{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:23:37Z","timestamp":1791491017574,"version":"4.3.4"},"reference-count":69,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T00:00:00Z","timestamp":1735862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Royal Society","award":["NIF\\R1\\231435"],"award-info":[{"award-number":["NIF\\R1\\231435"]}]},{"name":"Royal Society","award":["2024\/02373-3"],"award-info":[{"award-number":["2024\/02373-3"]}]},{"name":"Royal Society","award":["303829\/2022-2"],"award-info":[{"award-number":["303829\/2022-2"]}]},{"name":"FAPESP","award":["NIF\\R1\\231435"],"award-info":[{"award-number":["NIF\\R1\\231435"]}]},{"name":"FAPESP","award":["2024\/02373-3"],"award-info":[{"award-number":["2024\/02373-3"]}]},{"name":"FAPESP","award":["303829\/2022-2"],"award-info":[{"award-number":["303829\/2022-2"]}]},{"name":"CNPq","award":["NIF\\R1\\231435"],"award-info":[{"award-number":["NIF\\R1\\231435"]}]},{"name":"CNPq","award":["2024\/02373-3"],"award-info":[{"award-number":["2024\/02373-3"]}]},{"name":"CNPq","award":["303829\/2022-2"],"award-info":[{"award-number":["303829\/2022-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Chikungunya virus infection often manifests as an acute, self-limiting febrile illness, with arthralgia and musculoskeletal symptoms being the most commonly reported. Arthralgia can persist for months or even years, and approximately 50% of cases progress to chronic conditions. However, recent outbreaks have revealed a rising number of severe cases and fatalities. This review examines evidence from the past decade that suggests a higher incidence of severe chikungunya virus (CHIKV) infections and increased mortality rates, challenging official reports and guidelines from many countries. The literature review includes case reports, series, and studies with comparison groups to assess whether CHIKV-related mortality is underreported. Evaluating excess mortality involves analyzing consistent findings across different regions, biological plausibility, and systemic manifestations that contribute to severe outcomes. These findings aim to expand disease classifications in international guidelines and raise awareness among healthcare professionals to better identify severe CHIKV cases and related deaths. Studies were identified through PubMed using the search terms \u201cchikungunya\u201d, \u201cdeath\u201d, \u201csevere\u201d, \u201cpathogenesis\u201d, and \u201cpathophysiology\u201d.<\/jats:p>","DOI":"10.3390\/v17010062","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T07:10:17Z","timestamp":1735888217000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Chikungunya: From Hypothesis to Evidence of Increased Severe Disease and Fatalities"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5963-8178","authenticated-orcid":false,"given":"Carlos","family":"Brito","sequence":"first","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Medicina Tropical, Centro de Ci\u00eancias M\u00e9dicas, Universidade Federal de Pernambuco (UFPE), Recife 50740-465, Brazil"},{"name":"Departamento de Imunologia, Instituto Autoimune de Pesquisa, Recife 52011-040, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa Barreto","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Feira de Santana (UEFS), Feira de Santana 44036-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria de Fatima Pessoa Milit\u00e3o","family":"de Albuquerque","sequence":"additional","affiliation":[{"name":"Instituto Aggeu Magalh\u00e3es, Funda\u00e7\u00e3o Oswaldo Cruz, Recife 50740-465, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4534-2509","authenticated-orcid":false,"given":"Thiago","family":"Cerqueira-Silva","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Medicina e Sa\u00fade P\u00fablica de Precis\u00e3o, Funda\u00e7\u00e3o Oswaldo Cruz, Salvador 40296-710, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Gl\u00f3ria","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Coletiva, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1846-6007","authenticated-orcid":false,"given":"Rafael Freitas de Oliveira","family":"Franca","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz\u2014Fiocruz S\u00e3o Paulo, Ribeir\u00e3o Preto 14049-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,3]]},"reference":[{"key":"ref_1","first-page":"177","article-title":"The Newala epidemic. III. The virus: Isolation, pathogenic properties and relationship to the epidemic","volume":"54","author":"Ross","year":"1956","journal-title":"Epidemiol. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/0035-9203(55)90080-8","article-title":"An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952\u201353. I. Clinical features","volume":"49","author":"Robinson","year":"1955","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11644","DOI":"10.1128\/JVI.01432-14","article-title":"Reemergence of chikungunya virus","volume":"88","author":"Morrison","year":"2014","journal-title":"J. Virol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"de Lima Cavalcanti, T.Y.V., Pereira, M.R., de Paula, S.O., and Franca, R.F.O. (2022). A Review on Chikungunya Virus Epidemiology, Pathogenesis and Current Vaccine Development. Viruses, 14.","DOI":"10.3390\/v14050969"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1002\/acr.22900","article-title":"Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis","volume":"68","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.3201\/eid1408.080201","article-title":"Chikungunya-related fatality rates, Mauritius, India, and Reunion Island","volume":"14","author":"Renault","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"727","DOI":"10.4269\/ajtmh.2007.77.727","article-title":"A major epidemic of chikungunya virus infection on Reunion Island, France, 2005\u20132006","volume":"77","author":"Renault","year":"2007","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"de Souza, T.M.A., Ribeiro, E.D., Correa, V.C.E., Damasco, P.V., Santos, C.C., de Bruycker-Nogueira, F., Chouin-Carneiro, T., Faria, N., Nunes, P.C.G., and Heringer, M. (2018). Following in the Footsteps of the Chikungunya Virus in Brazil: The First Autochthonous Cases in Amapa in 2014 and Its Emergence in Rio de Janeiro during 2016. Viruses, 10.","DOI":"10.3390\/v10110623"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rodrigues Faria, N., Lourenco, J., Marques de Cerqueira, E., Maia de Lima, M., Pybus, O., and Carlos Junior Alcantara, L. (2016). Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014\u20132015. PLoS Curr., 8.","DOI":"10.1371\/currents.outbreaks.c97507e3e48efb946401755d468c28b2"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1590\/0074-02760170124","article-title":"Increased number of deaths during a chikungunya epidemic in Pernambuco, Brazil","volume":"112","author":"Brito","year":"2017","journal-title":"Mem. Inst. Oswaldo Cruz"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"i6360","DOI":"10.1136\/bmj.i6360","article-title":"Brazilian health authorities on alert after rise in deaths from chikungunya","volume":"355","author":"Collucci","year":"2016","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1590\/0037-8682-0479-2016","article-title":"Alert: Severe cases and deaths associated with Chikungunya in Brazil","volume":"50","author":"Brito","year":"2017","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Freitas, A.R.R., Cavalcanti, L., Von Zuben, A.P., and Donalisio, M.R. (2017). Excess Mortality Related to Chikungunya Epidemics in the Context of Co-circulation of Other Arboviruses in Brazil. PLoS Curr.","DOI":"10.1101\/140491"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"534","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 Reunion","volume":"137","author":"Economopoulou","year":"2009","journal-title":"Epidemiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S1473-3099(23)00739-9","article-title":"Risk of death following chikungunya virus disease in the 100 Million Brazilian Cohort, 2015\u20132018: A matched cohort study and self-controlled case series","volume":"24","author":"Pescarini","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.rbr.2017.05.005","article-title":"Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2\u2014Treatment","volume":"57","author":"Marques","year":"2017","journal-title":"Rev. Bras. Reumatol. Engl. Ed."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101672","DOI":"10.1016\/j.eclinm.2022.101672","article-title":"An evaluation of global Chikungunya clinical management guidelines: A systematic review","volume":"54","author":"Webb","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S441","DOI":"10.1093\/infdis\/jiw390","article-title":"Epidemiology of Chikungunya in the Americas","volume":"214","author":"Yactayo","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Khongwichit, S., Chansaenroj, J., Chirathaworn, C., and Poovorawan, Y. (2021). Chikungunya virus infection: Molecular biology, clinical characteristics, and epidemiology in Asian countries. J. Biomed. Sci., 28.","DOI":"10.1186\/s12929-021-00778-8"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Traverse, E.M., Millsapps, E.M., Underwood, E.C., Hopkins, H.K., Young, M., and Barr, K.L. (2022). Chikungunya Immunopathology as It Presents in Different Organ Systems. Viruses, 14.","DOI":"10.3390\/v14081786"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1017\/S0950268818002315","article-title":"Excess mortality in Guadeloupe and Martinique, islands of the French West Indies, during the chikungunya epidemic of 2014","volume":"146","author":"Freitas","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/trstmh\/try072","article-title":"Excess mortality profile during the Asian genotype chikungunya epidemic in the Dominican Republic, 2014","volume":"112","author":"Freitas","year":"2018","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2352","DOI":"10.3201\/eid2412.170639","article-title":"Excess Mortality and Causes Associated with Chikungunya, Puerto Rico, 2014\u20132015","volume":"24","author":"Freitas","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3201\/eid1403.070720","article-title":"Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India","volume":"14","author":"Mavalankar","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3201\/eid1402.071024","article-title":"Chikungunya fever, Mauritius, 2006","volume":"14","author":"Beesoon","year":"2008","journal-title":"Emerg. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.3201\/eid1212.060710","article-title":"Chikungunya disease outbreak, Reunion Island","volume":"12","author":"Josseran","year":"2006","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/20477724.2019.1574111","article-title":"Excess deaths associated with the 2014 chikungunya epidemic in Jamaica","volume":"113","author":"Freitas","year":"2019","journal-title":"Pathog. Glob. Health"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bonifay, T., Prince, C., Neyra, C., Demar, M., Rousset, D., Kallel, H., Nacher, M., Djossou, F., Epelboin, L., and Char Chik Working Group (2018). Atypical and severe manifestations of chikungunya virus infection in French Guiana: A hospital-based study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0207406"},{"key":"ref_29","first-page":"343","article-title":"Chikungunya virus-associated death in Malaysia","volume":"27","author":"Sam","year":"2010","journal-title":"Trop. Biomed."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"6","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":"Torres","year":"2015","journal-title":"IDCases"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1590\/0037-8682-0434-2016","article-title":"Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil","volume":"50","author":"Assuncao","year":"2017","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_32","first-page":"83","article-title":"A fatal case of chikungunya virus infection with liver involvement","volume":"65","author":"Chua","year":"2010","journal-title":"Med. J. Malays."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ijid.2016.05.010","article-title":"Severe manifestations of chikungunya virus in critically ill patients during the 2013\u20132014 Caribbean outbreak","volume":"48","author":"Crosby","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e345","DOI":"10.1093\/cid\/ciaa837","article-title":"Clinical Characteristics, Histopathology, and Tissue Immunolocalization of Chikungunya Virus Antigen in Fatal Cases","volume":"73","author":"Sharp","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"891","DOI":"10.3201\/eid2205.151449","article-title":"Severe Sepsis and Septic Shock Associated with Chikungunya Virus Infection, Guadeloupe, 2014","volume":"22","author":"Rolle","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e20190266","DOI":"10.1590\/0037-8682-0266-2019","article-title":"A major chikungunya epidemic with high mortality in northeastern Brazil","volume":"52","author":"Simiao","year":"2019","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.chom.2024.02.011","article-title":"Pathophysiology of chikungunya virus infection associated with fatal outcomes","volume":"32","author":"Fumagalli","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_38","first-page":"729","article-title":"Clinical and pathological studies on chikungunya fever in Madras city","volume":"53","author":"Thiruvengadam","year":"1965","journal-title":"Indian J. Med. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/0028-3886.51289","article-title":"Neurological complications of Chikungunya virus infection","volume":"57","author":"Chandak","year":"2009","journal-title":"Neurol. India"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e2436","DOI":"10.1093\/cid\/ciaa1038","article-title":"Fatal Outcome of Chikungunya Virus Infection in Brazil","volume":"73","author":"Cavalcante","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1978","DOI":"10.1002\/rmv.1978","article-title":"The neurological complications of chikungunya virus: A systematic review","volume":"28","author":"Mehta","year":"2018","journal-title":"Rev. Med. Virol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Mehta, R., Soares, C.N., Medialdea-Carrera, R., Ellul, M., da Silva, M.T.T., Rosala-Hallas, A., Jardim, M.R., Burnside, G., Pamplona, L., and Bhojak, M. (2018). The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: A case series. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006212"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/S1474-4422(20)30232-5","article-title":"Neurological disease in adults with Zika and chikungunya virus infection in Northeast Brazil: A prospective observational study","volume":"19","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1212\/WNL.0000000000002234","article-title":"Chikungunya virus-associated encephalitis: A cohort study on La Reunion Island, 2005\u20132009","volume":"86","author":"Gerardin","year":"2016","journal-title":"Neurology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1590\/0037-8682-0327-2017","article-title":"Neurologic manifestations in emerging arboviral diseases in Rio de Janeiro City, Brazil, 2015\u20132016","volume":"51","author":"Azevedo","year":"2018","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.4269\/ajtmh.16-0719","article-title":"Outbreak of Chikungunya in the French Caribbean Islands of Martinique and Guadeloupe: Findings from a Hospital-Based Surveillance System (2013\u20132015)","volume":"98","author":"Dorleans","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e04312019","DOI":"10.1590\/0037-8682-0431-2019","article-title":"Events preceding death among chikungunya virus infected patients: A systematic review","volume":"53","author":"Mesquita","year":"2020","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000514206","article-title":"Chikungunya and the Heart","volume":"146","author":"Cotella","year":"2021","journal-title":"Cardiology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2536","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":"Lemant","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"390","DOI":"10.12688\/f1000research.11078.2","article-title":"Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review","volume":"6","author":"Alvarez","year":"2017","journal-title":"F1000Res"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jcv.2009.06.027","article-title":"Systemic involvements and fatalities during Chikungunya epidemic in India, 2006","volume":"46","author":"Tandale","year":"2009","journal-title":"J. Clin. Virol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e2357","DOI":"10.1002\/rmv.2357","article-title":"The relationship between chikungunya virus and the kidneys: A scoping review","volume":"33","author":"Costa","year":"2023","journal-title":"Rev. Med. Virol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1111\/jgs.15004","article-title":"Atypical Clinical Presentations of Acute Phase Chikungunya Virus Infection in Older Adults","volume":"65","author":"Godaert","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s13098-018-0329-2","article-title":"Chikungunya and diabetes, what do we know?","volume":"10","author":"Montenegro","year":"2018","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e3201","DOI":"10.1097\/MD.0000000000003201","article-title":"Investigation Into an Outbreak of Dengue-like Illness in Pernambuco, Brazil, Revealed a Cocirculation of Zika, Chikungunya, and Dengue Virus Type 1","volume":"95","author":"Pessoa","year":"2016","journal-title":"Medicine"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Omarjee, R., Prat, C., Flusin, O., Boucau, S., Tenebray, B., Merle, O., Huc-Anais, P., Cassadou, S., and Leparc-Goffart, I. (2014). Importance of case definition to monitor ongoing outbreak of chikungunya virus on a background of actively circulating dengue virus, St Martin, December 2013 to January 2014. Eurosurveillance, 19.","DOI":"10.2807\/1560-7917.ES2014.19.13.20753"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.meegid.2015.08.006","article-title":"High rates of co-infection of Dengue and Chikungunya virus in Odisha and Maharashtra, India during 2013","volume":"35","author":"Saswat","year":"2015","journal-title":"Infect. Genet. Evol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/cid\/ciw667","article-title":"Coinfection with Zika and Dengue-2 Viruses in a Traveler Returning from Haiti, 2016: Clinical Presentation and Genetic Analysis","volume":"64","author":"Iovine","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"894","DOI":"10.4269\/ajtmh.16-0323","article-title":"Zika Virus and Chikungunya Virus CoInfections: A Series of Three Cases from a Single Center in Ecuador","volume":"95","author":"Zambrano","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1093\/cid\/ciw589","article-title":"Viremia and Clinical Presentation in Nicaraguan Patients Infected with Zika Virus, Chikungunya Virus, and Dengue Virus","volume":"63","author":"Waggoner","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Ahmed, S., Sultana, S., Kundu, S., Alam, S.S., Hossan, T., and Islam, M.A. (2024). Global Prevalence of Zika and Chikungunya Coinfection: A Systematic Review and Meta-Analysis. Diseases, 12.","DOI":"10.3390\/diseases12020031"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"106408","DOI":"10.1016\/j.actatropica.2022.106408","article-title":"Global prevalence of dengue and chikungunya coinfection: A systematic review and meta-analysis of 43,341 participants","volume":"231","author":"Irekeola","year":"2022","journal-title":"Acta Trop."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid1507.080638","article-title":"Co-infections with chikungunya virus and dengue virus in Delhi, India","volume":"15","author":"Chahar","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4067\/S0716-10182016000400013","article-title":"Co-infection by Chikungunya virus (CHIK-V) and dengue virus (DEN-V) during a recent outbreak in Cali, Colombia: Report of a fatal case","volume":"33","author":"Rosso","year":"2016","journal-title":"Rev. Chil. Infectol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Brito, C.A.A., Azevedo, F., Cordeiro, M.T., Marques, E.T.A., and Franca, R.F.O. (2017). Central and peripheral nervous system involvement caused by Zika and chikungunya coinfection. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005583"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Acevedo, N., Waggoner, J., Rodriguez, M., Rivera, L., Landivar, J., Pinsky, B., and Zambrano, H. (2017). Zika Virus, Chikungunya Virus, and Dengue Virus in Cerebrospinal Fluid from Adults with Neurological Manifestations, Guayaquil, Ecuador. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.00042"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Raza, F.A., Javed, H., Khan, M.M., Ullah, O., Fatima, A., Zaheer, M., Mohsin, S., Hasnain, S., Khalid, R., and Salam, A.A. (2021). Dengue and Chikungunya virus co-infection in major metropolitan cities of provinces of Punjab and Khyber Pakhtunkhwa: A multi-center study. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009802"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"720","DOI":"10.4269\/ajtmh.2012.11-0704","article-title":"A comparative study of clinical features between monotypic and dual infection cases with Chikungunya virus and dengue virus in West Bengal, India","volume":"86","author":"Taraphdar","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"de Morais Alves Barbosa Oliveira, R., Kalline de Almeida Barreto, F., Praca Pinto, G., Timbo Queiroz, I., Montenegro de Carvalho Araujo, F., Wanderley Lopes, K., Lucia Sousa do Vale, R., Rocha Queiroz Lemos, D., Washington Cavalcante, J., and Machado Siqueira, A. (2022). Chikungunya Death Risk Factors in Brazil, in 2017: A case-control study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0260939"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/1\/62\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:22:14Z","timestamp":1759918934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/1\/62"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,3]]},"references-count":69,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["v17010062"],"URL":"https:\/\/doi.org\/10.3390\/v17010062","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,3]]}}}