Discussion
CHIKV infection causes several clinical manifestations such as, fever,
myalgia, headache and severe joint pains.[17] In
general; the manifestations are like those in ZIKV and DENV infections.
Consequently, accurate clinical diagnostics are difficult and
laborious.[17] The biochemical parameters showed
alterations in all parameters analyzed. Based on our data, it could be
argued that, overall the alterations in the biochemical markers were
associated with clinical manifestations. The study population, and the
results showed no statistical significance in AST, ALT and uric acid
elevations, but a significant association was found between high levels
of creatinine and myalgia. Importantly, myalgia was one of the symptoms
most referred to by our patients during
infection.[18]
Creatinine alterations are indicative of severe renal
impairment.[19] However, creatinine is also a
product of the degradation of the muscular creatine. This could help
explain why we obtained a high level of this metabolite in the serum of
the infected patients. It is known that CHIKV can replicate in muscular
cells[19], causing intense cell lysis, elevating
creatine levels in the blood stream, which will be later converted in
creatinine and excreted by the kidneys.[19]Another hypothesis could be that CHIKV is able to cause renal lesions,
causing renal function imbalance during infection, as observed on murine
models. Fittingly, CHIKV is known to replicate in baby hamster kidney
(BHK-21) cells, and was found in their urine, suggesting a possible
viral replication on mice kidneys.[20] Moreover,
the virus was found in urine and semen of patients during infection,
also indicative of renal tropism.[20]