Elsevier

Transplantation Proceedings

Volume 49, Issue 9, November 2017, Pages 2076-2081
Transplantation Proceedings

Contributions in Transplantation
Kidney transplantation
Chikungunya Infection in Solid Organ Transplant Recipients

https://doi.org/10.1016/j.transproceed.2017.07.004Get rights and content

Highlights

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    Chikungunya infections in solid organ transplant recipients are described.

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    This is a case series of nine kidney and four liver transplant recipients.

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    Fever was observed in 11 (84.6%) patients.

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    Five (38.5%) patients presented with a rash.

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    Thirteen SOT recipients with confirmed CHIKV infection were included in our study (nine kidney and four liver transplant recipients).

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    All cases presented with arthralgia.

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    Forty-six percent developed chronic joint complaints.

Abstract

Background

Chikungunya virus (CHIKV) is an emerging mosquito-borne disease that causes acute febrile polyarthralgia and arthritis. CHIKV has spread rapidly to the Americas and, in Brazil, autochthonous cases are increasingly been reported. Solid organ transplant (SOT) recipients who travel to or live in CHIKV endemic areas are under high risk of acquiring the disease. Few data exist regarding the clinical characteristics of CHIKV infections in this population. We report the first case series of CHIKV infection in SOT recipients.

Methods

We retrospectively evaluated 13 cases of CHIKV infection in SOT recipients between January 2016 and December 2016 confirmed by laboratory tests and transplanted in the Renal and Liver Transplant Units of Walter Cantídio University Hospital from Federal University of Ceará.

Results

Positive CHIKV serology (enzyme-linked immunosorbent assay immunoglobulin M) was found in all patients (9 kidney and 4 liver transplant recipients). All of these patients had been living in endemic areas for dengue and CHIKV in the past months before the illness. The mean time between transplantation and CHIKV infection was of 7.2 years. Fever presented in 11 (84.6%) patients and 5 (38.5%) presented with a maculopapular rash. All cases had joint symptoms: 11 (84.6%) with symmetrical and peripheral polyarthralgia/polyarthritis and 2 (15.3%) with monoarthralgia/monoarthritis. Six (46%) patients had a joint complaint that lasted 3 months. Two patients had concomitant positive dengue serology (enzyme-linked immunosorbent assay immunoglobulin M). There were no cases of complications or deaths.

Conclusion

SOT with CHIKV infection seems to have a clinical presentation and evolution similar to those seen in the general population, with no apparent damage to the graft.

Section snippets

Materials and Methods

We retrospectively evaluated CHIKV infection in kidney and liver transplantation patients from the Walter Cantídio University Hospital from the Federal University of Ceará, in northeastern Brazil. The ethics committee of the institution approved the study. All CHIKV cases were diagnosed between January 2016 and December 2016. The inclusion criteria were kidney and liver transplantation patients in our center with CHIKV clinical symptoms and laboratory-confirmed infection. Laboratory diagnosis

Results

Between January 2016 and December 2016, 240 SOT (93 kidney and 147 liver transplantations) were performed. Thirteen SOT recipients with confirmed CHIKV infection were included in our study: 9 kidney and 4 liver transplant recipients, their characteristics are summarized in Table 3. The mean age of the patients was 50.8 years old (range, 40 to 73 years). All of these patients had been living in endemic areas for dengue virus (DENV) and CHIKV in the past months before the illness. Nine patients

Discussion

In the present study, we found 13 CHKIV cases in SOT recipients throughout 1 year in a single center located at a hyperendemic area. It is difficult to assess the real prevalence of the disease in this population because many mild or oligosymptomatic cases probably have been treated symptomatically, without serologic CHIKV confirmation. The symptoms of this infection are similar to those caused by many other infectious agents in the endemic areas, which contributes to the presumed fewer reports

Conclusion

CHIKV infection should always be considered in the differential diagnosis of acute febrile illness in transplant recipients living in or returning from endemic areas. Its presentation appears to be similar to that seen in an immunocompetent host, but more data are needed to better understand the clinical spectrum in these population. More research is necessary to develop better strategies for diagnosis, prevention, and treatment of CHIKV in SOT recipients.

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