Fatal Outcome of Chikungunya Virus Infection in Brazil.
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de Lima Shirlene Telmos Silva, de Souza William Marciel, Cavalcante John Washington, da Silva Candido Darlan, Fumagalli Marcilio Jorge, Carrera Jean-Paul, Simões Mello Leda Maria, De Carvalho Araújo Fernanda Montenegro, Cavalcante Ramalho Izabel Letícia, de Almeida Barreto Francisca Kalline, de Melo Braga Deborah Nunes, Simião Adriana Rocha, Miranda da Silva Mayara Jane, Alves Barbosa Oliveira Rhaquel de Morais, Lima Clayton Pereira Silva, de Sousa Lins Camila, Barata Rafael Ribeiro, Pereira Melo Marcelo Nunes, Caldas de Souza Michel Platini, Franco Luciano Monteiro, Fernandes Távora Fábio Rocha, Queiroz Lemos Daniele Rocha, de Alencar Carlos Henrique Morais, de Jesus Ronaldo, de Souza Fonseca Vagner, Dutra Leonardo Hermes, de Abreu André Luiz, Lima Araújo Emerson Luiz, Ribas Freitas André Ricardo, 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
Аннотация
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.