Chikungunya-attributable deaths: A neglected outcome of a neglected disease

Neto, Antonio S. Lima; Sousa, Geziel S.; Nascimento, Osmar José do; Castro, Márcia C.

doi:10.1371/journal.pntd.0007575

Cited by 33 publications

(18 citation statements)

References 16 publications

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“…According to the Pan American Health Organization (PAHO) 2.5 million cases of Chikungunya virus (CHIKV) and 631 deaths were reported in the North, Central, and South America, except Canada, Cuba, and Chile, where the cases of the virus were not observed ( Lima et al, 2019 ). The death rate of the Crimean-Congo hemorrhagic virus (CCHFV), a zoonotic viral illness, is from 5% to 30% in more than 30 countries worldwide ( Jeeva et al, 2019 ).…”

Section: The Antiviral Activity Of Chlorpromazine Fluphenazine Perpmentioning

confidence: 99%

Antiviral activity of chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine towards RNA-viruses. A review

Otręba

Kośmider

Rzepecka‐Stojko

2020

European Journal of Pharmacology

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In 2020 the whole world focused on antivirus drugs towards SARS-CoV-2. Most of the researchers focused on drugs used in other viral infections or malaria. We have not seen such mobilization towards one topic in this century. The whole situation makes clear that progress needs to be made in antiviral drug development. The first step to do it is to characterize the potential antiviral activity of new or already existed drugs on the market. Phenothiazines are antipsychotic agents used previously as antiseptics, anthelminthics, and antimalarials. Up to date, they are tested for a number of other disorders including the broad spectrum of viruses. The goal of this paper was to summarize the current literature on activity toward RNA-viruses of such drugs like chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine. We identified 49 papers, where the use of the phenothiazines for 23 viruses from different families were tested. Chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine possess anti-viral activity towards different types of viruses. These drugs inhibit clathrin-dependent endocytosis, cell-cell fusion, infection, replication of the virus, decrease viral invasion as well as suppress entry into the host cells. Additionally, since the drugs display activity at nontoxic concentrations they have therapeutic potential for some viruses, still, further research on animal and human subjects are needed in this field to verify cell base research.

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Section: The Antiviral Activity Of Chlorpromazine Fluphenazine Perpmentioning

confidence: 99%

Antiviral activity of chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine towards RNA-viruses. A review

Otręba

Kośmider

Rzepecka‐Stojko

2020

European Journal of Pharmacology

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“…Studies conducted first in India and more recently in Brazil reported significantly higher mortality rates in the months coinciding with chikungunya outbreaks than in the same period in previous years and the expected rates after the outbreak. Retrospective analyses in different Latin American countries have produced similar results, demonstrating a strong temporal association and potential causality between this surplus mortality and the outbreak 19 , 20 .…”

Section: Discussionmentioning

confidence: 66%

Classification of chikungunya cases: a proposal

Brito

Freitas

Said

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Since 2005, chikungunya virus (CHIKV) has caused large outbreaks, with reports of more than 10 million cases worldwide over the course of a decade. Since 2013, almost three million cases have been reported in the Americas. Although musculoskeletal involvement is the most prevalent symptom in the disease spectrum, systemic manifestations with involvement of important organs have also been described. Currently, case classifications of chikungunya based on the intensity and duration of articular symptoms have been used to guide the clinical management of the joint manifestations, with little or no emphasis on the severe clinical forms associated with systemic disease and target organ involvement. Thus, these classifications have failed to aid health professionals in the detection and early management of severe cases, which can lead to fatal outcomes and sequelae. Based on data from international literature and the opinions of clinical professionals, epidemiologists, and arbovirologists with extensive experience gained from the Brazilian chikungunya outbreak, a group of specialists proposed a revised classification for chikungunya cases. In this proposed classification, the specialists highlight the different patterns of the disease, including systemic manifestations, with the aim of sensitizing health professionals for the prompt detection and early management of severe conditions, which can contribute to reducing fatal outcomes.

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“…Death caused directly by CHIKV infection is not commonly reported; however, there are reports of excess deaths in countries in which a CHIKV epidemics have occurred [ 20 , 21 , 55 , 87 , 88 ] ( Table 2 and Table 4 ). In regard to CHIKV infections with altered cardiac status, 11 deaths were reported out of 23 individual case reports (48%) ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Further, the finding of viral myocarditis is concerning due to its connection with other cardiomyopathies such as dilated cardiomyopathy, which can also result in death [ 18 , 19 ]. While most CHIKV infections result in mild symptoms, myocarditis does not always present overtly, which could lead to a future high burden on healthcare systems where outbreaks have occurred [ 18 ]; a number of these countries have underdeveloped infrastructure; thus, this burden could be overwhelming [ 20 , 21 ]. Since there is no distinct course of action for CHIKV infection, nor a vaccine, CHIKV infection should be concerning to clinicians [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome

et al. 2021

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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.

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Chikungunya-attributable deaths: A neglected outcome of a neglected disease

Cited by 33 publications

References 16 publications

Antiviral activity of chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine towards RNA-viruses. A review

Antiviral activity of chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine towards RNA-viruses. A review

Classification of chikungunya cases: a proposal

Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome

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