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@article{Lima:2021:cid/ciaa1038,
author = {Lima, STSD and Souza, WMD and Cavalcante, JW and da, Silva Candido D and Fumagalli, MJ and Carrera, J-P and Simões, Mello LM and de, Carvalho Araújo FM and Cavalcante, Ramalho IL and de, Almeida Barreto FK and de, Melo Braga DN and Simião, AR and Miranda, da Silva MJ and Oliveira, RDMAB and Lima, CPS and Sousa, Lins CD and Barata, RR and Melo, MNP and de, Souza MPC and Franco, LM and Távora, FRF and Queiroz, Lemos DR and Alencar, CHMD and Jesus, RD and Souza, Fonseca VD and Dutra, LH and Abreu, ALD and Araújo, ELL and Ribas, Freitas AR and Gonçalves, Vianez Júnior JLDS and Pybus, OG and Moraes, Figueiredo LT and Faria, NR and Teixeira, Nunes MR and Góes, Cavalcanti LPD and Miyajima, F},
doi = {cid/ciaa1038},
journal = {Clinical Infectious Diseases},
pages = {e2436--e2443},
title = {Fatal outcome of chikungunya virus infection in Brazil.},
url = {http://dx.doi.org/10.1093/cid/ciaa1038},
volume = {73},
year = {2021}
}

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TY  - JOUR
AB  - 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.
AU  - Lima,STSD
AU  - Souza,WMD
AU  - Cavalcante,JW
AU  - da,Silva Candido D
AU  - Fumagalli,MJ
AU  - Carrera,J-P
AU  - Simões,Mello LM
AU  - de,Carvalho Araújo FM
AU  - Cavalcante,Ramalho IL
AU  - de,Almeida Barreto FK
AU  - de,Melo Braga DN
AU  - Simião,AR
AU  - Miranda,da Silva MJ
AU  - Oliveira,RDMAB
AU  - Lima,CPS
AU  - Sousa,Lins CD
AU  - Barata,RR
AU  - Melo,MNP
AU  - de,Souza MPC
AU  - Franco,LM
AU  - Távora,FRF
AU  - Queiroz,Lemos DR
AU  - Alencar,CHMD
AU  - Jesus,RD
AU  - Souza,Fonseca VD
AU  - Dutra,LH
AU  - Abreu,ALD
AU  - Araújo,ELL
AU  - Ribas,Freitas AR
AU  - Gonçalves,Vianez Júnior JLDS
AU  - Pybus,OG
AU  - Moraes,Figueiredo LT
AU  - Faria,NR
AU  - Teixeira,Nunes MR
AU  - Góes,Cavalcanti LPD
AU  - Miyajima,F
DO  - cid/ciaa1038
EP  - 2443
PY  - 2021///
SN  - 1058-4838
SP  - 2436
TI  - Fatal outcome of chikungunya virus infection in Brazil.
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/ciaa1038
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32766829
UR  - https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1038/5885158
UR  - http://hdl.handle.net/10044/1/84142
VL  - 73
ER  -

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