Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome.

Elizabeth M Traverse,Kelli L Barr,Hannah K Hopkins,Vedana Vaidhyanathan

doi:10.3390/tropicalmed6030108

Abstract

Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In adults, case reports include symptoms ranging from tachycardia and arrythmia, to myocarditis and cardiac arrest. In children, case reports describe symptoms such as arrythmia, myocarditis, and heart failure. Case reports of perinatal and neonatal CHIKV infections have also described cardiovascular compromise, including myocardial hypertrophy, ventricular dysfunction, myocarditis, and death. Myocarditis refers to inflammation of the heart tissue, which can be caused by viral infection, thus becoming viral myocarditis. Since viral myocarditis is linked as a causative factor of other cardiomyopathies, including dilated cardiomyopathy, in which the heart muscle weakens and fails to pump blood properly, the connection between CHIKV and the heart is concerning. We searched Pubmed, Embase, LILACS, and Google Scholar to identify case reports of CHIKV infections where cardiac symptoms were reported. We utilized NCBI Virus and NCBI Nucleotide to explore the lineage/evolution of strains associated with these outbreaks. Statistical analysis was performed to identify which clinical features were associated with death. Phylogenetic analysis determined that CHIKV infections with cardiac symptoms are associated with the Asian, the East Central South African, and the Indian Ocean lineages. Of patients admitted to hospital, death rates ranged from 26–48%. Myocarditis, hypertension, pre-existing conditions, and the development of heart failure were significantly correlated with death. As such, clinicians should be aware in their treatment and follow-up of patients.

Highlights

Chikungunya (CHIKV) is a positive sense RNA alphavirus generally vectored by Aedes aegypti and Aedes albopictus mosquitoes [1,2]
Chikungunya virus (CHIKV) infections with cardiac symptoms were reported across the globe (Figure 1)
Following the Reunion Island outbreak in 2004–2005, an increase in reporting of cardiac related incidents during CHIKV infection occurred, which may indicate newer strains have a higher likelihood of affecting the heart, or a lack of reporting in previous outbreaks [1,11,27] (Table 1)

Summary

Introduction

Chikungunya (CHIKV) is a positive sense RNA alphavirus generally vectored by Aedes aegypti and Aedes albopictus mosquitoes [1,2]. On the approximately 12 kb RNA genome of CHIKV, there are two open reading frames in which the non-structural proteins nsP1, nsP2. After human infection via an infected mosquito’s bite, CHIKV virions can target a vast array of cell types, including endothelial, epithelial, fibroblastic, and even muscle satellite cells [3,4,5]. The full virion replication cycle is typically complete in 8 h, and a host will generally begin to show symptoms between four and seven days following the initial mosquito bite [3,4]. Phylogenetic analysis breaks CHIKV down into three major branches, the

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