Myocarditis Following Recent Chikungunya and Dengue Virus Coinfection: A Case
            Report

Farias, Luís Arthur Brasil Gadelha; Beserra, Francisca Lillyan Christyan Nunes; Fernandes, Lucas; Teixeira, Anderson Alexsander Rodrigues; Ferragut, Juliana Mandato; Girão, Evelyne Santana; Neto, Roberto da Justa Pires

doi:10.5935/abc.20190187

Cited by 10 publications

(16 citation statements)

References 18 publications

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“…Todavia, epidemia de outras doenças virais como a Dengue na China tiveram prevalência e prognóstico de miocardite bem diferentes que o Brasil, e outros países. 9,10 Nosso trabalho demonstra que este não parece ser o caso da COVID-19, onde, em populações ocidentais e orientais, a prevalência de injúria miocárdica é prevalente e associada a pior prognóstico. Dentre os desfechos desfavoráveis encontram-se insuficiência cardíaca, arritmias, VM e morte.…”

Section: Resultsunclassified

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19

Almeida¹,

Braga²,

Jorge³

et al. 2020

Arquivos Brasileiros De Cardiologia

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Fundamento: A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico. Objetivos: Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19. Métodos: Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC. Resultados: Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/ dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC. Conclusão: Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19.

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Section: Resultsunclassified

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19

Almeida¹,

Braga²,

Jorge³

et al. 2020

Arquivos Brasileiros De Cardiologia

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“…Although dengue virus (DENV) and chikungunya virus (CHIKV) belong to two different families, Flaviviridae and Togaviridae , respectively, they are mainly transmitted by the same mosquito vector, Aedes aegypti [ 8 ]. Moreover, those viral infections share many signs and symptoms, such as fever, headache, exanthema, arthralgia, myalgia, nausea, and vomiting, that are, sometimes, clinically indistinguishable [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of a Routinely Used Commercial Anti-Chikungunya IgM ELISA Reveals Cross-Reactivities with Dengue in Brazil: A New Challenge for Differential Diagnosis?

Lima

Azeredo

et al. 2021

Diagnostics

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In Brazil, chikungunya emerged in 2014, and by 2016, co-circulated with other arbovirosis, such as dengue and zika. ELISAs (Enzyme-Linked Immunosorbent Assays) are the most widely used approach for arboviruses diagnosis. However, some limitations include antibody cross reactivities when viruses belong to the same genus, and sensitivity variations in distinct epidemiological scenarios. As chikungunya virus (CHIKV) is an alphavirus, no serological cross reactivity with dengue virus (DENV) should be observed. Here, we evaluated a routinely used chikungunya commercial IgM (Immunoglobulin M) ELISA test (Anti-Chikungunya IgM ELISA, Euroimmun) to assess its performance in confirming chikungunya in a dengue endemic area. Samples (n = 340) representative of all four DENV serotypes, healthy individuals and controls were tested. The Anti-CHIKV IgM ELISA test had a sensitivity of 100% and a specificity of 25.3% due to the cross reactivities observed with dengue. In dengue acute cases, the chikungunya test showed an overall cross-reactivity of 31.6%, with a higher cross-reactivity with DENV-4. In dengue IgM positive cases, the assay showed a cross-reactivity of 46.7%. Serological diagnosis may be challenging and, despite the results observed here, more evaluations shall be performed. Because distinct arboviruses co-circulate in Brazil, reliable diagnostic tools are essential for disease surveillance and patient management.

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“…Echocardiographic findings are inconsistent and not specific for CHIKV. Wall motion abnormalities, ventricular enlargement, and different degrees of ejection fraction impairment have been described [17, 18]. Pleural and pericardial effusions are less frequent but have been reported as well [17].…”

Section: Resultsmentioning

confidence: 99%

“…Supportive measures, such as strict cardiac monitoring, oxygenation, and inotropic drugs when necessary, are highly encouraged. Intravenous hydrocortisone has been proposed as an efficient treatment in CHIKV myocarditis, but there are concerns about its use, considering that benefit in terms of mortality remains unclear [18]. Empirical interventions, like excessive fluid administration and fresh frozen plasma, are discouraged [20].…”

Section: Treatmentmentioning

confidence: 99%

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Chikungunya and the Heart

et al. 2021

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Introduction: Neglected tropical diseases are a group of communicable diseases that occur in tropical and subtropical conditions and are closely related to poverty and inadequate sanitation conditions. Among these entities, chikungunya remains one of the most widely spread diseases. Although the main symptoms are related to a febrile syndrome, cardiovascular (CV) involvement has been reported, with short- and long-term implications. As part of the “Neglected Tropical Diseases and other Infectious Diseases involving the Heart” (NET-Heart) Project, the aim of this review is to compile all the information available regarding CV involvement of this disease, to help healthcare providers gain knowledge in this field, and contribute to improving early diagnosis, treatment, and prevention strategies. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in conducting and reporting this systematic review. The search was conducted using MEDLINE/PubMed, SciELO, and LILACS databases to identify any relevant studies or reviews detailing an association between chikungunya and cardiac involvement published from January 1972 to May 31, 2020. Results: Despite its mechanism not being fully understood, CV involvement has been described as the most frequent atypical presentation of chikungunya (54.2%). Myocarditis is the most prevalent CV complication. Different rhythm disturbances have been reported in 52% of cases, whereas heart failure was reported in 15% of cases, pericarditis in 5%, and acute myocardial infarction in 2%. Overall estimated CV mortality is 10%, although in patients with other comorbidities, it may increase up to 20%. In the proper clinical setting, the presence of fever, polyarthralgia, and new-onset arrhythmia suggests chikungunya virus-related myocarditis. Conclusion: Although most cases are rarely fatal, CV involvement in chikungunya infection remains the most frequent atypical presentation of this disease and may have severe manifestations. Timely diagnosis and appropriate management are necessary to improve patient outcomes.

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Myocarditis Following Recent Chikungunya and Dengue Virus Coinfection: A Case Report

Cited by 10 publications

References 18 publications

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19

Valor Prognóstico da Troponina T e do Peptídeo Natriurético Tipo B em Pacientes Internados por COVID-19

Analysis of a Routinely Used Commercial Anti-Chikungunya IgM ELISA Reveals Cross-Reactivities with Dengue in Brazil: A New Challenge for Differential Diagnosis?

Chikungunya and the Heart

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