{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:58:24Z","timestamp":1793228304297,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/f1000research.11078.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T00:00:00Z","timestamp":1493683200000}}],"reference-count":57,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T00:00:00Z","timestamp":1493683200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013367","name":"Universidad Tecnol\u00f3gica de Pereira","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>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. No previous systemic reviews have been found in major databases about it.<\/ns4:p>\n                  <ns4:p>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 compromise were included as well, to compare both arbovirus\u2019 organic compromises. 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. This systematic review does not reach or performed a meta-analysis.<\/ns4:p>\n                  <ns4:p>Results: Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic compromise. 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).<\/ns4:p>\n                  <ns4:p>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. More research about cardiovascular involvement and manifestations of systemic Chikungunya virus infection is urgently needed.<\/ns4:p>","DOI":"10.12688\/f1000research.11078.2","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T09:05:09Z","timestamp":1493715909000},"page":"390","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":55,"title":["Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review"],"prefix":"10.12688","volume":"6","author":[{"given":"Mar\u00eda Fernanda","family":"Alvarez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri\u00e1n","family":"Bol\u00edvar-Mej\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9773-2192","authenticated-orcid":false,"given":"Alfonso J.","family":"Rodriguez-Morales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Ramirez-Vallejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2017,5,2]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"123-37","DOI":"10.1097\/MD\/0b013e31806010a5","article-title":"Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases.","volume":"86","author":"F Simon","year":"2007","journal-title":"Medicine (Baltimore)."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"65-74","DOI":"10.17533\/udea.iatreia.v29n1a06","article-title":"El virus Chikungunya en Colombia: aspectos cl\u00ednicos y epidemiol\u00f3gicos y revisi\u00f3n de la literatura.","volume":"29","author":"M Zuluaga","year":"2016","journal-title":"Iatreia."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"120-31","DOI":"10.1016\/j.antiviral.2015.07.002","article-title":"Chikungunya virus pathogenesis: From bedside to bench.","volume":"121","author":"T Couderc","year":"2015","journal-title":"Antiviral Res."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"218-28","DOI":"10.1007\/s11908-011-0180-1","article-title":"Chikungunya virus infection.","volume":"13","author":"F Simon","year":"2011","journal-title":"Curr Infect Dis Rep."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"165-72","DOI":"10.1016\/j.jinf.2012.04.005","article-title":"Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study.","volume":"65","author":"M Moro","year":"2012","journal-title":"J Infect."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"91-8","DOI":"10.1016\/j.bjid.2015.10.004","article-title":"Chikungunya: bending over the Americas and the rest of the world.","volume":"20","author":"M Madariaga","year":"2016","journal-title":"Braz J Infect Dis."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"5902-7","DOI":"10.3390\/v7112917","article-title":"Chikungunya Virus Replication in Salivary Glands of the Mosquito Aedes albopictus.","volume":"7","author":"A Vega-R\u00faa","year":"2015","journal-title":"Viruses."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"386-92","DOI":"10.1093\/tropej\/fmv051","article-title":"Congenital Chikungunya Virus Infection in Sincelejo, Colombia: A Case Series.","volume":"61","author":"W Villamil-G\u00f3mez","year":"2015","journal-title":"J Trop Pediatr."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"243-63","DOI":"10.1016\/j.medmal.2015.05.007","article-title":"French guidelines for the management of chikungunya (acute and persistent presentations). November 2014.","volume":"45","author":"F Simon","year":"2015","journal-title":"Med Mal Infect."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"145-9","DOI":"10.1016\/j.jcv.2009.06.027","article-title":"Systemic involvements and fatalities during Chikungunya epidemic in India, 2006.","volume":"46","author":"B Tandale","year":"2009","journal-title":"J Clin Virol."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"534-41","DOI":"10.1017\/S0950268808001167","article-title":"Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005\u20132006 outbreak on R\u00e9union.","volume":"137","author":"A Economopoulou","year":"2009","journal-title":"Epidemiol Infect."},{"key":"ref-12","first-page":"343-7","article-title":"Chikungunya virus-associated death in Malaysia.","volume":"27","author":"I Sam","year":"2010","journal-title":"Trop Biomed."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"386-9","DOI":"10.4269\/ajtmh.2011.10-0725","article-title":"Case reports of neuro-Chikungunya in southern Thailand.","volume":"85","author":"S Chusri","year":"2011","journal-title":"Am J Trop Med Hyg."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"6-10","DOI":"10.1016\/j.idcr.2014.12.002","article-title":"Chikungunya fever: Atypical and lethal cases in the Western hemisphere: A Venezuelan experience.","volume":"2","author":"J Torres","year":"2014","journal-title":"IDCases."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"27-9","DOI":"10.1016\/j.jcv.2015.05.021","article-title":"Fatal cases of Chikungunya virus infection in Colombia: Diagnostic and treatment challenges.","volume":"69","author":"J Hoz","year":"2015","journal-title":"J Clin Virol."},{"key":"ref-16","first-page":"83-4","article-title":"A fatal case of chikungunya virus infection with liver involvement.","volume":"65","author":"H Chua","year":"2010","journal-title":"Med J Malaysia."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/1869-5760-3-35","article-title":"Chikungunya and the eye: a review.","volume":"3","author":"P Mahendradas","year":"2013","journal-title":"J Ophthalmic Inflamm Infect."},{"key":"ref-18","doi-asserted-by":"crossref","first-page":"212-3","DOI":"10.4269\/ajtmh.2008.78.212","article-title":"Chikungunya virus-induced myopericarditis: toward an increase of dilated cardiomyopathy in countries with epidemics?","volume":"78","author":"F Simon","year":"2008","journal-title":"Am J Trop Med Hyg."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"186-94","DOI":"10.1016\/0002-8703(73)90459-6","article-title":"Arbovirus heart disease: myocarditis and cardiomyopathy following dengue and chikungunya fever--a follow-up study.","volume":"85","author":"I Obeyesekere","year":"1973","journal-title":"Am Heart J."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"821-7","DOI":"10.1136\/hrt.34.8.821","article-title":"Myocarditis and cardiomyopathy after arbovirus infections (dengue and chikungunya fever).","volume":"34","author":"I Obeyesekere","year":"1972","journal-title":"Br Heart J."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"204-6","DOI":"10.1136\/hrt.35.2.204","article-title":"Arbovirus (dengue type) as a cause of acute myocarditis and pericarditis.","volume":"35","author":"N Nagaratnam","year":"1973","journal-title":"Br Heart J."},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"e7-8","DOI":"10.1016\/j.ijcard.2007.04.153","article-title":"Acute myocarditis due to Chikungunya virus assessed by contrast-enhanced MRI.","volume":"121","author":"M Mirabel","year":"2007","journal-title":"Int J Cardiol."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"89-96","DOI":"10.1016\/j.trstmh.2009.07.031","article-title":"Atypical manifestations of chikungunya infection.","volume":"104","author":"S Rajapakse","year":"2010","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"e7603","DOI":"10.1371\/journal.pone.0007603","article-title":"Prospective study of Chikungunya virus acute infection in the Island of La R\u00e9union during the 2005\u20132006 outbreak.","volume":"4","author":"F Staikowsky","year":"2009","journal-title":"PLoS One."},{"key":"ref-25","first-page":"441-2","article-title":"A case of ADEM following Chikungunya fever.","volume":"62","author":"P Maity","year":"2014","journal-title":"J Assoc Physicians India."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"177-80","DOI":"10.4103\/0028-3886.51289","article-title":"Neurological complications of Chikungunya virus infection.","volume":"57","author":"N Chandak","year":"2009","journal-title":"Neurol India."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"94-102","DOI":"10.1212\/WNL.0000000000002234","article-title":"Chikungunya virus\u2013associated encephalitis: A cohort study on La R\u00e9union Island, 2005\u20132009.","volume":"86","author":"P G\u00e9rardin","year":"2016","journal-title":"Neurology."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"1326-8","DOI":"10.1007\/s12098-010-0174-2","article-title":"A child with serious Chikungunya virus (CHIKV) infection requiring intensive care, after an outbreak.","volume":"77","author":"P Menon","year":"2010","journal-title":"Indian J Pediatr."},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"2536-41","DOI":"10.1097\/CCM.0b013e318183f2d2","article-title":"Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005\u20132006.","volume":"36","author":"J Lemant","year":"2008","journal-title":"Crit Care Med."},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"887-93","DOI":"10.1161\/01.CIR.0000155616.07901.35","article-title":"High Prevalence of Viral Genomes and Multiple Viral Infections in the Myocardium of Adults With \u201cIdiopathic\u201d Left Ventricular Dysfunction.","volume":"111","author":"U K\u00fchl","year":"2005","journal-title":"Circulation."},{"key":"ref-31","doi-asserted-by":"publisher","first-page":"A946","DOI":"10.1016\/S0735-1097(15)60946-9","article-title":"Chikungunya myocarditis: an emerging threat to America.","volume":"65","author":"I Mendoza","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"120-129","DOI":"10.1016\/j.acmx.2012.07.002","article-title":"Manifestaciones cardiovasculares de la toxocariasis humana.","volume":"83","author":"A Bol\u00edvar-Mej\u00eda","year":"2013","journal-title":"Arch Cardiol Mex."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"e69-71","DOI":"10.1016\/j.ijcard.2008.05.023","article-title":"Fulminant dengue myocarditis masquerading as acute myocardial infarction.","volume":"136","author":"C Lee","year":"2009","journal-title":"Int J Cardiol."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"e316-18","DOI":"10.1016\/j.ijid.2009.01.017","article-title":"Atrial fibrillation as a complication of dengue hemorrhagic fever: non-self-limiting manifestation.","volume":"13","author":"M Mahmod","year":"2009","journal-title":"Int J Infect Dis."},{"key":"ref-35","first-page":"13-5","article-title":"Electrocardiographic changes in patients with chikungunya fever.","volume":"18","author":"D Hidalgo-Zambrano","year":"2016","journal-title":"Rev Panam Infectol."},{"key":"ref-36","doi-asserted-by":"publisher","first-page":"31-6","DOI":"10.1016\/S0167-5273(98)00008-4","article-title":"Cardiac involvement in Dengue Haemorrhagic Fever.","volume":"64","author":"J Wali","year":"1998","journal-title":"Int J Cardiol."},{"key":"ref-37","doi-asserted-by":"publisher","first-page":"804-8","DOI":"10.1016\/j.trstmh.2007.02.021","article-title":"Cardiac complications of a dengue fever outbreak in Sri Lanka, 2005.","volume":"101","author":"S Kularatne","year":"2007","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"ref-38","doi-asserted-by":"publisher","first-page":"457-69","DOI":"10.1016\/j.micinf.2011.12.008","article-title":"Expression profile of immune response genes during acute myopathy induced by chikungunya virus in a mouse model.","volume":"14","author":"D Patil","year":"2012","journal-title":"Microbes Infect."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"e919-22","DOI":"10.1016\/j.ijid.2010.06.011","article-title":"Acute myocarditis in dengue hemorrhagic fever: a case report and review of cardiac complications in dengue-affected patients.","volume":"14","author":"I Lee","year":"2010","journal-title":"Int J Infect Dis."},{"key":"ref-40","doi-asserted-by":"publisher","first-page":"510-2","DOI":"10.1016\/j.tmaid.2016.06.004","article-title":"Electrocardiographic alterations in patients with chikungunya fever from Sucre, Colombia: A 42-case series.","volume":"14","author":"W Villamil-G\u00f3mez","year":"2016","journal-title":"Travel Med Infect Dis."},{"key":"ref-41","first-page":"66","article-title":"Severe and fatal chikungunya fever in the Americas.","author":"J Torres","year":"2016"},{"key":"ref-42","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ijcard.2005.09.027","article-title":"Dengue myocarditis, rare but not fatal manifestation.","volume":"112","author":"V Wiwanitkit","year":"2006","journal-title":"Int J Cardiol."},{"key":"ref-43","first-page":"410-4","article-title":"Chikungunya: case definitions for acute, atypical and chronic cases. Conclusions of an expert consultation, Managua, Nicaragua, 20\u201321 May 2015.","volume":"90","year":"2015","journal-title":"Wkly Epidemiol Rec."},{"key":"ref-44","doi-asserted-by":"publisher","first-page":"684-685","DOI":"10.3855\/jidc.7230","article-title":"Zika: the new arbovirus threat for Latin America.","volume":"9","author":"A Rodr\u00edguez-Morales","year":"2015","journal-title":"J Infect Dev Ctries."},{"key":"ref-45","doi-asserted-by":"publisher","first-page":"55-57","DOI":"10.1016\/j.tmaid.2015.07.005","article-title":"A bibliometric analysis of global Zika research.","volume":"14","author":"D Martinez-Pulgarin","year":"2016","journal-title":"Travel Med Infect Dis."},{"key":"ref-46","doi-asserted-by":"publisher","first-page":"177-179","DOI":"10.1016\/j.tmaid.2016.05.004","article-title":"The arboviral burden of disease caused by co-circulation and co-infection of dengue, chikungunya and Zika in the Americas.","volume":"14","author":"A Rodr\u00edguez-Morales","year":"2016","journal-title":"Travel Med Infect Dis."},{"key":"ref-47","doi-asserted-by":"publisher","first-page":"925-927","DOI":"10.3201\/eid2205.151934","article-title":"Fatal Sickle Cell Disease and Zika Virus Infection in Girl from Colombia.","volume":"22","author":"L Arzuza-Ortega","year":"2016","journal-title":"Emerg Infect Dis."},{"key":"ref-48","doi-asserted-by":"publisher","first-page":"523-524","DOI":"10.1016\/S1473-3099(16)30006-8","article-title":"Zika virus associated deaths in Colombia.","volume":"16","author":"A Sarmiento-Ospina","year":"2016","journal-title":"Lancet Infect Dis."},{"key":"ref-49","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.ijcard.2016.06.293","article-title":"Cardiovascular complications after Zika virus infection.","volume":"221","author":"C Krittanawong","year":"2016","journal-title":"Int J Cardiol."},{"key":"ref-50","doi-asserted-by":"publisher","first-page":"532-534","DOI":"10.1016\/j.jiph.2015.10.001","article-title":"Bibliometric assessment of the scientific production of literature regarding Mayaro.","volume":"9","author":"A Pati\u00f1o-Barbosa","year":"2016","journal-title":"J Infect Public Health."},{"key":"ref-51","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12941-016-0157-x","article-title":"ChikDenMaZika Syndrome: the challenge of diagnosing arboviral infections in the midst of concurrent epidemics.","volume":"15","author":"A Paniz-Mondolfi","year":"2016","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"ref-52","doi-asserted-by":"publisher","first-page":"72-73","DOI":"10.1016\/j.tmaid.2016.11.001","article-title":"Mayaro, Oropouche and Venezuelan Equine Encephalitis viruses: following in the footsteps of Zika?","volume":"15","author":"A Rodr\u00edguez-Morales","year":"2017","journal-title":"Travel Med Infect Dis."},{"key":"ref-53","doi-asserted-by":"publisher","first-page":"194","DOI":"10.12688\/f1000research.10936.1","article-title":"Bibliometric analysis of Oropouche research: impact on the surveillance of emerging arboviruses in Latin America [version 1; referees: 2 approved].","volume":"6","author":"C Culquichic\u00f3n","year":"2017","journal-title":"F1000Res."},{"key":"ref-54","doi-asserted-by":"publisher","first-page":"78-79","DOI":"10.1016\/j.tmaid.2016.09.003","article-title":"Bibliometric assessment of global research on Venezuelan Equine Encephalitis: a latent threat for the Americas.","volume":"15","author":"Y Ortiz-Martinez","year":"2017","journal-title":"Travel Med Infect Dis."},{"key":"ref-55","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2017.02.007","article-title":"Venezuelan Equine Encephalitis: how likely are we to see the next epidemic?","author":"A Paniz-Mondolfi","year":"2017","journal-title":"Travel Med Infect Dis."},{"key":"ref-56","first-page":"98-104","article-title":"Aspectos agudos y cr\u00f3nicos de la infecci\u00f3n por virus chikungunya: aun aprendiendo.","volume":"24","author":"A Rodriguez-Morales","year":"2016","journal-title":"Actualizaciones en SIDA e Infectolog\u00eda."},{"key":"ref-57","doi-asserted-by":"publisher","first-page":"123-126","DOI":"10.1016\/j.ijid.2016.09.001","article-title":"The ever changing landscape of Zika virus infection. Learning on the fly.","volume":"51","author":"J Torres","year":"2016","journal-title":"Int J Infect Dis."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/6-390\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/6-390\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/6-390\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,17]],"date-time":"2020-05-17T17:17:09Z","timestamp":1589735829000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/6-390\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,2]]},"references-count":57,"URL":"https:\/\/doi.org\/10.12688\/f1000research.11078.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.12414.r22430","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.12414.r22430","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,2]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/6-390\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.11949.r21381, Jos\u00e9 Antonio Su\u00e1rez, Unidad Cl\u00ednica de Enfermedades Tropicales, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama, Panama, 18 Apr 2017, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/6-390\/v1#referee-response-21381","order":0,"name":"referee-response-21381","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alfonso Rodriguez-Morales<\/b>; \n<i>Posted: 19 Apr 2017<\/i>; Dear Dr. Su&aacute;rezThanks for your assessment as well your positive comments on our review, which as can be appreciated after reviewing&nbsp; major bibliographical databases, such as Scopus, PubMed and\/or Web of Science, is probably the first to address specifically the cardiovascular involvement and manifestations of systemic Chikungunya virus infection.","URL":"https:\/\/f1000research.com\/articles\/6-390\/v2#referee-comment-2652","order":1,"name":"referee-comment-2652","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.11949.r21382, Stalin Vilcarromero, Sociedad Cient\u00edfica de Estudiantes de Medicina de la Amazon\u00eda Peruana (SOCIEMAP), Facultad de Medicina, Universidad Nacional de la Amazon\u00eda Peruana, Iquitos, Peru, 18 Apr 2017, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/6-390\/v1#referee-response-21382","order":2,"name":"referee-response-21382","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alfonso Rodriguez-Morales<\/b>; \n<i>Posted: 19 Apr 2017<\/i>; Dear Dr. VilcarromeroFirst, thanks for your initial comments on our systematic review (SR) (without meta-analysis). In second place we want to clarify that making for the first time a SR about cardiovascular involvement and manifestations of systemic Chikungunya virus infection implies comparisons with dengue, unavoidably, as well, to introduce readers about the systemic manifestations of chikungunya, to better understand the cardiovascular involvement and manifestations in this arboviral disease. By the way, still on this specific topic, many aspects will become more detailed along with research in the near future. In which our group is specifically also contributing with studies, already published on the cardiovascular electrocardiographical alterations, as well ongoing on the ecochardiographical and cardiovascular biochemical ones.\n<b>Objective:It s not clear, author start assessing that the objective focus among cardiovascular involvement and manifestation, however, other systemic manifestation or atypical manifestation also become relevant in the results section.<\/b>Our SR has as objectives, not just one:-To systematically review published literature on the cardiovascular manifestations and involvement of systemic CHIKV infection;-To explore which are the main clinical cardiovascular features of chikungunya infection?-To identify which are the main electrocardiographical findings of chikungunya infection?All of them, are clearly developed in the section Synthesis of Results, which is the main part of the SR.Before that section, a brief introduction on other systemic manifestation or atypical manifestation of chikungunya infection is at Clinical Course, short section of just 3 paragraphs and atypical presentations, a section of just 2 paragraphs, which include, by the way, the transition to the cardiovascular aspects, developed in the section Synthesis of Results and later sections of the SR.\n<b>MethodologyThe main objective of systematic reviews is to respond to a specific question. <\/b>In our case, to three specific questions, with the proper context to make it readable and understandable given the novelty of the topic, as mentioned, also with ongoing research in multiple aspects.\n<b>Initially authors seem to do that pointing on cardiovascular involvement, but then, when they write the introduction and results section, this main point seem to disappear or is not clear for the reader. <\/b>From the title it's clear that this SR is not only about the cardiovascular involvement, but also about cardiovascular manifestations of chikungunya. Nevertheless, we will make more clarifications on our Introduction regarding this.\n<b>However, in the discussion section, authors re-take the objectives again.<\/b>Ok. Thanks.\n<b>Certainly, the big amount of information given in the introduction section and talking about the virus, history, classification, vector and cycles is very interesting, but it is not the purpose of this study.<\/b>This is not properly a study, it is a SR, without meta-analysis. Then, we consider, given the still novelty of the topic, such aspects are necessary for the readers.\n<b>I suggest them shortening it and focussing on the cardiovascular involvement and complications. <\/b>We have done that at Synthesis of Results and later sections of the SR.\n<b>I also recommend displaying a flow (figure) of how papers were excluded and included.<\/b>With our submission we provided the PRISMA Flow Chart and Checklist. However, this was not published by the journal with our article. Considering its importance and agreeing with you about it, we will incorporate as a Figure 1 and including properly in the manuscript, and not as supplementary file of our submission.\n<b>What guideline do the authors follow up in order to assess the risk of bias (PRISMA or Cochrane? It is possible you follow PRISMA approach (For example: http:\/\/prisma-statement.org\/PRISMAStatement\/Checklist.aspx). Please give this information explaining the steps.<\/b>We followed the PRISMA statement, as recommended by F1000 Research. We will clarify more on this in our revised manuscript.\n<b>In the Methods section, the next key word \u201cChikungunya AND Systemic AND Manifestation\u201d used by authors has probably given them no specific references or papers. Instead of that, why do not they also use specific \u201ckey words\u201d such as: \u201cChikungunya AND cardiac involvement\u201d&nbsp; \u201cChikungunya AND cardiac complication\u201d or \u201cChikungunya AND cardiovascular involvement\u201d&nbsp; \u201cChikungunya AND cardiovascular complications\u201d or Chikungunya AND Atypical manifestation\/complications\u201c. The idea is to be more specific and less general.<\/b>Given the lack of studies, we explore both options, finally trying to be more sensitive in order to include all the possibly relevant studies related to our SR.\n<b>According to the authors, the protocol was registered in PROSPERO; however it was not possible to view the registered protocol in the web (https:\/\/www.crd.york.ac.uk\/prospero\/searchadvanced.php). <\/b>&nbsp;We agree with you. This protocol was not prospectively registered in PROSPERO. But this is not a mandatory aspect for publication at F1000 Research, then this was modified later, but when published appeared with that incorrect comment. This will be deleted in the revised version.\n<b>I wonder if the inclusion of reviews may cause a bias. Please clarify and if it is true, consider in the \u201climitations section\u201d.<\/b>We will extend more on our Limitations.\n<b>ResultsAuthors use \u201ccardiac affectation\u201d and also \u201ccardiovascular compromise\u201d. I recommend to standardize the term in order to avoid creating confusion for the reader.<\/b>Agree, we will use only &quot;compromise&quot; and not &quot;affectation&quot;.\n<b>Authors describe with detail the clinical features during the acute, post-acute and chronic stage of CHIKV infection. I recommend shortening and focusing on the topic.<\/b>We will consider this in the revised version.\n<b>In \u201cAtypical presentation\u201d section, authors shows systemic manifestation considering the affectation in different organs such as neurological, cardiovascular, etc.&nbsp; Why did not the authors use also the key word \u201catypical\u201d rather than \u201csystemic manifestation\u201d or \u201cextra-articular\u201d in the searching strategy and also in the analyses? It is confusing.<\/b>In chikungunya, the definition of systemic manifestation or extra-articular has not well typified. Conversely, atypical case was defined by PAHO\/WHO during the expert consultation meeting in Managua, Nicaragua, 2016, and later published at the Weekly Epidemiological Record of the WHO 14 august 2015, 90, 33, 409-420. We will clarify this in our revised version.\n<b>In Table 2, the word \u201cSystemic extra-articular involvement of atypical CHIKV\u201d shows clinical manifestation, however, we do not know more information about \u201cwho (co-morbidities? Older? Young?)\u201d, \u201chow many\u201d(number\/percentage), type of paper(case report, case control, etc), etc. Are these clinical manifestations in outpatients or inpatients? Are these early clinical features or complications? So there are many questions around this information that would be useful in order to form a correct interpretation.<\/b>We will consider the improvement of this Table.\n<b>In Table 3, it is important to consider more information about the selected papers. I recommend a big table showing the different cardiovascular involvement\/complication, for example: 1. the clinical diagnoses (heart failure, acute coronary syndrome, refractory shock, and rhythm abnormalities), relevant signs and symptoms, especially early signs\/symptoms (chest pain, dyspnea, bradycardia, etc), laboratory diagnose (Troponin, BNP, CK-MB, etc), Imaging studies (echocardiography, Magnetic resonance), final diagnose (Myocarditis?), Management (inotropics, corticosteroid, etc) and outcome (survive, died). I consider, this data would be important to understand the impact of cardiovascular involvement due to CHIKV.<\/b>Unfortunately the number of papers as well the data available is limited to fully performed that, although was discussed by the group of authors of this SR. Nevertheless, we will consider your comment to improve this Table.\n<b>In dengue, now it is known that more about the cardiovascular involvement is mostly characterized by rhythm abnormalities (bradycardia) with no symptoms or complications. However, in moderate or severe cases where there was a cardiovascular affectation or complication, myocarditis has been an important cause. Myocarditis due to DENV infection may present several patterns such as \u201crefractory shock\u201d, \u201cheart failure\u201d, \u201carrhythmia\u201d, etc and It would be important to consider this diagnose. In the comparison with CHIKV infection and cardiac involvement, myocarditis, should be discussed.&nbsp; It is not clear what do authors try to assess when they say: \u201cThe cardiac tropism of CHIKV seem to be shared with DENV\u201d, it is important to clarify.<\/b>Thanks for this comment. We will use it in the revised version.\n<b>Diagnose myocarditis by those arbovirus, need to consider a myocardial biopsy or a cardiac magnetic resonance, however performing these in tropical areas where these arbovirus are prevalent, is very hard.<\/b>We fully agree with this.\n<b>The management of myocarditis, whatever is the etiology, focus in the management of the agent (virus, bacteria, etc); management of the cardiovascular event (heart failure, cardiog&eacute;nico shock, arrhythmia, etc) and the management of the inflammatory process. The last, is under discussion and needs more research, although in some severe cases by DENV, the corticosteroids administration changed the evolution.<\/b>We fully agree with this.\n<b>DiscussionAuthors say, \u201cThe key for a successful outcome of CHIKV-induced cardiomyopathy is recognizing signs and symptoms\u201d. Here I recommend repeating the most important ones.<\/b>Ok. Agree.\n<b>LimitationsThis section would consider some of the bias common to this kind of study where there is no clinical trials included and where \u201ccase reports\u201d were including. Bias such as \u201cselection\u201d or \u201cpublication\u201d bias, etc.<\/b>We will comment more on that.","URL":"https:\/\/f1000research.com\/articles\/6-390\/v2#referee-comment-2653","order":3,"name":"referee-comment-2653","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.12414.r22430, Cecilia Perret, Divisi\u00f3n de Pediatr\u00eda, Departamento de Enfermedades Infecciosas e Inmunolog\u00eda Pedi\u00e1tricas, Escuela de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile, 12 Jun 2017, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/6-390\/v2#referee-response-22430","order":4,"name":"referee-response-22430","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Data associated with the article are available under the terms of the Creative Commons Zero \"No rights reserved\" data waiver (CC0 1.0 Public domain dedication).","order":0,"name":"copyright-info","label":"Copyright"}]}}