title: Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005-2006.
abstract: 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.
authors.affiliation: Department of Medical Intensive Care, South Hospital, Saint-Pierre, Reunion, France. jerome.lemant@orange.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lemant
authors.forename: Véronique
authors.initials: V
authors.lastname: Boisson
authors.forename: Arnaud
authors.initials: A
authors.lastname: Winer
authors.forename: Laure
authors.initials: L
authors.lastname: Thibault
authors.forename: Hélène
authors.initials: H
authors.lastname: André
authors.forename: François
authors.initials: F
authors.lastname: Tixier
authors.forename: Marie
authors.initials: M
authors.lastname: Lemercier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Antok
authors.forename: Marie Pierre
authors.initials: MP
authors.lastname: Cresta
authors.forename: Philippe
authors.initials: P
authors.lastname: Grivard
authors.forename: Mathieu
authors.initials: M
authors.lastname: Besnard
authors.forename: Olivier
authors.initials: O
authors.lastname: Rollot
authors.forename: François
authors.initials: F
authors.lastname: Favier
authors.forename: Michel
authors.initials: M
authors.lastname: Huerre
authors.forename: José L
authors.initials: JL
authors.lastname: Campinos
authors.forename: Alain
authors.initials: A
authors.lastname: Michault
mesh_terms: 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