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Fatal Outcome of Chikungunya Virus Infection in Brazil
Shirlene Telmos Silva de Lima1,2, William Marciel de Souza3, John Washington Cavalcante1
1Federal University of Ceará, Fortaleza, Brazil.
Insights
Chikungunya virus (CHIKV) deaths in Brazil were linked to neurological symptoms and organ failure. The East-Central-South African (ECSA) CHIKV lineage caused fatalities across all age groups, with no specific mutations identified in fatal cases.
Area of Science:
- Medical virology
- Epidemiology
- Genomics
Background:
- Chikungunya virus (CHIKV) emerged in the Americas in 2013, leading to millions of cases and hundreds of deaths.
- A retrospective study was conducted in Ceará state, northeast Brazil, to investigate CHIKV-related fatalities.
Purpose of the Study:
- To describe the clinical, epidemiological, and viral genomic characteristics of deaths caused by CHIKV.
- To identify independent factors associated with the risk of death during CHIKV infection.
Main Methods:
- Testing of sera, cerebrospinal fluid (CSF), and tissue samples from 100 fatal cases for CHIKV, dengue virus (DENV), and Zika virus (ZIKV).
- Analysis of clinical, epidemiological, and death reports for confirmed CHIKV cases.
- Logistic regression and phylogenetic analysis of CHIKV whole genomes.
Main Results:
- CHIKV infection was confirmed in 68 fatal cases; co-detections with DENV and ZIKV were observed.
- Neurological symptoms were present in 39 CHIKV deaths, with CHIKV-RNA detected in CSF in 92.3% of these cases.
- Fatal outcomes were linked to multiple organ dysfunction syndrome; diabetes was associated with higher mortality in the subacute phase. Two CHIKV ECSA lineages circulated, with no unique mutations linked to fatal outcomes.
Conclusions:
- CHIKV-ECSA strains can cause death in individuals across all risk groups, including young adults.
- This study represents the largest cohort of CHIKV deaths analyzed to date.
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.
