Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

Abstract

Background: In the last three years, chikungunya virus disease has been spreading, affecting particularly the Americas, producing more than two million cases. In this setting, not only new disease-related epidemiological patterns have been found, but also new clinical findings have been reported by different research groups. These include findings on the cardiovascular system, including clinical, electrocardiographic and echocardiographic alterations. No previous systemic reviews have been found in major databases about it. Methods: We performed a systematic review looking for reports about cardiovascular compromise during chikungunya disease. Cardiac compromise is not so common in isolated episodes; but countries where chikungunya virus is an epidemic should be well informed about this condition. We used 6 bibliographical databases as resources: Medline/Pubmed, Embase, ScienceDirect, ClinicalKey, Ovid and SciELO. Dengue reports on cardiovascular compromise were included as well, to compare both arbovirus' organic compromises. Articles that delved mainly into the rheumatic articular and cutaneous complications were not considered, as they were not in line with the purpose of this study. The type of articles included were reviews, meta-analyses, case-controls, cohort studies, case reports and case series. This systematic review does not reach or performed a meta-analysis. Results: Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic compromise. Cardiovascular manifestations can be considered common and have been reported in France, India, Sri Lanka, Malaysia, Colombia, Venezuela and USA, including mainly, but no limited to: hypotension, shock and circulatory collapse, Raynaud phenomenon, arrhythmias, murmurs, myocarditis, dilated cardiomyopathy, congestive insufficiency, heart failure and altered function profile (Troponins, CPK). Conclusions: Physicians should be encouraged to keep divulgating reports on the cardiovascular involvement of chikungunya virus disease, to raise awareness and ultimately encourage suitable diagnosis and intervention worldwide. More research about cardiovascular involvement and manifestations of systemic Chikungunya virus infection is urgently needed.

Chikungunya Viral Infection Requiring Intensive Care – Experience in a Tertiary Care Hospital in Bangladesh

“…This result is similar with another study 22 but differ from other studies where cardiovascular (54%) followed by neurological (37%) involvement 20 or neurological involvement was more frequent. 27 Mortality was 10% in one study where cardiac complications were common 20 and another study showed mortality is 48% in patients admitted in intensive care unit. 27 This study showed 17% mortality.…”

“…Sepsis, cardiac and renal involvements were common in expired patients. 20,22,23 This was a single center study involving only one Intensive Care Unit. So no comparison with other Intensive Care Units of Bangladesh is possible through this study.…”

“…Infection can lead to cardiovascular manifestations, but in addition, patients with existing cardiovascular disease can deteriorate quickly, worsening the short-term prognosis; fatal outcomes seen in patients with diabetes, lupus; or neurological, renal, pulmonary and cardiovascular insufficiency. [18][19][20] And the aim of this study was to highlight life threatening menifestations, complications and probable outcome of chikungunya fever in intensive care unit (ICU).…”

Prevalence of chronic comorbidities in chikungunya: A systematic review and meta-analysis

“…Epidemiologic evidence suggests that CHIKV patients at risk of severe disease outcomes are elderly subjects (Godaert et al, 2017) and those with certain comorbidities, e.g., obesity (Padmakumar et al, 2010), diabetes (Jean-Baptiste et al, 2016), cardiac diseases (Alvarez et al, 2017), and asthma (Paganin et al, 2010). The presence of these comorbidities was proposed to predispose CHIKV patients to severe complications of the viral infection (Padmakumar et al, 2010;Jean-Baptiste et al, 2016;Alvarez et al, 2017;Paganin et al, 2010). However, the prevalence of co-existing medical conditions in severe CHIKV cases has not been described.…”

Chikungunya Outbreak in Bangladesh (2017): Clinical and hematological findings

“…There is evidence from different countries - especially France, India, Sri Lanka, Malaysia, Colombia, Venezuela and USA - to suggest that sudden rise of heart rate was associated with the infection at both the acute and the chronic phases [58]. In our cohort, cardiovascular manifestations were not reported by patients during the acute phase and till M6.…”