[Severe forms of chikungunya virus infection in a pediatric intensive care unit on Reunion Island].
In 2005-2006, an unexpected, massive outbreak of chikungunya occurred on Reunion Island, a French overseas territory in the Indian Ocean. This arboviral infection transmitted by a mosquito of the Aedes genus is usually benign. A surprising feature of the Reunion Island epidemic was the occurrence of rare severe forms involving adults as well as children.


OBJECTIVE
The purpose of this report is to describe severe forms of chikungunya observed in children hospitalized in a pediatric intensive care unit.


METHODS
This retrospective single-center study was conducted from January 1st to April 30th, 2006. Children between 1 month and 15 years admitted to the pediatric intensive care unit with proven chikungunya infection were included.


RESULTS
A total of 9 children were included. The main manifestations were extensive skin blisters in 5 cases, neurological symptoms (encephalopathy) in 4, cardiac complications (myocarditis, hemodynamic disorders) in 5 and bleeding in 1. Two children died. The causes of death were circulatory failure associated with coma and massive hemorrhage in one case and post-infectious encephalitis in the other. Three survivors present long-term neurologic or dermatologic sequels.


CONCLUSIONS
Severe cases of chikungunya in children provide a stark reminder of the cardiac and neurological tropism of the virus and its hemorrhagic forms with high potential mortality and morbidity. These cases underline the need for personal protection measures and for research to develop specific antiviral therapy and vaccines to prevent potentially lethal forms of the disease.
Service de Réanimation Néonatale et Pédiatrique, CHR Félix Guyon, 97405 Saint-Denis, La Réunion.
A S
AS
Pellot
J L
JL
Alessandri
S
S
Robin
S
S
Sampériz
T
T
Attali
C
C
Brayer
M
M
Pasquet
M C
MC
Jaffar-Bandjee
L S
LS
Benhamou
I
I
Tiran-Rajaofera
D
D
Ramful
D000293:Adolescent; D018354:Alphavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D065632:Chikungunya Fever; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D017508:Reunion / Q000453:epidemiology; D012720:Severity of Illness Index; D012872:Skin Diseases, Vesiculobullous / Q000453:epidemiology / Q000209:etiology