High Prevalence of Septic Shock in Hospitalized Infants With Chikungunya During the 2023 Epidemic in Paraguay.

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.