title: Severe manifestations of chikungunya virus in critically ill patients during the 2013-2014 Caribbean outbreak.
abstract: OBJECTIVE
  A chikungunya epidemic occurred in 2013-2014 in the Caribbean and Americas. Although the disease is usually benign, some patients required admission to the intensive care unit (ICU). The characteristics and outcomes of patients with chikungunya virus (CHIKV) infection admitted to an ICU during this epidemic are reported.
  
  
  METHODS
  An observational study of consecutive patients with confirmed CHIKV infection admitted to ICUs in Martinique and Guadeloupe, French West Indies, between January and November 2014, was performed. In addition, patients with CHIKV-related manifestations were compared with those whose manifestations were not specifically related to CHIKV infection.
  
  
  RESULTS
  Sixty-five patients were admitted to the ICU with CHIKV infection. Fifty-four (83%) had a pre-existing underlying disease and 27 (41.5%) were admitted due to exacerbation of a comorbidity. Thirty-seven (57%) patients were mechanically ventilated. ICU and hospital mortality rates were 26% and 27%, respectively. CHIKV-related manifestations were observed in 28 (18%) patients and were mainly encephalitis, Guillain-Barré syndrome, and severe sepsis. These patients less frequently had chronic arterial hypertension and diabetes and more frequently had autoimmune diseases compared with patients without CHIKV-related manifestations.
  
  
  CONCLUSIONS
  Most patients admitted to the ICU with CHIKV infection had a pre-existing comorbidity. However, severe manifestations such as Guillain-Barré syndrome, encephalitis, and severe sepsis could be specifically related to CHIKV.
authors.affiliation: Intensive Care Unit, University Hospital of Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Crosby
authors.affiliation: Intensive Care Unit, University Hospital of Fort de France, Martinique, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Perreau
authors.affiliation: Intensive Care Unit, University Hospital of Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Madeux
authors.affiliation: Intensive Care Unit, University Hospital of Fort de France, Martinique, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Cossic
authors.affiliation: Department of Public Health and Medical Information, University Hospital of Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Armand
authors.affiliation: Laboratory of Virology, University Hospital of Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Herrmann-Storke
authors.affiliation: Laboratory of Virology, University Hospital of Fort de France, Martinique, France.
authors.forename: Fatiha
authors.initials: F
authors.lastname: Najioullah
authors.affiliation: Intensive Care Unit, University Hospital of Fort de France, Martinique, France.
authors.forename: Ruddy
authors.initials: R
authors.lastname: Valentino
authors.affiliation: Intensive Care Unit, University Hospital of Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, France. Electronic address: guillaume.thiery@chu-guadeloupe.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiéry
mesh_terms: D000328:Adult; D017691:Caribbean Region / Q000453:epidemiology; D065632:Chikungunya Fever / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016638:Critical Illness; D004196:Disease Outbreaks; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology; D013997:Time Factors
keywords: Arbovirus; Chikungunya; Encephalopathy; Guillain–Barré syndrome; Intensive care; Sepsis