiro} and T{\'a}vora, {F{\'a}bio Rocha Fernandes} and Lemos, {Daniele Rocha Queiroz} and {de Alencar}, {Carlos Henrique Morais} and {de Jesus}, Ronaldo and {de Souza Fonseca}, Vagner and Dutra, {Leonardo Hermes} and {de Abreu}, {Andr{\'e} Luiz} and Ara{\'u}jo, {Emerson Luiz Lima} and Freitas, {Andr{\'e} Ricardo Ribas} and {da Silva Gon{\c c}alves Vianez}, {Jo{\~a}o L{\'i}dio} and Pybus, {Oliver G.} and Figueiredo, {Luiz Tadeu Moraes} and Faria, {Nuno Rodrigues} and Nunes, {M{\'a}rcio Roberto Teixeira} and {de G{\'o}es Cavalcanti}, {Luciano Pamplona} and Fabio Miyajima",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2021",

month = oct,

day = "1",

doi = "10.1093/cid/ciaa1038",

language = "English (US)",

volume = "73",

pages = "E2436--E2443",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "7",

}

TY - JOUR

T1 - Fatal Outcome of Chikungunya Virus Infection in Brazil

AU - de Lima, Shirlene Telmos Silva

AU - de Souza, William Marciel

AU - Cavalcante, John Washington

AU - da Silva Candido, Darlan

AU - Fumagalli, Marcilio Jorge

AU - Carrera, Jean Paul

AU - Mello, Leda Maria Simões

AU - de Carvalho Araújo, Fernanda Montenegro

AU - Ramalho, Izabel Letícia Cavalcante

AU - de Almeida Barreto, Francisca Kalline

AU - de Melo Braga, Deborah Nunes

AU - Simião, Adriana Rocha

AU - da Silva, Mayara Jane Miranda

AU - de Morais Alves Barbosa Oliveira, Rhaquel

AU - Lima, Clayton Pereira Silva

AU - de Sousa Lins, Camila

AU - Barata, Rafael Ribeiro

AU - Melo, Marcelo Nunes Pereira

AU - de Souza, Michel Platini Caldas

AU - Franco, Luciano Monteiro

AU - Távora, Fábio Rocha Fernandes

AU - Lemos, Daniele Rocha Queiroz

AU - de Alencar, Carlos Henrique Morais

AU - de Jesus, Ronaldo

AU - de Souza Fonseca, Vagner

AU - Dutra, Leonardo Hermes

AU - de Abreu, André Luiz

AU - Araújo, Emerson Luiz Lima

AU - Freitas, André Ricardo Ribas

AU - da Silva Gonçalves Vianez, João Lídio

AU - Pybus, Oliver G.

AU - Figueiredo, Luiz Tadeu Moraes

AU - Faria, Nuno Rodrigues

AU - Nunes, Márcio Roberto Teixeira

AU - de Góes Cavalcanti, Luciano Pamplona

AU - Miyajima, Fabio

PY - 2021/10/1

Y1 - 2021/10/1

N2 - 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.

AB - 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.

KW - Alphavirus

KW - arbovirus

KW - arthritogenic

KW - chikungunya virus

KW - fatal cases

UR - http://www.scopus.com/inward/record.url?scp=85118286842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85118286842&partnerID=8YFLogxK

U2 - 10.1093/cid/ciaa1038

DO - 10.1093/cid/ciaa1038

M3 - Article

C2 - 32766829

AN - SCOPUS:85118286842

SN - 1058-4838

VL - 73

SP - E2436-E2443

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 7

ER -

Fatal Outcome of Chikungunya Virus Infection in Brazil

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this