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Prevalence, Risk Factors, and Prognosis of Liver Involvement in Adult Patients with Chikungunya in Thailand

Punyavee SrikirinDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand;

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Tanaya SiripoonDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Lantharita CharoenpongBamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand;

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Ngamphol SoonthornworasiriDepartment of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Wasin MatseeDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Chatporn KittitrakulDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Pisit TangkijvanichDepartment of Biochemistry, Faculty of Medicine, Center of Excellence in Hepatitis and Liver Cancer, Chulalongkorn University, Bangkok, Thailand;

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Prakaykaew CharunwatthanaDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

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Kittiyod PoovorawanDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

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ABSTRACT.

Chikungunya is a mosquito-borne disease mainly characterized by fever with polyarthralgia. Currently, liver complications of chikungunya remain rarely described. This study assesses the prevalence, severity, and risk factors of liver involvement, and the association between liver involvement severity and prognosis. We conducted a retrospective cohort study at two referral centers for tropical infectious diseases—the Hospital for Tropical Diseases and Bamrasnaradura Infectious Diseases Institute in Thailand—from January 2016 to April 2021. The study included 400 patients diagnosed with chikungunya. Of them, 254 (63.5%) were female with a mean age of 41.5 ± 14.1 years, and 98.5% of them presented with fever with arthralgia. Gastrointestinal presentations included nausea or vomiting (n = 62, 15.5%), diarrhea (n = 33, 8.3%), and abdominal pain (n = 4, 1%). Of 88 patients with available liver function tests, 39.8% had hepatitis (abnormal alanine aminotransferase levels), of whom 5.7% had moderate hepatitis. Nausea or vomiting is a clinical risk factor associated with liver involvement (adjusted odds ratio, 5.17; 95% CI, 1.20–22.34). Liver involvement was usually observed during the first 2 weeks of illness and resolved eventually. None of the patients experienced severe hepatitis, liver failure, or death caused by a liver problem. In conclusion, most of the patients with chikungunya did not have significant liver involvement. In those patients with severe liver injury, coexisting causes should be considered.

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Author Notes

Address correspondence to Kittiyod Poovorawan, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rachavithee Road, Bangkok 10400, Thailand. E-mail: kittiyod.poo@mahidol.ac.th

Financial support: This work was supported by the Faculty of Tropical Medicine, Mahidol University.

This study was approved by HTD and BIDI, and the protocol was approved by the International Review Board of the Faculty of Tropical Medicine, Mahidol University, Thailand (TMEC 21-037). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Punyavee Srikirin, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand, E-mail: punyavee71@gmail.com. Tanaya Siripoon, Wasin Matsee, and Chatporn Kittitrakul, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: tanaya.toey@gmail.com, wasin.mat@mahidol.ac.th, and chatporn.kit@mahidol.ac.th. Lantharita Charoenpong, Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand, E-mail: lalitac154@gmail.com. Ngamphol Soonthornworasiri, Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: ngamphol.soo@mahidol.ac.th. Pisit Tangkijvanich, Department of Biochemistry, Faculty of Medicine, Center of Excellence in Hepatitis and Liver Cancer, Chulalongkorn University, Bangkok, Thailand, E-mail: pisittkvn@yahoo.com. Prakaykaew Charunwatthana and Kittiyod Poovorawan, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: prakaykaew.cha@mahidol.ac.th and kittiyod.poo@mahidol.ac.th.

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