Boonanek Artchavit, Chokephaibulkit Kulkanya, Phongsamart Wanatpreeya, Lapphra Keswadee, Rungmaitree Supattra, Horthongkham Navin, Wittawatmongkol Orasri
Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Siriraj Institute of Clinical Research (SICRES), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS One. 2025 Sep 25;20(9):e0330527. doi: 10.1371/journal.pone.0330527. eCollection 2025.
This retrospective observational study assesses the clinical characteristics, atypical manifestations, and treatment outcomes in pediatric patients hospitalized with chikungunya virus (CHIKV) infection during the Bangkok outbreak in 2019. Children <18 years old hospitalized from January 1 to December 31, 2019, and confirmed positive for CHIKV infection by RT-PCR or IgM antibodies were included in this study at a tertiary care center in Bangkok, Thailand. Patient demographics, clinical manifestations, and laboratory findings at the time of hospitalization were collected from de-identified medical records. Of 31 included children, seven (22.6%) were <1 year old, 22 (71.0%) were male, nine (29.0%) had underlying medical conditions, four (17.4%) tested positive for dengue coinfection, and four (12.9%) had multi-organ involvement. The median age was 9.5 (IQR 6.9-12.5) years. Most (90.3%) had atypical clinical manifestations, four (12.9%) had life-threatening manifestations. Two (6.5%) neonates had congenital CHIKV. The most common manifestations included fever (100.0%), rashes (77.4%), myalgia (41.9%), and arthralgia (35.5%). The three most involved organ systems presenting atypical manifestations included gastrointestinal (32.3%), dermatologic (32.3%), and neurological (22.6%) systems. Of those with dermatologic involvement, 67.7% had maculopapular rashes, 19.4% bullous skin lesions, and 6.5% generalized erythroderma. At the time of presentation, 25 (80.6%) children had lymphopenia, five (16.1%) had anemia, and none had thrombocytopenia. Five (16.1%) children required intensive care and four (12.9%) developed shock. Thirteen (41.9%) children, five with neurological involvement, fully recovered at discharge. Among the remaining children, five (16.1%) still had musculoskeletal conditions, 11 (35.5%) had skin lesions, and two (6.5%) with congenital CHIKV had skin lesions and neurological sequelae. Despite the small cohort, the observed frequency of neurological complications attributed to CHIKV infection justifies long-term follow-up in children with neurological manifestations and complications. CHIKV should be suspected in endemic countries and tested for in febrile children, particularly those with rash and neurological involvement.
这项回顾性观察研究评估了2019年曼谷疫情期间因基孔肯雅病毒（CHIKV）感染住院的儿科患者的临床特征、非典型表现及治疗结果。2019年1月1日至12月31日期间，在泰国曼谷一家三级医疗中心住院的18岁以下儿童，经逆转录聚合酶链反应（RT-PCR）或IgM抗体确诊为CHIKV感染的纳入本研究。从匿名的病历中收集患者的人口统计学资料、临床表现及住院时的实验室检查结果。纳入研究的31名儿童中，7名（22.6%）年龄小于1岁，22名（71.0%）为男性，9名（29.0%）有基础疾病，4名（17.4%）登革热合并感染检测呈阳性，4名（12.9%）有多器官受累。中位年龄为9.5（四分位间距6.9 - 12.5）岁。大多数（90.3%）有非典型临床表现，4名（12.9%）有危及生命的表现。2名（6.5%）新生儿有先天性CHIKV感染。最常见的表现包括发热（100.0%）、皮疹（77.4%）、肌痛（41.9%）和关节痛（35.5%）。出现非典型表现的三个最常受累器官系统包括胃肠道（32.3%）、皮肤（32.3%）和神经（22.6%）系统。皮肤受累的患者中，67.7%有斑丘疹，19.4%有大疱性皮肤损害，6.5%有全身红皮病。就诊时，25名（80.6%）儿童有淋巴细胞减少，5名（16.1%）有贫血，无血小板减少。5名（16.1%）儿童需要重症监护，4名（12.9%）发生休克。13名（41.9%）儿童，其中5名有神经受累，出院时完全康复。其余儿童中，5名（16.1%）仍有肌肉骨骼疾病，11名（35.5%）有皮肤损害，2名（6.5%）先天性CHIKV感染的儿童有皮肤损害和神经后遗症。尽管队列较小，但观察到的CHIKV感染所致神经并发症发生率表明，对有神经表现和并发症的儿童进行长期随访是合理的。在流行国家，对于发热儿童，尤其是有皮疹和神经受累的儿童，应怀疑CHIKV感染并进行检测。
