[Septic shock secondary to non-congenital chikungunya fever in a young infant: A clinical case]

Chikungunya Immunopathology as It Presents in Different Organ Systems

Chikungunya virus (CHIKV) is currently an urgent public health problem as high morbidity from the virus leaves populations with negative physical, social, and economic impacts. CHIKV has the potential to affect every organ of an individual, leaving patients with lifelong impairments which negatively affect their quality of life. In this review, we show the importance of CHIKV in research and public health by demonstrating the immunopathology of CHIKV as it presents in different organ systems. Papers used in this review were found on PubMed, using “chikungunya and [relevant organ system]”. There is a significant inflammatory response during CHIKV infection which affects several organ systems, such as the brain, heart, lungs, kidneys, skin, and joints, and the immune response to CHIKV in each organ system is unique. Whilst there is clinical evidence to suggest that serious complications can occur, there is ultimately a lack of understanding of how CHIKV can affect different organ systems. It is important for clinicians to understand the risks to their patients.

Events preceding death among chikungunya virus infected patients: a systematic review

Since its re-emergence in the late 1990s, there have been reports of Chikungunya fever (CHIK-F) presenting with severe or atypical findings. There is little knowledge regarding the clinical events leading to the death of patients with CHIK-F. This study aimed to systematically review the literature regarding CHIK-F and identify clinical features preceding death. We searched PubMed, Scopus, Embase, Lilacs, and IsiWeb for case-reports, case-series, or cohorts of CHIK-F reporting at least one death, up to December 2019. Fifty-seven reports were analyzed, including 2140 deaths. Data about specific clinical events that precede death are scarce. The central tendency of time between disease onset and death ranged from 2 days to 150 days. The most common clinical findings among decedents were fever (22.0%), arthralgia (15.7%), myalgia (10.7%), and headache (8.2%). Excluding pediatric populations, the reported central tendency of age among the decedents was 53 or older, with a non-weighted median of 67, ranging up to 80 years old. Authors mentioned organic dysfunction in 91.2% reports. Among all the 2140 decedents, the most common dysfunctions were cardiovascular (7.2%), respiratory (6.4%), neurological (5.4%), renal (4.2%), liver (3.0%), and hematological (1.3%) dysfunction. Exacerbation of previous diabetes (5.6%) or hypertension (6.9%) was mentioned as conditions preceding death. Currently, older age, primary neurological, cardiovascular, or respiratory dysfunction and a previous diagnosis of diabetes or hypertension are the main clinical events preceding death.

Chikungunya in Infants and Children: Is Pathogenesis Increasing?

Chikungunya virus (CHIKV) was first extensively described in children during outbreaks in India and South Asia during the mid-1960s. Prior to the 2005 emergence of CHIKV on Reunion Island, CHIKV infection was usually described as a dengue-like illness with arthralgia in Africa and febrile hemorrhagic disease in Asia. Soon after the 2005 emergence, severe CNS consequences from vertical and perinatal transmission were described and as CHIKV continued to emerge in new areas over the next 10 years, severe manifestation of infection and sequelae were increasingly reported in infants and neonates. The following review describes the global reemergence and the syndromes of Chikungunya fever (CHIKF) in infants and children. The various manifestations of CHIKF are described and connected to the viral lineage that was documented in the area at the time the disease was described. The data show that certain manifestations of CHIKF occur with specific viral lineages and genetic motifs, which suggests that severe manifestations of CHIKF in the very young may be associated with the emergence of new viral lineages.

[Clinical and epidemiological profile of chikungunya infection in hospital patients in 2015 in Mérida, MexicoPerfil clÍnico-epidemiológico da infecção por chikungunya em casos hospitalares atendidos em 2015 em Mérida, México]

Objectives

Describe the epidemiological profile and analyze clinical manifestations by age group in chikungunya patients treated in 2015 in a Mérida, Mexico general hospital.

Methods

An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December 2015 and analyzing clinical manifestations by age group. A logistic regression model was used to analyze the association between signs and symptoms and hospital admission.

Results

A total of 830 diagnosed chikungunya cases were treated. Average age was 27.4 ± 17.05 years and the male-to-female ratio was 1:1.4. Most patients came from urban areas (n = 592, 87%) and, in particular, the capital city. Contact with the arthropod vector in the peridomiciliary area was reported in 723 (90%) cases. Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group.

Conclusions

Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, hemorrhage, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.