Severe Manifestations of Chikungunya Fever in Children, India, 2016

Emerg Infect Dis. 2018 Sep;24(9):1737-1739

Contributed by Dr Vinay Devraj

The authors conducted a retrospective, observational study in the pediatric intensive care unit (PICU) and pediatric high-dependency unit of a tertiary care hospital in New Delhi, India. They included patients whose chikungunya infection was diagnosed by positive real-time reverse transcription PCR (RT-PCR) during September–December 2016. The RTPCR was done using a Gene Finder DENV/CHKV Re alAmp Kit (Osang Healthcare, Gyeonggi-do, South Korea) at Oncquest Laboratories (New Delhi, India). This qualita tive assay uses a 1-tube RT-PCR technique with internal control for amplification and detection of chikungunya vi rus RNA.

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 ill ness 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 pedi atric 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).

Although chikungunya usually has a mild course, se vere life-threatening manifestations can occur. Clinicians should be aware that these manifestations can develop within 24 hours of the onset of illness, and a high index of suspicion is required to establish diagnosis. In this study, age <1 year and 11–14 years were predictive of severe disease.