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de Oliveira JL, Nogueira IA, Amaral JK, Campos LR, Mendonça MMM, Ricarte MDB, Cavalcanti LPDG, Schoen RT. Extra-articular Manifestations of Chikungunya. Rev Soc Bras Med Trop 2023; 56:0341. [PMID: 38088664 PMCID: PMC10706034 DOI: 10.1590/0037-8682-0341-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.
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Affiliation(s)
- Jobson Lopes de Oliveira
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza, CE, Brasil
- Centro Universitário Christus, Faculdade de Medicina, Fortaleza, CE, Brasil
| | - Igor Albuquerque Nogueira
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza, CE, Brasil
| | - J. Kennedy Amaral
- Instituto de Medicina Diagnóstica do Cariri, Juazeiro do Norte, CE, Brasil
| | | | | | | | - Luciano Pamplona de Góes Cavalcanti
- Centro Universitário Christus, Faculdade de Medicina, Fortaleza, CE, Brasil
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Fortaleza, CE, Brasil
| | - Robert T. Schoen
- Yale University School of Medicine, Section of Rheumatology, New Haven, CT, USA
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Cai L, Hu X, Liu S, Wang L, Lu H, Tu H, Huang X, Tong Y. The research progress of Chikungunya fever. Front Public Health 2023; 10:1095549. [PMID: 36699921 PMCID: PMC9870324 DOI: 10.3389/fpubh.2022.1095549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Chikungunya fever, an acute infectious disease caused by Chikungunya virus (CHIKV), is transmitted by Aedes aegypti mosquitoes, with fever, rash, and joint pain as the main features. 1952, the first outbreak of Chikungunya fever was in Tanzania, Africa, and the virus was isolated in 1953. The epidemic has expanded from Africa to South Asia, the Indian Ocean islands and the Americas, and is now present in more than 100 countries and territories worldwide, causing approximately 1 million infections worldwide each year. In addition, fatal cases have been reported, making CHIKV a relevant public health disease. The evolution of the virus, globalization, and climate change may have contributed to the spread of CHIKV. 2005-2006 saw the most severe outbreak on Reunion Island, affecting nearly 35% of the population. Since 2005, cases of Chikungunya fever have spread mainly in tropical and subtropical regions, eventually reaching the Americas through the Caribbean island. Today, CHIKV is widely spread worldwide and is a global public health problem. In addition, the lack of a preventive vaccine and approved antiviral treatment makes CHIKV a major global health threat. In this review, we discuss the current knowledge on the pathogenesis of CHIKV, focusing on the atypical disease manifestations. We also provide an updated review of the current development of CHIKV vaccines. Overall, these aspects represent some of the most recent advances in our understanding of CHIKV pathogenesis and also provide important insights into the current development of CHIKV and potential CHIKV vaccines for current development and clinical trials.
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Affiliation(s)
- Li Cai
- Department of Infectious Disease Control and Prevention, Wuhan Center for Disease Control and Prevention, Wuhan, China,School of Public Health, Wuhan University, Wuhan, China
| | - Xinyi Hu
- Global Study Institute, University of Geneva, Geneva, Switzerland
| | - Shuang Liu
- Department of Infectious Disease Control and Prevention, Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Lei Wang
- Department of Economic Management, China University of Geosciences, Wuhan, China
| | - Hao Lu
- Department of Infectious Disease Control and Prevention, Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Hua Tu
- Department of Infectious Disease Control and Prevention, Hubei Center for Disease Control and Prevention, Wuhan, China
| | - Xibao Huang
- Department of Infectious Disease Control and Prevention, Hubei Center for Disease Control and Prevention, Wuhan, China,Xibao Huang ✉
| | - Yeqing Tong
- Department of Infectious Disease Control and Prevention, Hubei Center for Disease Control and Prevention, Wuhan, China,*Correspondence: Yeqing Tong ✉
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Costa DMDN, Gouveia PADC, Silva GEDB, Neves PDMDM, Vajgel G, Cavalcante MAGDM, Oliveira CBLD, Valente LM, Silveira VMD. The relationship between chikungunya virus and the kidneys: A scoping review. Rev Med Virol 2023; 33:e2357. [PMID: 35521644 DOI: 10.1002/rmv.2357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 01/28/2023]
Abstract
Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.
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Affiliation(s)
| | | | | | - Precil Diego Miranda de Menezes Neves
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil.,Nephrology and Dialysis Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Gisele Vajgel
- Nephrology Division, Federal University of Pernambuco, Recife, Brazil
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Silva Junior GBD, Pinto JR, Mota RMS, Pires Neto RDJ, Daher EDF. Risk factors for death among patients with Chikungunya virus infection during the outbreak in northeast Brazil, 2016-2017. Trans R Soc Trop Med Hyg 2020; 113:221-226. [PMID: 30551206 DOI: 10.1093/trstmh/try127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/10/2018] [Accepted: 11/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) infection is a current public health problem. The aim of this study was to investigate risk factors for death among patients with CHIKV infection during a large epidemic in northeast Brazil. METHODS This is a cross-sectional study with all registered cases of CHIKV in Ceara, Brazil, during 2016-2017. Data from notification reports were collected, and we have compared non-survivors and survivors. RESULTS A total of 182 731 cases were reported, with a mean age of 38±19 years, and the majority was female (62%). There were 383 deaths. Non-survivors were elderly, with a predominance of males, and with a lower educational level. Conditions that were significantly more frequent in the non-survivor group were systemic arterial hypertension, diabetes mellitus and chronic kidney disease (p<0.0001). Independent risk factors for death were advanced age (OR 7.35, p<0.0001), male gender (OR 2.05, p<0.0001), leukopenia (OR 3.18, p<0.0001) and vomiting (OR 2.19, p<0.0001), and comorbidities like hypertension (OR 3.74, p<0.0001), diabetes (OR 3.29, p<0.0001) and chronic kidney disease (OR 3.14, p<0.0001). CONCLUSION Advanced age and low educational level were associated with higher risk of mortality in CHIKV. Leukopenia and vomiting were signs of severity, as well as the presence of comorbidities, especially hypertension, diabetes and kidney disease.
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Affiliation(s)
- Geraldo Bezerra da Silva Junior
- Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza-UNIFOR. Fortaleza, Ceará, Brazil
| | - José Reginaldo Pinto
- Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza-UNIFOR. Fortaleza, Ceará, Brazil
| | - Rosa Maria Salani Mota
- Department of Statistics and Applied Mathematics, Sciences Center, Federal University of Ceará-UFC. Fortaleza, Ceará, Brazil
| | - Roberto da Justa Pires Neto
- Post-Graduation Program in Public Health, Department of Community Health, Federal University of Ceará-UFC. Fortaleza, Ceará, Brazil
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará-UFC. Fortaleza, Ceará, Brazil
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Cerbino-Neto J, Mesquita EC, Amancio RT, Brasil PEAAD. Events preceding death among chikungunya virus infected patients: a systematic review. Rev Soc Bras Med Trop 2020; 53:e04312019. [PMID: 32401863 PMCID: PMC7269536 DOI: 10.1590/0037-8682-0431-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/24/2020] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- José Cerbino-Neto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | | | - Rodrigo Teixeira Amancio
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Shahid U, Farooqi JQ, Barr KL, Mahmood SF, Jamil B, Imitaz K, Azizullah Z, Malik FR, Prakoso D, Long MT, Khan E. Comparison of clinical presentation and out-comes of Chikungunya and Dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan. PLoS Negl Trop Dis 2020; 14:e0008086. [PMID: 32203509 PMCID: PMC7141694 DOI: 10.1371/journal.pntd.0008086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/08/2020] [Accepted: 01/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation. Methodology A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion of dengue infections at local hospitals are suffering from dengue and that other arboviruses such as Chikungunya, West Nile viruses, Japanese Encephalitis virus and Zika virus are co-circulating in the Sindh region of Pakistan. Out-patients and hospitalized (in-patients) of selected district hospitals in different parts of Sindh province of Pakistan were recruited. Patients with presumptive dengue like illness (Syndromic diagnosis) by the treating physicians were enrolled between 2015 and 2017. Current study is a subset of larger study mentioned above. Here-in we compared laboratory confirmed cases of CHIKV and DENV to assess clinical features and laboratory findings that may help differentiate CHIKV from DENV infection at the time of clinical presentation. Results Ninety-eight (n = 98) cases tested positive for CHIKV, by IgM and PCR and these were selected for comparative analysis with DENV confirmed cases (n = 171). On multivariable analysis, presence of musculoskeletal [OR = 2.5 (95% CI:1.6–4.0)] and neurological symptoms [OR = 4.4 (95% CI:1.9–10.2)], and thrombocytosis [OR = 2.2 (95% CI:1.1–4.0)] were associated with CHIKV infection, while atypical lymphocytes [OR = 8.3 (95% CI:4.2–16.7)] and thrombocytopenia [OR = 8.1 (95% CI:1.7–38.8)] were associated with DENV cases at time of presentation. These findings may help clinicians in differentiating CHIKV from DENV infection. Conclusion CHIKV is an important cause of illness amongst patients presenting with acute febrile illness in Sindh region of Pakistan. Arthralgia and encephalitis at time of presentation among patients with dengue-like illness should prompt suspicion of CHIKV infection, and laboratory confirmation must be sought. Chikungunya and Dengue viral infection are prevalent in South Asia. These are spread by mosquito bites and present as acute febrile illness with clinical presentation difficult to differentiate. In this study we analysed clinical findings of patients with lab confirmed Dengue virus and Chikungunya virus infection and compared the clinical symptoms to assess significant features that can differentiate the two infections at time of presentation to clinics and hospitals. The study was conducted at the Aga Khan University Hospital, Karachi Pakistan. Our study confirms presence of Chikungunya virus as an etiologic agent of fever among patients with dengue like illness in Sindh province of Pakistan. Presence of joint pains, central nervous symptoms were more common in CHKV patients, while gastrointestinal symptoms and elevated liver enzymes were more commonly associated with dengue patients. Both viruses are endemic in Pakistan and clinical and lab diagnosis is essential.
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Affiliation(s)
- Uzma Shahid
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Joveria Q. Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kelli L. Barr
- Department of Biology, Baylor University, Waco, Texas, United States of America
| | | | - Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Kehkashan Imitaz
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zahida Azizullah
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Faisal R. Malik
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Dhani Prakoso
- Department of Comparative, Diagnostic, and Population Medicine, University of Florida, College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Maureen T. Long
- Department of Comparative, Diagnostic, and Population Medicine, University of Florida, College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- * E-mail:
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Silva Junior GBD, Pinto JR, Mota RMS, Pires Neto RDJ, Daher EDF. Impact of Chronic Kidney Disease on Chikungunya Virus Infection Clinical Manifestations and Outcome: Highlights during an Outbreak in Northeastern Brazil. Am J Trop Med Hyg 2019; 99:1327-1330. [PMID: 30226152 DOI: 10.4269/ajtmh.18-0531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The northeastern region of Brazil has faced in the last 2 years the largest outbreak of chikungunya virus (CHIKV) infection in its history. There are still few studies on kidney involvement in CHIKV. The aim of this study is to describe the impact of chronic kidney disease (CKD) on CHIKV clinical manifestations and outcome. This is a cross-sectional study conducted in the State of Ceara, northeastern Brazil, including all registered cases of CHIKV infection in the period from January 2016 to December 2017. Clinical manifestations were collected from the notification reports from official data bank from the State Secretary of Health of Ceara: National System of Diseases Notification and Laboratory Manager. A total of 182,731 cases were notified. Patients' mean age was 32.4 ± 14.6 years, and 62.2% were female. The most common clinical manifestations were fever (88.6%), headache (72.9%), intense arthralgia (69.5%), and myalgia (65.6%). Hospital admission was required for 3,080 cases (3.3%), and death occurred in 383 cases (0.2%). Chronic kidney disease was reported in 691 cases (0.3%). Patients with CKD had a higher frequency of almost all clinical manifestations, including fever, myalgia, exanthema, vomiting, nausea, back pain, conjunctivitis, arthritis, severe arthralgia, petechiae, and retro-orbital pain. They also had a significantly higher frequency of diabetes, hematological disorders, liver diseases, hypertension, peptic ulcer disease, and autoimmune diseases. Mortality was significantly higher among CKD patients than patients without CKD (3.0% versus 0.2%, P < 0.0001).
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Affiliation(s)
| | - José Reginaldo Pinto
- Post-Graduation Program in Collective Health, Health Sciences Center, University of Fortaleza-UNIFOR, Fortaleza, Brazil
| | - Rosa Maria Salani Mota
- Department of Statistics and Applied Mathematics, Sciences Center, Federal University of Ceará-UFC, Fortaleza, Brazil
| | - Roberto da Justa Pires Neto
- Post-Graduation Program in Public Health, Department of Community Health, Federal University of Ceará-UFC, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, Federal University of Ceará-UFC, Fortaleza, Brazil
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Calderwood C, Bhagani S, Cropley I, Papineni P. Severe chikungunya requiring intensive care in two travellers returning to the UK. J Travel Med 2019; 26:5486055. [PMID: 31066458 DOI: 10.1093/jtm/taz033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022]
Abstract
Chikungunya (CHIKV), an Alphavirus transmitted by Aedes mosquitoes, has been responsible for several outbreaks of infection in Asia and the Americas. Although the severe manifestations of CHIKV are increasingly reported in endemic settings, information on returning travelers is limited. We report two cases of travel-associated acute CHIKV requiring intensive care.
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Affiliation(s)
- Claire Calderwood
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Cropley
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases and Tropical Medicine, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
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Sharma PK, Kumar M, Aggarwal GK, Kumar V, Srivastava RD, Sahani A, Goyal R. Severe Manifestations of Chikungunya Fever in Children, India, 2016. Emerg Infect Dis 2019; 24:1737-1739. [PMID: 30124414 PMCID: PMC6106424 DOI: 10.3201/eid2409.180330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Chikungunya is a relatively benign disease, and a paucity of literature on severe manifestations in children exits. We describe a cohort of pediatric chikungunya fever patients in New Delhi, India, who had severe sepsis and septic shock, which can develop during the acute phase of illness.
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