Pathak Santosh, Chaudhary Nagendra, Dhakal Prativa, Yadav Sanjay Ray, Gupta Binod Kumar, Kurmi Om Prakash
Department of Pediatrics, Chitwan Medical College, Bharatpur, Nepal.
Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal.
Int J Pediatr. 2021 Apr 20;2021:6613564. doi: 10.1155/2021/6613564. eCollection 2021.
Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children.
A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded.
Out of the 382 admitted cases with fever, 11% ( = 42) were diagnosed with chikungunya, and the majority ( = 30, 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more ( value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died.
Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome.
基孔肯雅热和恙虫病感染是热带地区不明原因发热的重要病因。这两种疾病的临床表现均无特异性，且常相互重叠。本研究比较了儿童基孔肯雅热与基孔肯雅热 - 恙虫病合并感染的临床表现及预后。
2017 - 2018年，对15岁以下儿童进行了为期16个月的基于医院的观察性研究。通过IgM ELISA诊断基孔肯雅热。所有基孔肯雅热阳性病例均接受恙虫病检测、登革热检测、钩端螺旋体检测和疟疾检测。记录所有患者的临床表现和预后。
在382例发热入院病例中，11%（n = 42）被诊断为基孔肯雅热，其中大多数（n = 30，71.4%）为男性。在42例基孔肯雅热病例中，17例（40.5%）恙虫病检测呈阳性，1例恶性疟原虫检测呈阳性。在总共42例基孔肯雅热病例中，肌痛、恶心/呕吐、头痛、腹痛、淋巴结肿大、肝肿大、脾肿大和水肿的发生率分别为81%、73.8%、66.7%、64.3%、59.5%、52.4%、40.5%和38.1%。此外，意识改变（31%）、黄疸（26.2%）、干咳（21.4%）、呼吸急促（19%）和惊厥（16.7%）是该组儿童的其他临床表现。与仅患基孔肯雅热的患者相比，基孔肯雅热 - 恙虫病合并感染的患者头痛、腹痛、干咳、呼吸急促、惊厥和脾肿大的报告明显更多（p值<0.05）。13例（31%）儿童发生休克，基孔肯雅热组5例，基孔肯雅热 - 恙虫病合并感染组8例。合并感染组有6名儿童接受了血管活性药物治疗。在仅患基孔肯雅热的病例中，22例康复，1例死亡；而在基孔肯雅热 - 恙虫病合并感染组中，14例康复，3例死亡。
基孔肯雅热组和基孔肯雅热 - 恙虫病合并感染组有许多相似的临床表现。在儿童中，恙虫病合并感染常导致临床症状、并发症及基孔肯雅热预后的改变。
