Elenga Narcisse, Folin Marion, Vandamme Yves-Marie, Cuadro-Alvarez Emma, Long Laurence, Njuieyon Falucar, Martin Elise, Kom-Tchameni Rémi, Defo Antoine, Herinantenaina Razafindrakoto Sitraka, Mrsic Yajaira, Couppie Pierre, Nacher Mathieu, Dufour Julie
From the *Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana; †Department of Infectious Disease, University Hospital of Angers, France; ‡Department of Dermatology, and §Centre d'Investigation Clinique Antilles-Guyane, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana.
Pediatr Infect Dis J. 2017 Aug;36(8):736-740. doi: 10.1097/INF.0000000000001541.
Fever in infants younger than 3 months is generally a cause for concern because of the risk for a serious bacterial infection. The aim of this study was to describe clinical and biologic features of Chikungunya infection in infants <3 months of age hospitalized in Cayenne Hospital during the 2014-2015 outbreak.
We performed a preliminary retrospective study followed by a prospective study from March 2014 to February 2015. All infants younger than 3 months presenting with fever and hospitalized in Cayenne Hospital were included. The main diagnostic criteria were fever and positive Chikungunya polymerase chain reaction.
One hundred and twenty infants were hospitalized with fever. The mean age was 46 days (standard deviation ± 22 days). The mean hospitalization duration was 7.4 days (standard deviation ± 6.1 days). Chikungunya infection was diagnosed in 26 children. The most important clinical findings were high [80.8% (77.5-84)] and prolonged fever [76.9% (73.4-80.4)], irritability [96.2% (94.5-97.7)] and skin rash [69.2% (65.4-73)]. Half of the infants presented edema of the extremities (hands and feet principally). However, in 15% of infants, Chikungunya infection was associated with a serious bacterial infection. Infants who presented with irritability, high fever and elevated PCT were at high risk for Chikungunya: OR 39 (9.2-243; P < .001), with a specificity of 96.7% and a negative predictive value of 89.4%. The area of the receiver operating characteristic curve was 0.96.
Our results confirm that Chikunguyna infection is a cause of high fever in infants younger than 3 months. Our data should be confirmed by larger studies.
3个月以下婴儿发热通常令人担忧，因为存在严重细菌感染的风险。本研究的目的是描述2014 - 2015年疫情期间在卡宴医院住院的3个月以下婴儿基孔肯雅热感染的临床和生物学特征。
我们先进行了一项初步回顾性研究，随后于2014年3月至2015年2月进行了前瞻性研究。纳入所有在卡宴医院住院且出现发热的3个月以下婴儿。主要诊断标准为发热和基孔肯雅病毒聚合酶链反应阳性。
120名婴儿因发热住院。平均年龄为46天（标准差±22天）。平均住院时间为7.4天（标准差±6.1天）。26名儿童被诊断为基孔肯雅热感染。最重要的临床发现是高热[80.8%（77.5 - 84）]和持续发热[76.9%（73.4 - 80.4）]、易激惹[96.2%（94.5 - 97.7）]和皮疹[69.2%（65.4 - 73）]。一半的婴儿出现肢体水肿（主要是手和脚）。然而，15%的婴儿基孔肯雅热感染与严重细菌感染相关。出现易激惹、高热和降钙素原升高症状的婴儿感染基孔肯雅热的风险较高：比值比为39（9.2 - 243；P <.001），特异性为96.7%，阴性预测值为89.4%。受试者工作特征曲线面积为0.96。
我们的结果证实基孔肯雅热感染是3个月以下婴儿高热的一个原因。我们的数据应通过更大规模的研究加以证实。
