Chikungunya in solid organ transplant recipients, a case series and literature review

Abstract

Chikungunya virus is a recent emerging arbovirus in Latin America, and the clinical manifestations can vary from fever and rash to severe chronic inflammatory arthritis. Few reports have been published regarding this infection in immunocompromised patients, including solid organ transplant recipients. We report a case series of solid organ transplant recipients with confirmed Chikungunya infection by positive reverse transcription polymerase chain reaction (RT-PCR), identified between January 2014 and December 2016. In addition, we conducted a literature review searching PubMed, EMBASE, and LILACS databases on Chikungunya infection in solid organ transplant recipients. Ten solid organ transplant recipients were included, consisting of 5 kidney, 4 liver, and 1 liver/kidney transplant recipient. Mean age of the transplant recipients was 47 years, and the most frequent symptoms of Chikungunya infection were arthralgia and fever. None of the patients required treatment in the intensive care unit, no deaths or graft rejection occurred. None of our patients had recurrent arthritis during 3-month follow-up period after the infection. Twenty-one cases of Chikungunya virus were identified in the literature review. Most cases had a benign clinical course with no severe complications, death, or chronic inflammatory arthritis. In conclusion, Chikungunya infection in solid organ transplant recipients has a benign course and has no chronic recurrent arthritis. It is possible that the immunosuppression regimen could decrease the risk of severe or chronic inflammatory manifestations in solid organ transplant recipients infected with Chikungunya.

Chikungunya in a kidney transplant recipient: a case report

“…CHIKV and other arboviruses such as Dengue, Zika and Yellow fever (YF) can infect people living in or traveling to endemic areas in Latin America, Africa, and East Asia. There are few data about arboviruses in solid organ transplant recipients, but the real incidence of these infectious diseases is probably greater than we think 9,10 . There is no reported case of YF transmitted by blood transfusion or organ transplantation, probably due to the vaccine against YF.…”

Imported Arbovirus Infections in Spain, 2009–2018

“…In our study, data were registered for 12 immunosuppressed patients with arbovirus disease; we found no association between infection and immune status, and none of the severe cases (all dengue) occurred in immunosuppressed patients. According to published data, CHIKV in solid organ transplant recipients seems to have a benign course and favorable outcome (19,20), whereas data for DENV in these patients are less clear. Case descriptions report uncomplicated outcomes, whereas a recent literature review reported a significantly higher incidence of severe dengue and a higher mortality rate among transplant patients with dengue (21)(22)(23).…”

Yellow fever disease in a renal transplant recipient: Case report and literature review

“…Little is known about the natural history of Zika virus infection in organ recipients, with some fatal cases reported . Chikungunya infection otherwise was associated with a benign course in solid organ transplant recipients, without chronic recurrent arthritis, possibly due to the effect of immunosuppressive drugs . YF has been considered the most severe disease, with a high mortality rate.…”