Severe Chikungunya infection in Northern Mozambique: a case report.
BACKGROUND
Although Chikungunya virus has rapidly expanded to several countries in sub-Saharan Africa, little attention has been paid to its control and management. Until recently, Chikungunya has been regarded as a benign and self-limiting disease. In this report we describe the first case of severe Chikungunya disease in an adult patient in Pemba, Mozambique.


METHODS
A previously healthy 40 year old male of Makonde ethnicity with no known past medical history and resident in Pemba for the past 11 years presented with a severe febrile illness. Despite administration of broad spectrum intravenous antibiotics the patient rapidly deteriorated and became comatose while developing anaemia, thrombocytopenia and later, melaena. Laboratory testing revealed IgM antibodies against Chikungunya virus. Malaria tests were consistently negative.


CONCLUSIONS
This report suggests that Chikungunya might cause unsuspected severe disease in febrile patients in Mozambique and provides insights for the improvement of national protocols for management of febrile patients in Mozambique. We recommend that clinicians should consider Chikungunya in the differential diagnosis of febrile illness in locations where Aedes aegypti mosquitos are abundant.
Pemba Operational Research Unit, Ministry of Health, Pemba, Mozambique.
Mussa Manuel
MM
Aly
National Institute of Health, Ministry of Health, Av Eduardo Mondlane 1008, Ministry of Health Main Building, 2nd Floor, PO Box 264, Maputo, Mozambique.
Sadia
S
Ali
National Institute of Health, Ministry of Health, Av Eduardo Mondlane 1008, Ministry of Health Main Building, 2nd Floor, PO Box 264, Maputo, Mozambique.
Argentina Felisbela
AF
Muianga
National Institute of Health, Ministry of Health, Av Eduardo Mondlane 1008, Ministry of Health Main Building, 2nd Floor, PO Box 264, Maputo, Mozambique.
Vanessa
V
Monteiro
Cabo Delgado Provincial Health Directorate, Pemba, Mozambique.|Pemba Provincial Hospital, Pemba, Mozambique.
Jorge Galano
JG
Gallego
Centre for Emerging and Zoonotic Diseases, National Institute for Communicable Disease, National Health Laboratory Service, Sandringham, South Africa.
Jacqueline
J
Weyer
The Public Health Agency of Sweden, Stockholm, Sweden.|Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Kerstin I
KI
Falk
Centre for Emerging and Zoonotic Diseases, National Institute for Communicable Disease, National Health Laboratory Service, Sandringham, South Africa.|Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg, South Africa.
Janusz Tadeusz
JT
Paweska
Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Julie
J
Cliff
National Institute of Health, Ministry of Health, Av Eduardo Mondlane 1008, Ministry of Health Main Building, 2nd Floor, PO Box 264, Maputo, Mozambique. esamogudojr@gmail.com.
Eduardo Samo
ES
Gudo
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D001772:Blood Cell Count; D065632:Chikungunya Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D002646:Chikungunya virus / Q000472:pathogenicity* / Q000502:physiology; D003937:Diagnosis, Differential; D005334:Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007195:Indian Ocean Islands; D007964:Leukocytosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008297:Male; D008551:Melena / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D009073:Mozambique; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D000914:Antibodies, Viral; D007075:Immunoglobulin M
Arboviruses; Case reports; Chikungunya; Fever; Mozambique