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Chikungunya on Kidney Transplant Recipients

Is It the Same?

Tavares, Bruno M.1; Fernandes, Paula FCBC2,3; Oliveira, Cláudia Maria C.2; Silva, Sônia L.2,4; Mota, Márcia U.2; Andrade, Tacilla HS3; Cunha, Samuel F.3; Girão, Evelyne S.1,2

doi: 10.1097/TP.0000000000002363
Original Clinical Science—General

Background Chikungunya virus (CHIKV) infection is an acute febrile illness with polyarthralgia and arthritis. There are few data about CHIKV infection in kidney transplant recipients (KTR). We report the largest case series of CHIKV infection in this population.

Methods We retrospectively analyzed 32 cases of CHIKV infection in KTR between January 2016 and December 2017 at Hospital Universitário Walter Cantídio of Federal University of Ceará.

Results All patients had been in endemic areas before the beginning of the symptoms. All presented arthralgia, 15 (46.9%) with joint inflammatory symptoms and 14 (43.8%) evolved to chronic arthralgia. Seven (21.9%) showed acute kidney injury (AKI) by Kidney Disease: Improving Global Outcomes criteria during the acute phase. Acute kidney injury was not related to prednisone use (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.04-2.61, P = 0.3) nor chronic arthralgia (OR, 1.2; 95% CI, 0.2-8.4, P = 0.8) as well as male sex, chronic kidney disease and older than 60 years (OR, 1.7; 95% CI, 0.3-10.3, P = 0.58; OR, 0.4; 95% CI, 0.1-2.7, P = 0.4; and OR, 2.1; 95% CI, 0.3-14.9, P = 0.45, respectively). Hospitalization was associated to AKI (OR, 44.0; 95% CI, 3.8-503.1; P = 0.002), probably due to diarrhea or dehydration. One patient died throughout the study, possibly unassociated with CHIKV infection.

Conclusions KTR with CHIKV infection have a clinical presentation and evolution similar to those seen in the general population. Kidney function is generally well preserved, with transitory graft dysfunction without negative impact after 3 months from the beginning of the symptoms. Previous costicosteroids use did not relate with AKI or chronic arthralgia.

This retrospective cohort analysis summarizes data from 32 patients who were diagnosed with Chikungunya virus infection after kidney transplantation in an endemic area, suggesting that clinical and laboratorial features are no different from those seen in the general population.

1 Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil.

2 Kidney Transplant Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil.

3 Universidade Estadual do Ceará, Fortaleza, Brazil.

4 Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil.

Received 12 March 2018. Revision received 24 June 2018.

Accepted 4 July 2018.

The authors declare no funding or conflicts of interest.

B.M.T. participated in data collection, analysis and interpretation, preparing the figures and writing the article. P.FCBC.F. participated in research design, data collection, analysis and interpretation and critical revision of the article. C.M.C.O. participated in research design, data collection, analysis and interpretation, writing and critical revision of the article. S.L.S. participated in data collection. M.U.M. participated in data collection. T.HS.A. participated in data collection. S.F.C. participated in data collection. E.S.G. participated in research design, data collection, analysis and interpretation, writing and critical revision of the article.

Correspondence: Bruno M. Tavares, Hospital São José de Doenças Infecciosas, Rua Nestor Barbosa, 315 Parquelândia, Fortaleza, CE 60455-610, Brazil. (brunomelotavares@gmail.com).

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