1. Fatal Outcome of Chikungunya Virus Infection in Brazil.
- Author
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de Lima STS, de Souza WM, Cavalcante JW, da Silva Candido D, Fumagalli MJ, Carrera JP, Simões Mello LM, De Carvalho Araújo FM, Cavalcante Ramalho IL, de Almeida Barreto FK, de Melo Braga DN, Simião AR, Miranda da Silva MJ, Alves Barbosa Oliveira RM, Lima CPS, de Sousa Lins C, Barata RR, Pereira Melo MN, Caldas de Souza MP, Franco LM, Fernandes Távora FR, Queiroz Lemos DR, de Alencar CHM, de Jesus R, de Souza Fonseca V, Dutra LH, de Abreu AL, Lima Araújo EL, Ribas Freitas AR, Vianez Júnior JLDSG, Pybus OG, Figueiredo LTM, Faria NR, Nunes MRT, Cavalcanti LPG, and Miyajima F
- Subjects
- Brazil epidemiology, Cross-Sectional Studies, Humans, Phylogeny, Retrospective Studies, Young Adult, Chikungunya Fever epidemiology, Dengue, Dengue Virus, Zika Virus genetics, Zika Virus Infection epidemiology
- 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., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)
- Published
- 2021
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