{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:56:57Z","timestamp":1787972217842,"version":"build-2784847793"},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,7]]},"abstract":"<jats:p>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\u2019 mean age was 32.4 \u00b1 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%, <jats:italic>P<\/jats:italic> &lt; 0.0001).<\/jats:p>","DOI":"10.4269\/ajtmh.18-0531","type":"journal-article","created":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T07:01:15Z","timestamp":1537254075000},"page":"1327-1330","source":"Crossref","is-referenced-by-count":21,"title":["Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil"],"prefix":"10.4269","volume":"99","author":[{"given":"Geraldo Bezerra da","family":"Silva Junior","sequence":"first","affiliation":[{"name":"Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza-UNIFOR, Fortaleza, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Reginaldo","family":"Pinto","sequence":"additional","affiliation":[{"name":"Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza-UNIFOR, Fortaleza, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Maria Salani","family":"Mota","sequence":"additional","affiliation":[{"name":"Department of Statistics and Applied Mathematics, Sciences Center, Federal University of Cear\u00e1-UFC, Fortaleza, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto da Justa","family":"Pires Neto","sequence":"additional","affiliation":[{"name":"Post-Graduation Program in Public Health, Department of Community Health, Federal University of Cear\u00e1-UFC, Fortaleza, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth De Francesco","family":"Daher","sequence":"additional","affiliation":[{"name":"Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Cear\u00e1-UFC, Fortaleza, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Wkly Epidemiol Rec","first-page":"571","article-title":"Chikungunya disease: gaps and opportunities in public health and research in the Americas [in English, French]","volume":"90","author":"World Health Organization","year":"2015"},{"key":"b2","series-title":"N Engl J Med","first-page":"1231","article-title":"Chikungunya v\u00edrus and the global spread of a mosquito-borne disease","volume":"13","author":"Weaver","year":"2015"},{"key":"b3","series-title":"Emerg Infect Dis","first-page":"557","article-title":"Reappearance of chikungunya, formerly called dengue, in the Americas","volume":"4","author":"Halstead","year":"2015"},{"key":"b4","series-title":"Braz J Infect Dis","first-page":"248","article-title":"Inability to work due to chikungunya virus infection: impact on public service during the first epidemic in the state of Cear\u00e1, northeastern Brazil","volume":"22","author":"Bastos","year":"2018"},{"key":"b5","series-title":"Euro Surveill","first-page":"1","article-title":"Clinical and histopathological features of fatal cases with dengue and chikungunya virus co-infection in Colombia, 2014 to 2015","volume":"21","author":"Mercado","year":"2016"},{"key":"b6","series-title":"J Clin Virol","first-page":"16","article-title":"Renal involvement in fatal cases of chikungunya virus infection","volume":"103","author":"Mercado","year":"2018"},{"key":"b7","series-title":"F1000 Res","first-page":"390","article-title":"Cardiovascular involvement and manifestations of systemic chikungunya virus infection: a systematic review","volume":"6","author":"Alvarez","year":"2017"},{"key":"b8","series-title":"Int J Infect Dis","first-page":"96","article-title":"Chikungunya in kidney transplant recipients: a series of cases","volume":"64","author":"Pierrotti","year":"2017"},{"key":"b9","series-title":"J Nephropathol","first-page":"57","article-title":"Dengue-associated kidney disease","volume":"3","author":"Lizarraga","year":"2014"},{"key":"b10","series-title":"J Infect Dis","first-page":"162","article-title":"Zika virus infection of the human glomerular cells: implications for viral reservoirs and renal pathogenesis","volume":"216","author":"Alcendor","year":"2017"},{"key":"b11","series-title":"Emerg Microbes Infect","first-page":"e77","article-title":"Zika virus infects renal proximal tubular epithelial cells with prolonged persistency and cytopathic effects","volume":"6","author":"Chen","year":"2017"},{"key":"b12","series-title":"J Clin Virol","first-page":"1","article-title":"Renal manifestations of dengue virus infections","volume":"101","author":"Gurugama","year":"2018"},{"key":"b13","author":"Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Desenvolvimento da Epidemiologia em Servi\u00e7os. Ministry of Public Health, Brazil","year":"2017"},{"key":"b14","series-title":"Kidney Int Suppl","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2013"},{"key":"b15","series-title":"PLoS Curr","first-page":"1","article-title":"Excess mortality related to chikungunya epidemics in the context of co-circulation of other arboviruses in Brazil","volume":"9","author":"Freitas","year":"2017"},{"key":"b16","series-title":"Emerg Infect Dis","first-page":"1038","article-title":"Atypical chikungunya virus infections in immunocompromised patients","volume":"16","author":"Kee","year":"2010"},{"key":"b17","series-title":"Clin Exp Immunol","first-page":"142","article-title":"The role of the immune system in kidney disease","volume":"192","author":"Tecklenborg","year":"2018"},{"key":"b18","series-title":"J Am Geriatr Soc","first-page":"2529","article-title":"Chikungunya virur infection: why should U.S. geriatricians be aware of it?","volume":"11","author":"Lang","year":"2017"},{"key":"b19","series-title":"Clin Kidney J","first-page":"698","article-title":"Elderly patients with chronic kidney disease: do they really need referral to the nephrology clinic?","volume":"10","author":"McClure","year":"2017"},{"key":"b20","series-title":"Clin Microbiol Rev","first-page":"564","article-title":"Dengue virus pathogenesis: an integrated view","volume":"4","author":"Martina","year":"2009"},{"key":"b21","series-title":"Am J Med","first-page":"e59","article-title":"Capillary fragility in Zika virus infection","volume":"130","author":"Kulkarni","year":"2017"},{"key":"b22","series-title":"Int J Infect Dis","first-page":"107","article-title":"Prevalence of chronic comorbidities in chikungunya: a systematic review and meta-analysis","volume":"67","author":"Badawi","year":"2018"},{"key":"b23","series-title":"Rev Soc Bras Med Trop","first-page":"63","article-title":"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?","volume":"51","author":"Cavalcanti","year":"2018"},{"key":"b24","series-title":"Indian J Crit Care Med","first-page":"5","article-title":"Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with chikungunya","volume":"22","author":"Gupta","year":"2018"},{"key":"b25","series-title":"BMJ Open","first-page":"e018838","article-title":"Prognostic factors of inhospital death in elderly patients: a time-to-event analysis of a cohort study in Martinique (French West Indies)","volume":"8","author":"Godaert","year":"2018"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/5\/article-p1327.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/5\/article-p1327.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/5\/article-p1327.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:34:22Z","timestamp":1722458062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/5\/article-p1327.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,7]]},"references-count":25,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.18-0531","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,7]]}}}