| Author | Lima, Shirlene Telmos Silva de | |
| Author | Souza, William Marciel de | |
| Author | Cavalcante, John Washington | |
| Author | Candido, Darlan da Silva | |
| Author | Fumagalli, Marcilio Jorge | |
| Author | Carrera, Jean-Paul | |
| Author | Mello, Leda Maria Simões | |
| Author | Araújo, Fernanda Montenegro de Carvalho | |
| Author | Ramalho, Izabel Letícia Cavalcante | |
| Author | Barreto, Francisca Kalline de Almeida | |
| Author | Braga, Deborah Nunes de Melo | |
| Author | Simião, Adriana Rocha | |
| Author | Silva, Mayara Jane Miranda da | |
| Author | Oliveira, Rhaquel de Morais Alves Barbosa | |
| Author | Lima, Clayton Pereira Silva | |
| Author | Lins, Camila de Sousa | |
| Author | Barata, Rafael Ribeiro | |
| Author | Melo, Marcelo Nunes Pereira | |
| Author | Souza, Michel Platini Caldas de | |
| Author | Franco, Luciano Monteiro | |
| Author | Távora, Fábio Rocha Fernandes | |
| Author | Lemos, Daniele Rocha Queiroz | |
| Author | Alencar, Carlos Henrique Morais de | |
| Author | Jesus, Ronaldo de | |
| Author | Fonseca, Vagner de Souza | |
| Author | Dutra, Leonardo Hermes | |
| Author | Abreu, André Luiz de | |
| Author | Araújo, Emerson Luiz Lima | |
| Author | Freitas, André Ricardo Ribas | |
| Author | Vianez Júnior, João Lídio da Silva Gonçalves | |
| Author | Pybus, Oliver G. | |
| Author | Figueiredo, Luiz Tadeu Moraes | |
| Author | Faria, Nuno Rodrigues | |
| Author | Nunes, Márcio Roberto Teixeira | |
| Author | Cavalcanti, Luciano Pamplona de Góes | |
| Author | Miyajima, Fabio | |
| Access date | 2024-09-09T12:27:51Z | |
| Available date | 2024-09-09T12:27:51Z | |
| Document date | 2021 | |
| Citation | LIMA, Shirlene Telmos Silva de et al. Fatal Outcome of Chikungunya Virus Infection in Brazil. Clinical Infectious Diseases, v. 73, n. 7, p. 2436-2443, Oct. 2021. | en_US |
| ISSN | 1058-4838 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/65798 | |
| Sponsorship | This work was supported by the São Paulo Research Foundation, Brazil (grant numbers 2017/13981-0, 2018/09383-3, 2018/14389-0, 2018/00837-1, and 2019/24251–9); the Brazilian National Council for Scientific and Technological Development (grant number 302584/2015-3, 408338/2018-0); the Clarendon Scholarship; Department of Zoology, University of Oxford; Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico (FUNCAP 01/2017-SUS/PPSUS-CE FUNCAPSESADecit/SCTIE); Wellcome Trust and Royal Society Sir Henry Dale Fellowship (grant number 204311/Z/16/Z); and the Network of Clinical and Applied Research into Chikungunya through funds from the Department of Science and Technology, Brazilian Ministry of Health. | en_US |
| Language | eng | en_US |
| Publisher | Oxford | en_US |
| Rights | open access | en_US |
| Title | Fatal Outcome of Chikungunya Virus Infection in Brazil | en_US |
| Type | Article | en_US |
| DOI | 10.1093/cid/ciaa1038 | |
| 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. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil / Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil. | en_US |
| Affilliation | University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | University of Oxford. Department of Zoology. Oxford, United Kingdom. | en_US |
| Affilliation | University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil. | en_US |
| Affilliation | University of Oxford. Department of Zoology. Oxford, United Kingdom / Gorgas Memorial Institute of Health Studies. Department of Research in Virology and Biotechnology. Panama City, Panama. | en_US |
| Affilliation | Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil / Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brasil. | en_US |
| Affilliation | Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | State Health Secretariat of Ceará. Death Verification Service Dr Rocha Furtado. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil. | en_US |
| Affilliation | Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil / Ministry of Health. Brasilia, DF, Brazil. | en_US |
| Affilliation | Ministry of Health. Brasilia, DF, Brazil. | en_US |
| Affilliation | Ministry of Health. Brasilia, DF, Brazil. | en_US |
| Affilliation | Ministry of Health. Brasilia, DF, Brazil. | en_US |
| Affilliation | Faculdade de Medicina São Leopoldo Mandic. Campinas, SP, Brasil. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | University of Oxford. Department of Zoology. Oxford, United Kingdom. | en_US |
| Affilliation | University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil. | en_US |
| Affilliation | University of Oxford. Department of Zoology. Oxford, United Kingdom / Imperial College London. Department of Infectious Disease Epidemiology. London, United Kingdom. | en_US |
| Affilliation | Ministry of Health. Evandro Chagas Institute. Ananindeua, PA, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil. | en_US |
| Affilliation | Federal University of Ceará. Fortaleza, CE, Brazil / Fundação Oswaldo Cruz. Fiocruz Ceará. Eusébio, CE, Brasil. | en_US |
| Subject | Chikungunya virus | en_US |
| Subject | Alphavirus | en_US |
| Subject | Arthritogenic | en_US |
| Subject | Arbovirus | en_US |
| Subject | Fatal cases | en_US |
| e-ISSN | 1537-6591 | |
