Risk Factors for Severity of Chikungunya in Children

Pinzón-Redondo, Hernando; Paternina-Caicedo, Ángel; Barrios-Redondo, Katherine; Zarate-Vergara, Andrea Carolina; Tirado-Pérez, Irina Suley; Fortich, Rossana; Alvis-Guzmán, Nelson; Máttar, Salim

doi:10.1097/inf.0000000000001135

Cited by 21 publications

(17 citation statements)

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“…As in this patient, elevated white cell counts have previously been noted in case reports of patients with severe CHIKV disease [ 32 – 35 ]. A recent study by Rolle et al [ 36 ] to assess predictive factors for severe forms of CHIKV disease found higher leukocyte counts in patients with severe disease.…”

Section: Discussionsupporting

confidence: 74%

Severe Chikungunya infection in Northern Mozambique: a case report

et al. 2017

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BackgroundAlthough Chikungunya virus has rapidly expanded to several countries in sub-Saharan Africa, little attention has been paid to its control and management. Until recently, Chikungunya has been regarded as a benign and self-limiting disease. In this report we describe the first case of severe Chikungunya disease in an adult patient in Pemba, Mozambique.Case presentationA previously healthy 40 year old male of Makonde ethnicity with no known past medical history and resident in Pemba for the past 11 years presented with a severe febrile illness. Despite administration of broad spectrum intravenous antibiotics the patient rapidly deteriorated and became comatose while developing anaemia, thrombocytopenia and later, melaena. Laboratory testing revealed IgM antibodies against Chikungunya virus. Malaria tests were consistently negative.ConclusionsThis report suggests that Chikungunya might cause unsuspected severe disease in febrile patients in Mozambique and provides insights for the improvement of national protocols for management of febrile patients in Mozambique. We recommend that clinicians should consider Chikungunya in the differential diagnosis of febrile illness in locations where Aedes aegypti mosquitos are abundant.

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Section: Discussionsupporting

confidence: 74%

Severe Chikungunya infection in Northern Mozambique: a case report

et al. 2017

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“…Some of the results of this study have been published recently. 16 Recent estimates, also from Colombia, suggest a high economic impact of pediatric infection in this region. Indeed, the average cost per uncomplicated CHIKF case was US$ 517.5 for children !1 year of age and US$ 375.1 for children <1 year old.…”

Section: Discussionmentioning

confidence: 99%

Congenital and perinatal complications of chikungunya fever: a Latin American experience

Torres

Falleiros-Arlant

Dueñas

et al. 2016

International Journal of Infectious Diseases

108

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This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.

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“…Infants (<1 year old) with chikungunya are often hospitalized and admitted to an intensive care unit (ICU) 16,50 . The disease usually presents as fever and rash 51,52 ; arthralgia is difficult to assess in infants, but is perhaps expressed as irritability and excessive crying 28,50 . Skin rashes are common (~60-80%) and generalized, and include maculopapular rash, pigment changes, vesiculobullous lesions (fluidfilled lesions) and (sometimes extensive) desquamation (skin peeling) 16,[50][51][52] .…”

Section: Disease In Infants and Childrenmentioning

confidence: 99%

“…The disease usually presents as fever and rash 51,52 ; arthralgia is difficult to assess in infants, but is perhaps expressed as irritability and excessive crying 28,50 . Skin rashes are common (~60-80%) and generalized, and include maculopapular rash, pigment changes, vesiculobullous lesions (fluidfilled lesions) and (sometimes extensive) desquamation (skin peeling) 16,[50][51][52] . Atypical symptoms include (sometimes complex) seizures, diarrhoea, tachycardia, viral sepsis and septic shock [51][52][53][54] .…”

Section: Disease In Infants and Childrenmentioning

confidence: 99%

Rheumatic manifestations of chikungunya: emerging concepts and interventions

2019

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Chikungunya virus (CHIKV) is a member of a group of globally distributed, mosquito-transmitted arthritogenic alphaviruses that cause sporadic outbreaks of primarily rheumatic disease every 2-50 years 1-4. The largest epidemic of CHIKV disease (hereafter simply referred to as chikungunya) ever recorded began on Lamu Island, Kenya, in 2004 (Fig. 1). The epidemic expanded across four continents, with cases still being reported in 2019 (Fig. 1; Supplementary Table 1). Three major genotypes of CHIKV are now recognized-the Asian, the West African and the Asian and East-Central South African (ECSA) genotypes 5-but a new lineage, the Indian Ocean Lineage (IOL), also emerged from the ECSA genotype during the 2004-2019 epidemic 6. The epidemic reached >100 countries (Supplementary Table 1), caused >10 million cases (Supplementary Table 2), and might arguably be called a pandemic. An estimated 1.3 billion people are at risk of chikungunya 7. Climate change modelling suggests that many more areas of the world (including parts of China, sub-Saharan Africa, South America and the United States) might become able to accommodate transmission of CHIKV in the future 8,9. Chikungunya was previously often viewed as (and for many patients remains) a relatively benign and selflimiting rheumatic disease. However, a considerably more complex spectrum of less common atypical and severe manifestations is now recognized in subgroups of patients, with chikungunya often complicated by comorbidities and co-infections. Hospitalization rates for chikun gunya range from 0.6% to 13% 10-14 and estimates of chikungunya-related mortality range from 0.024% to 0.7% 10,12,15-17. In addition, many patients develop protracted rheumatic disease lasting many months, occasionally years, with a number of sequelae now also recognized 18-22. Estimates for the total economic costs (direct and indirect) of chikungunya have ranged from a median of US$67 for adults and $258 for children in Columbia 23 , to a mean of $150 per outpatient and $3,300 per inpatient in 2006 in Réunion Island 11. In a large study of a chikungunya outbreak in Bangladesh in 2017, >10 days of productivity were lost in ~30% of patients with chikung unya because of severe arthropathy 24. Such costs might be viewed as relatively modest by Western standards; however, the occasionally high attack rate of chikungunya, with up to 30-75% of a given population affected by chikungunya disease at any one time 1,25 , can result in a substantial economic burden, especially in resource-poor communities that are often affected by the disease 26. Considerable research in patients and animal models has now provided extensive insights into the complex Pandemic An epidemic of disease that has spread across a large region; for instance, multiple continents, or even worldwide. Attack rate The total number of new cases of a disease divided by the total population (that is, the percentage of a defined population that is affected by a disease).

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Risk Factors for Severity of Chikungunya in Children

Cited by 21 publications

References 12 publications

Severe Chikungunya infection in Northern Mozambique: a case report

Severe Chikungunya infection in Northern Mozambique: a case report

Congenital and perinatal complications of chikungunya fever: a Latin American experience

Rheumatic manifestations of chikungunya: emerging concepts and interventions

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