Pathophysiology of Fatal Chikungunya Virus Infection

Lethal chikungunya infection involves viral invasion of the central nervous system, with endothelial dysfunction leading to multi-organ failure.

Chikungunya virus (CHIKV) is transmitted by Aedes mosquitos in tropical and subtropical areas, lethally in 0.1% of cases. While 1.3 billion people live in at-risk areas, that number is expected to increase with climate change-driven expansion of regions favorable to this vector. In an analysis of 32 fatal and 39 nonfatal cases of chikungunya infection compared with 15 healthy controls from January 2015 to June 2023 in Brazil, de Souza et al. considered epidemiology, immunology, and host responses.

Viral loads did not differ between survivors and non-survivors. Neurologic symptoms were present in 22% of fatal cases, which showed significantly higher blood concentrations of pro-inflammatory cytokines such as IL-6, IL-8, IFN-alpha, TNF-alpha, a…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases