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.

Diagnosis and Molecular Characterization of Chikungunya Virus Infections

“…In a case series of Rosso et al, 80% of the patients presented high viral load (>10 6 copies/ml), and none of the solid organ transplant patients with CHIKV infection developed graft rejection or died [110].…”

Beyond Fever and Pain: Diagnostic Methods for Chikungunya Virus

“…Patients older than 65 years of age may present a more complicated clinical picture during acute chikungunya, with more frequent manifestations other than arthralgia, including high rates of neurological complaints (73). Limited data are available from immunocompromised hosts, but chikungunya manifestations and severity do not appear to differ among solid organ transplant recipients (74). Atypical chikungunya cases, defined as cases with predominant manifestations other than fever and arthralgia, have been reported ( Fig.…”

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.…”