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. 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 affectation were included as well, to compare both arbovirus’ organic affectations. 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. Results: Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic affectation. 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.

Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil

“…Cardiovascular disease is also considered common, and infrequent manifestations of CHIKV infection include neurologic complications, skin lesions, kidney involvement, and gastrointestinal, hepatic, and hematologic disturbances. 7 Another recent study, with patients admitted in an intensive care unit because of CHIKV infection in India, evidenced that disease severity was mainly associated with advanced age and the presence of underlying comorbidities, and risk factors for death were high acute physiology and chronic health evaluation (APACHE) II score at admission and dialysis requirement, 24 which also evidences that kidney injury increases mortality. Cardiovascular disorders, respiratory secondary infections, sensoriomotor deficit, absence of musculoskeletal pain, history of alcoholism, digestive symptoms, and presence of confusion/ delirium were factors independently associated with death among elderly patients admitted with CHIKV infection in a university hospital in Martinique 25 and reinforce the fact that comorbidities increase the infection severity and the risk of death.…”

“…There are recent evidences that cellular immunity suffers important impairment in end-stage renal disease, with reduction in the number and function of lymphocytes, so that patients become more susceptible to infections, mainly viral infections. 1,7 Another factor related to immunity is age. It is described that older adults are more susceptible to CHIKV infection because of decreased immunity, and it is also associated with more severe diseases.…”

“…5,6 Other investigations evidence that CHIKV can lead to albuminuria, hematuria, nephritis, acute kidney injury, and other renal function abnormalities. 7 Among kidney-transplanted patients, the course of CHIKV infection was observed to be less severe, with milder arthralgia, a fact that could be attributed to the effects of the immunosuppressant drugs routinely used in the post-transplantation period. 8 It is possible that a direct kidney damage can be caused by CHIKV (cytopathic effect of viral proteins on glomerular and tubular cells), associated with immune complex deposition on glomeruli, as has been described for other arbovirus infections such as dengue and Zika.…”

Knowledge of Chikungunya Disease among Academic Population in Private Universities, Khartoum State, Sudan - 2019

“…Atypical forms of Chikungunya disease are rare. However, it could cause neonatal encephalitis by vertical transmission of the virus [4,5], uveitis, retinitis and other neurological and cardiovascular symptoms [6][7][8].…”

Chikungunya virus infection in developing countries - What should we do?

“…During this period they cannot work properly and thus causing severe economic loss. Recently, complicated case of CHIKV infection has been reported where systemic involvement such as involvement of cardiovascular system was found (Alvarez et al, 2017).…”