High Prevalence of Septic Shock in Hospitalized Infants With Chikungunya During the 2023 Epidemic in Paraguay
Mirta Noemi Mesquita Ramirez1,2, Leonidas Adelaida Rodriguez2,3, Sonia Viviana Pavlicich3,4
1From the Teaching and Research Department, Pediatric General Hospital "Children of Acosta Ñu".
Insights
Chikungunya fever (CHIKV) in children often presents with fever and rash. This study found infants under 60 days with altered pediatric assessment triangle (PAT) were at high risk for septic shock.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Clinical Medicine
Background:
- Chikungunya fever (CHIKV) commonly causes fever, rash, and joint pain in children.
- Septic shock is a rare but severe complication of CHIKV in pediatric populations.
- This study examines CHIKV cases during Paraguay's 2023 epidemic.
Purpose of the Study:
- To describe the epidemiology of CHIKV in children admitted to a pediatric emergency department.
- To detail the clinical presentation and outcomes of pediatric CHIKV patients.
- To identify risk factors for severe CHIKV complications in children.
Main Methods:
- Retrospective, observational study of pediatric patients (0-18 years) diagnosed with CHIKV via RT-PCR.
- Data collected included demographics, clinical signs (e.g., Pediatric Assessment Triangle - PAT), disease progression, and outcomes.
- Study conducted between February 1 and March 30, 2023, in Asunción, Paraguay.
Main Results:
- 200 pediatric patients were admitted; 57.5% were infants ≤60 days old, and 56.5% were male.
- Common symptoms included fever (99%), rash (76.5%), and signs of shock (60.5% altered PAT, 57.5% prolonged capillary refill).
- 57.2% developed septic shock within 24 hours, significantly associated with age ≤60 days and altered PAT; 2.5% mortality rate.
Conclusions:
- Febrile infants with altered PAT are prone to developing septic shock early in hospitalization.
- CHIKV in children, particularly neonates, can lead to severe outcomes including shock and death.
- Early recognition and intervention are crucial for managing pediatric CHIKV cases, especially in infants.
Background:
Clinical manifestations of Chikungunya fever (CHIKV) in children include fever, skin lesions and joint pain. CHIKV rarely leads to septic shock in children. The aim of this study was to describe the epidemiological characteristics, clinical presentation and evolution of patients with CHIKV admitted at the Pediatric Emergency Department of a public hospital in Asunción, Paraguay, during the 2023 epidemic in this country.
Material And Methods:
The study was retrospective and observational. The patients included were 0 to 18 years old, with CHIKV diagnosis confirmed by reverse transcription polymerase chain reaction between February 1 and March 30, 2023. The variables analyzed included demographic data, pediatric assessment triangle (PAT), disease evolution prior to admission, signs and symptoms at admission, admission to the pediatric intensive care unit and status at discharge. The study was approved by the Ethics Committee of the hospital.
Results:
A total of 200 patients were admitted. Of them, 57.5% were infants ≤60 days of age, and 56.5% were male. Symptoms included fever (99%), rash (76.5%), shock at the PAT (60.5%), prolonged capillary filling (57.5%), seizures (15%) and myalgias/arthralgias (11%). Besides, 57.2% had septic shock within 24 hours of admission, associated with age ≤60 days [odds ratio (OR): 2; 95% confidence interval (CI): 1.1-3.5; P = 0.01] and altered PAT (OR: 3.5; 95% CI:1.8-6.6; P = 0.0001), 15% were admitted to the pediatric intensive care unit, and 2.5% died.
Conclusions:
Results showed a predominance of febrile infants with altered PAT who presented septic shock within the first 24 hours of hospital admission, 15% of patients with seizures and 2.5% who died.
Related Concept Videos
01:28Infectious Diseases and Their Occurrence
01:25Cholera
01:18Viral Meningitis
01:25Arboviral Encephalitis
01:22Bacterial Meningitis I: Introduction
01:19Encephalitis l: Introduction