Table 1.
Virus coinfection | CHIKV–ZIKV | DENV–CHIKV | DENV–CHIKV | CHIKV–ZIKV | CHIKV–ZIKV |
---|---|---|---|---|---|
Clinical features | |||||
Age (years) | 47 | 71 | 54 | 78 | 28 |
Comorbidities | Hypertension Diabetes mellitus Obesity |
Hypertension Smoker |
Hypertension Smoker |
Hypertension Diabetes mellitus Chronic kidney disease Chronic cardiac disease |
No |
Time from symptom onset to admission (days) | 2 | 3 | 3 | 1 | 2 |
Fever | No | No | Yes | No | Yes |
Arthralgia | No | No | Yes | No | Yes |
Rash | No | No | No | No | No |
Haemorrhagic manifestations | No | No | Yes | No | Yes |
Oedema | No | No | No | No | No |
Time from admission to mortality (days) | 9 | 10 | 1 | 15 | 2 |
Complications | Neurological syndrome | Neurological syndrome | Hepatic failure Acute kidney injury Pneumonia |
Neurological syndrome |
Multiple organ failure |
Laboratory findings at admission | |||||
Haemoglobin (g/dl) | 13 | NA | 13.8 | 14.8 | 14.6 |
Haematocrit (%) | 41 | NA | 40.5 | 42.7 | 41 |
Total white cells (10/l) | 10 100 | NA | 2400 | 4800 | 9500 |
Platelets (10/l) | 320 000 | NA | 8000 | 103 000 | 306 000 |
Creatinine (mg/dl) | 0.66 | NA | 1.91 | 0.89 | 0.6 |
Aspartate aminotransferase (U/l) | NA | NA | 987 | 28.9 | 550 |
Alanine aminotransferase (U/l) | NA | NA | 1478 | 23.1 | 150 |
Histopathologic findings | Tubule-interstitial nephritis, changes related to SIRS | Acute motor axonal polyneuropathy, CNS without alterations, coagulative non-confluent zonal liver necrosis pneumonia, tubule-interstitial nephritis | Coagulative non-confluent zonal liver necrosis, acute tubular necrosis, spleen with reactive plasmacytosis, pulmonary haemorrhage, changes related to SIRS | Acute demyelinating polyneuropathy, pneumonia, changes related to SIRS in liver and spleen | NA |
NA, not available; CHIKV, chikungunya virus; ZIKV, zika virus; DENV, dengue virus; CNS, central nervous system; SIRS, systemic inflammatory response syndrome.
Normal ranges: Haemoglobin: 12–17 g/dl; haematocrit: 40–50%; platelets: 150–600 × 109/l; total white cells: 4–12 × 109/l; creatinine: 0.75–1.2 mg/dl; aspartate aminotransferase 10–34 U/l; alanine aminotransferase: 5–59 U/l.