Arboviral infections in solid organ transplant recipients in Southern Thailand: A case series

Abstract

Objective: To describe the clinical features and outcomes of arboviral infections in solid organ transplant recipients (SOTRs).

Methods: This study included SOTRs identified from a passive surveillance cohort of 1 466 patients with acute undifferentiated febrile illness between 2012 and 2019. Diagnosis of arboviral infection was confirmed using RT-PCR and/or serological testing. Clinical, laboratory, and outcome data were extracted and analyzed descriptively.

Results: Eleven SOTRs (10 kidney, 1 heart transplant recipient) were diagnosed with arboviral infections: 8 with dengue (DENV), 2 with chikungunya virus (CHIKV), and 1 with Zika virus (ZIKV) infection. The median time from transplantation to symptom onset was 35.0 days (IQR 28.5-111.0). DENV infection was associated with severe disease, including dengue shock syndrome (50%, 4/8) and dengue hemorrhagic fever (25%, 2/8). Six patients (75%, 6/8) required ICU admission. Common laboratory abnormalities in dengue patients included leukopenia (100%, 8/8), thrombocytopenia (100%, 8/8), elevated transaminases (87.5%, 7/8), and acute kidney injury (50%, 4/8). CHIKV and ZIKV cases presented as mild, self-limiting febrile illnesses without complications. All patients recovered without long-term morbidity.

Conclusions: DENV infection in SOTRs is associated with significant morbidity, particularly early post-transplant, and requires heightened clinical vigilance. In contrast, CHIKV and ZIKV infections tend to follow a benign course. Enhanced vector control, early diagnostic testing, supportive management, and consideration of dengue vaccination in appropriate candidates are essential to mitigate the impact of arboviral infections in transplant recipients in endemic areas.

Keywords

Arboviruses / Dengue / Zika / Chikungunya / Solid organ transplantation

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