Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005-2006.
OBJECTIVE
To report the clinical and laboratory findings of adults with serious chikungunya virus acute infection hospitalized in an intensive care unit.


METHODS
Case series study from August 2005 to May 2006.


METHODS
Medical intensive care unit, South Reunion Hospital.


METHODS
We observed 33 episodes of confirmed acute chikungunya virus infection (chikungunya virus-IgM or reverse transcription-polymerase chain reaction positive in the serum) admitted to the intensive care unit.


METHODS
We collected cerebrospinal fluid, serum, and sometimes tissue samples from patients with suspected chikungunya fever in our intensive care unit. These samples underwent viral testing for evidence of acute chikungunya virus infection.


RESULTS
Of the 33 patients, 19 (58%) had chikungunya virus specific manifestations, 8 (24%) had associated acute infectious disease and 6 (18%) exacerbations of previous complaints. Among the chikungunya virus specific manifestations, we identified 14 cases of encephalopathy, one case each of myocarditis, hepatitis and Guillain Barré syndrome. Eighty-five percent of patients had a McCabe score = 1 (for nonfatal or no underlying disease). Mortality was 48%.


CONCLUSIONS
Chikungunya virus infection may be responsible for very severe clinical presentation, including young patients with unremarkable medical histories. Chikungunya virus infection is strongly suspected to have neurologic, hepatic, and myocardial tropism leading to dramatic complications and high mortality rate.
Lemant
Jérôme
J
Department of Medical Intensive Care, South Hospital, Saint-Pierre, Reunion, France. jerome.lemant@orange.fr
Boisson
Véronique
V
Winer
Arnaud
A
Thibault
Laure
L
André
Hélène
H
Tixier
François
F
Lemercier
Marie
M
Antok
Emmanuel
E
Cresta
Marie Pierre
MP
Grivard
Philippe
P
Besnard
Mathieu
M
Rollot
Olivier
O
Favier
François
F
Huerre
Michel
M
Campinos
José L
JL
Michault
Alain
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018354:Alphavirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002646:Chikungunya virus; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007195:Indian Ocean Islands / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction