Global & Disaster Medicine

India, 2016: Severe Manifestations of Chikungunya Fever in Kids


“……A total of 49 children had chikungunya fever; 36 had nonsevere disease and 13 had severe disease. All patients with severe disease were admitted to the PICU; 11 had illness consistent with the case definition of severe sepsis and septic shock, and 2 had acute liver failure. Of the 36 patients with nonsevere disease, 16 were admitted to the PICU (11 had seizures, 4 had fluid-responsive shock, 1 had peripheral cyanosis and mottling) and 20 were admitted to the pediatric high-dependency unit (3 had bleeding manifestations, 4 had severe abdominal pain, 2 had underlying cyanotic congenital heart disease, 2 had body temperature >40.3°C with irrelevant talking, 7 had dehydration, and 2 had severe rash). The median age was 12 years for patients with severe disease and 6.5 years for patients with nonsevere disease; male sex predominated in both groups (Table). Frequency of fever, body ache, arthralgia, and vomiting were similar for both groups. Peripheral cyanosis, along with mottling of skin and encephalopathy, was significantly higher in the group with severe disease. Serum albumin was significantly lower in the group with severe disease (3 vs. 3.75 g/dL). Of the 11 children with septic shock, 8 were admitted to the hospital within 24 hours of developing fever; 9 had hypotensive shock, and 2 had compensated shock. In this group, 6 children required 1 vasoactive agent, 3 children required 2 vasoactive agents, and 2 children required 3 vasoactive agents. Dopamine was used in 8 patients, dobutamine in 5 patients, epinephrine in 2 patients, and norepinephrine in 2 patients. The median duration of vasoactive support was 56 hours (range 31–114 hours), and the median vasoactive inotropic score in the first 24 hours was 10 (range 5–90; score >15–20 is considered serious). A vasoactive inotropic score >20 was seen in 2 children. Mean pH was 7.26 (reference range 7.35–7.45), mean lactate 5.1 mmol/L (reference range <2 mmol/L), mixed venous saturation 55% (reference range 70%–80%), and mean base excess at admission –7.7 mEq (reference range –2 to 2 mEq). Of the 2 children with acute liver failure with encephalopathy, 1 had dengue virus (positive dengue IgM by enzyme immunoassay) and the other had hepatitis E virus (reactive anti–hepatitis E IgM by enzyme immunoassay) co-infection…..”

Sharma PK, Kumar M, Aggarwal GK, Kumar V, Srivastava R, Sahani A, et al. Severe Manifestations of Chikungunya Fever in Children, India, 2016. Emerg Infect Dis. 2018;24(9):1737-1739.


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