Severe Chikungunya infection in the pediatric intensive care unit: A case series

Abstract

Often known to be a self-limiting disease presenting with fever-rash-arthralgia, chikungunya may cause severe manifestations mimicking septic shock. This case series highlights the clinical profile, course, and outcome of four severe chikungunya cases who were admitted to our tertiary care pediatric intensive care unit (PICU). All four cases had neurological manifestations and presented to the emergency department with features consistent with warm septic shock, requiring fluids, multiple vasoactive drugs, and mechanical ventilation within 2 h of admission. There was no specific hematological or biochemical abnormality on admission, and all cultures remained sterile. The diagnosis of chikungunya was made using real-time polymerase chain reaction in three cases and enzyme-linked immunosorbent assay IgM in one, with one case also showing dengue IgM positivity. All four cases had fever of more than 2 weeks and required multiorgan support and prolonged PICU stay. All children showed complete recovery with neither neurological sequelae nor other morbidities.