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Fatal outcome of chikungunya virus infection in Brazil.

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Title: Fatal outcome of chikungunya virus infection in Brazil.
Authors: Lima, STSD
Souza, WMD
Cavalcante, JW
Da Silva Candido, D
Fumagalli, MJ
Carrera, J-P
Simões Mello, LM
De Carvalho Araújo, FM
Cavalcante Ramalho, IL
De Almeida Barreto, FK
De Melo Braga, DN
Simião, AR
Miranda da Silva, MJ
Oliveira, RDMAB
Lima, CPS
Sousa Lins, CD
Barata, RR
Melo, MNP
De Souza, MPC
Franco, LM
Távora, FRF
Queiroz Lemos, DR
Alencar, CHMD
Jesus, RD
Souza Fonseca, VD
Dutra, LH
Abreu, ALD
Araújo, ELL
Ribas Freitas, AR
Gonçalves Vianez Júnior, JLDS
Pybus, OG
Moraes Figueiredo, LT
Faria, NR
Teixeira Nunes, MR
Góes Cavalcanti, LPD
Miyajima, F
Item Type: Journal Article
Abstract: BACKGROUND: Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused ~2.1 million cases and over 600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological and virus 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 (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: 68 fatal cases had CHIKV infection confirmed by RT-qPCR (52.9%), viral antigen (41.1%), and/or specific-IgM (63.2%). Co-detection of CHIKV with DENV were 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 sub-acute phase. Genetic analysis showed circulation of two CHIKV-East Central South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome. CONCLUSION: 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 non-risk groups, including young adults.
Issue Date: 1-Oct-2021
Date of Acceptance: 20-Jul-2020
URI: http://hdl.handle.net/10044/1/84142
DOI: 10.1093/cid/ciaa1038
ISSN: 1058-4838
Publisher: Oxford University Press (OUP)
Start Page: e2436
End Page: e2443
Journal / Book Title: Clinical Infectious Diseases
Volume: 73
Issue: 7
Copyright Statement: © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Wellcome Trust
Medical Research Council-São Paulo Research Foundation (FAPESP)
Medical Research Council (MRC)
Funder's Grant Number: 204311/Z/16/Z
Keywords: Alphavirus; arthritogenic
chikungunya virus
fatal cases
Chikungunya virus
alphavirus artritogenic
fatal cases
06 Biological Sciences
11 Medical and Health Sciences
Publication Status: Published
Conference Place: United States
Online Publication Date: 2020-08-07
Appears in Collections:Faculty of Medicine
School of Public Health

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