Volume 99, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The northeastern region of Brazil has faced in the last 2 years the largest outbreak of chikungunya virus (CHIKV) infection in its history. There are still few studies on kidney involvement in CHIKV. The aim of this study is to describe the impact of chronic kidney disease (CKD) on CHIKV clinical manifestations and outcome. This is a cross-sectional study conducted in the State of Ceara, northeastern Brazil, including all registered cases of CHIKV infection in the period from January 2016 to December 2017. Clinical manifestations were collected from the notification reports from official data bank from the State Secretary of Health of Ceara: National System of Diseases Notification and Laboratory Manager. A total of 182,731 cases were notified. Patients’ mean age was 32.4 ± 14.6 years, and 62.2% were female. The most common clinical manifestations were fever (88.6%), headache (72.9%), intense arthralgia (69.5%), and myalgia (65.6%). Hospital admission was required for 3,080 cases (3.3%), and death occurred in 383 cases (0.2%). Chronic kidney disease was reported in 691 cases (0.3%). Patients with CKD had a higher frequency of almost all clinical manifestations, including fever, myalgia, exanthema, vomiting, nausea, back pain, conjunctivitis, arthritis, severe arthralgia, petechiae, and retro-orbital pain. They also had a significantly higher frequency of diabetes, hematological disorders, liver diseases, hypertension, peptic ulcer disease, and autoimmune diseases. Mortality was significantly higher among CKD patients than patients without CKD (3.0% versus 0.2%, < 0.0001).


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2015. Chikungunya disease: gaps and opportunities in public health and research in the Americas [in English, French]. Wkly Epidemiol Rec 90: 571576. [Google Scholar]
  2. Weaver SC, Lecuit M, , 2015. Chikungunya vírus and the global spread of a mosquito-borne disease. N Engl J Med 13: 12311239. [Google Scholar]
  3. Halstead SB, , 2015. Reappearance of chikungunya, formerly called dengue, in the Americas. Emerg Infect Dis 4: 557561. [Google Scholar]
  4. Bastos MLA, Abreu FS, Silva Junior GBD, , 2018. Inability to work due to chikungunya virus infection: impact on public service during the first epidemic in the state of Ceará, northeastern Brazil. Braz J Infect Dis 22: 248249. [Google Scholar]
  5. Mercado M, Acosta-Reyes J, Parra E, Pardo L, Rico A, Campo A, Navarro E, Viasus D, , 2016. Clinical and histopathological features of fatal cases with dengue and chikungunya virus co-infection in Colombia, 2014 to 2015. Euro Surveill 21: 16. [Google Scholar]
  6. Mercado M, Acosta-Reyes J, Parra E, Guzmán L, Beltrán M, Gasque P, Mejía-García C, Viasus D, , 2018. Renal involvement in fatal cases of chikungunya virus infection. J Clin Virol 103: 1618. [Google Scholar]
  7. Alvarez MF, Bolívar-Mejía A, Rodriguez-Morales AJ, Ramirez-Vallejo E, , 2017. Cardiovascular involvement and manifestations of systemic chikungunya virus infection: a systematic review. F1000 Res 6: 390. [Google Scholar]
  8. Pierrotti LC, Lopes MIBF, Nascimento APD, Caiaffa-Filho H, Lemos FBC, Reusing JO, Jr. Sejas ONE, David-Neto E, Azevedo LS, , 2017. Chikungunya in kidney transplant recipients: a series of cases. Int J Infect Dis 64: 9699. [Google Scholar]
  9. Lizarraga KJ, Nayer A, , 2014. Dengue-associated kidney disease. J Nephropathol 3: 5762. [Google Scholar]
  10. Alcendor DJ, , 2017. Zika virus infection of the human glomerular cells: implications for viral reservoirs and renal pathogenesis. J Infect Dis 216: 162171. [Google Scholar]
  11. Chen J, 2017. Zika virus infects renal proximal tubular epithelial cells with prolonged persistency and cytopathic effects. Emerg Microbes Infect 6: e77. [Google Scholar]
  12. Gurugama P, Jayarajah U, Wanigasuriya K, Wijewickrama A, Perera J, Seneviratne SL, , 2018. Renal manifestations of dengue virus infections. J Clin Virol 101: 16. [Google Scholar]
  13. Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. Ministry of Public Health, Brazil, 2017. Guia de Vigilância em Saúde. Available at: http://portalarquivos.saude.gov.br/images/pdf/2017/outubro/06/Volume-Unico-2017.pdf. Accessed June 21, 2018.
  14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, 2013. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3: 1150. [Google Scholar]
  15. Freitas ARR, Cavalcanti L, Von Zuben AP, Donalisio MR, , 2017. Excess mortality related to chikungunya epidemics in the context of co-circulation of other arboviruses in Brazil. PLoS Curr 9: 113. [Google Scholar]
  16. Kee ACL, Yang S, Tambyah P, , 2010. Atypical chikungunya virus infections in immunocompromised patients. Emerg Infect Dis 16: 10381040. [Google Scholar]
  17. Tecklenborg J, Clayton D, Siebert S, Coley SM, , 2018. The role of the immune system in kidney disease. Clin Exp Immunol 192: 142150. [Google Scholar]
  18. Lang PO, Loulergue P, Aspinall R, , 2017. Chikungunya virur infection: why should U.S. geriatricians be aware of it? J Am Geriatr Soc 11: 25292534. [Google Scholar]
  19. McClure M, Jorna T, Wilkinson L, Taylor J, , 2017. Elderly patients with chronic kidney disease: do they really need referral to the nephrology clinic? Clin Kidney J 10: 698702. [Google Scholar]
  20. Martina BE, Koraka P, Osterhaus AD, , 2009. Dengue virus pathogenesis: an integrated view. Clin Microbiol Rev 4: 564581. [Google Scholar]
  21. Kulkarni SA, Strobelt E, Sargsyan Z, , 2017. Capillary fragility in Zika virus infection. Am J Med 130: e59. [Google Scholar]
  22. Badawi A, Ryoo SG, Vasileva D, Yaghoubi S, , 2018. Prevalence of chronic comorbidities in chikungunya: a systematic review and meta-analysis. Int J Infect Dis 67: 107113. [Google Scholar]
  23. Cavalcanti LPG, D’angelo SM, Lemos DRQ, Barreto FKA, Siqueira AM, Miyajima F, , 2018. Is the recent increment in attributable deaths to type-2 diabetes (T2D) associated with the latest chikungunya outbreak in a major epidemic area in Brazil? Rev Soc Bras Med Trop 51: 6365. [Google Scholar]
  24. Gupta A, Juneja D, Singh O, Garg SK, Arora V, Deepak D, , 2018. Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with chikungunya. Indian J Crit Care Med 22: 59. [Google Scholar]
  25. Godaert L, Bartholet S, Dorléans F, Najioullah F, Colas S, Fanon JL, Cabié A, Césaire R, Dramé M, , 2018. Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies). BMJ Open 8: e018838. [Google Scholar]

Data & Media loading...

  • Received : 26 Jun 2018
  • Accepted : 17 Aug 2018
  • Published online : 17 Sep 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error