Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 5;73(7):e2436-e2443.
doi: 10.1093/cid/ciaa1038.

Fatal Outcome of Chikungunya Virus Infection in Brazil

Affiliations

Fatal Outcome of Chikungunya Virus Infection in Brazil

Shirlene Telmos Silva de Lima et al. Clin Infect Dis. .

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.

Keywords: Alphavirus; arthritogenic; arbovirus; chikungunya virus; fatal cases.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
A, Weekly epidemiologic curve of chikungunya cases notified in Ceará state and other Brazilian states, and incidence of chikungunya cases notified by municipalities in Ceará state in 2017. B, Weekly epidemiologic curve and geographical distribution of chikungunya deaths described in this study. C, Diagnosis of 68 Chikungunya deaths described in this study. Abbreviations: CHIKV, chikungunya virus; CSF, cerebrospinal fluid; DENV, dengue virus; IgM, immunoglobulin M; IHC, immunohistochemistry; qPCR, quantitative polymerase chain reaction; ZIKV, Zika virus.
Figure 2.
Figure 2.
Demographics, symptoms, and comorbidities of 68 chikungunya deaths from Ceará state, Brazil. A, Age range and sex. B, Clinical characteristics. C, Days from the onset of symptoms of individuals till death. D, Comorbidities associated with chikungunya deaths. Abbreviations: CHIKV, chikungunya virus; COPD, chronic obstructive pulmonary disease; NA, not available.
Figure 3.
Figure 3.
A–F, Autopsy findings of 42 chikungunya deaths from Ceará state, Brazil.
Figure 4.
Figure 4.
Maximum clade credibility tree of the East-Central-South African genotype of Chikungunya virus in Brazil (n = 71), including 6 new sequences from Ceará State. Tips are colored according to the source region of each sample. Clusters from the Southeast, Center-West, and North regions have been collapsed for better visualization. The 2 clusters of sequences from this study were identified as clade 1 and clade 2 based on the earliest estimated time to most recent common ancestor. A molecular clock approach was used for generating the time-rooted tree (see Methods).

References

    1. Chen R, Mukhopadhyay S, Merits A, et al. ICTV virus taxonomy profile: Togaviridae. J Gen Virol 2018; 99:761–2. - PubMed
    1. Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med 2015; 372:1231–9. - PubMed
    1. Queyriaux B, Simon F, Grandadam M, Michel R, Tolou H, Boutin JP. Clinical burden of chikungunya virus infection. Lancet Infect Dis 2008; 8:2–3. - PubMed
    1. Nunes MR, Faria NR, de Vasconcelos JM, et al. Emergence and potential for spread of chikungunya virus in Brazil. BMC Med 2015; 13:102. - PMC - PubMed
    1. Ministério da Saúde, Departamento de Vigilância das Doenças Transmissíveis , Brasil. Chikungunya: manejo clínico. Brasília: Ministério da Saúde, 2017:65p.

Publication types