Volume 24, Number 9—September 2018
Dispatch
Severe Manifestations of Chikungunya Fever in Children, India, 2016
Pradeep K. Sharma
, Maneesh Kumar, Girraj K. Aggarwal, Virender Kumar, R.D. Srivastava, Ashish Sahani, and Rohit Goyal
, Maneesh Kumar, Girraj K. Aggarwal, Virender Kumar, R.D. Srivastava, Ashish Sahani, and Rohit Goyal
Table
Demographic, clinical, and laboratory features at admission of pediatric patients with severe and nonsevere chikungunya fever, New Delhi, India, 2016*
| Parameters | Nonsevere disease, n = 36 | Severe disease, n = 13 | p value† |
|---|---|---|---|
| Median age, y (range) | 6.5 (0.75–15) | 12 (0.5–14) | 0.28 |
| Male:female ratio |
3.5:1 |
2.25:1 |
0.53 |
| Age group | |||
| Infant, 1 mo–1 y | 3 (8.3) | 4 (30.7) | 0.06 |
| Toddler, 2–5 y | 13 (36) | 1 (7.7) | |
| School age, 6–12 y | 3 (8.3) | 0 | |
| Adolescent, 13 to <18 y |
17 (47.2) |
8 (61.5) |
|
| Clinical profile | |||
| Fever | 36 (100) | 13 (100) | |
| Body ache | 10 (27.7) | 4 (30.7) | 0.83 |
| Rash | 15 (41.6) | 8 (61.5) | 0.22 |
| Arthralgia | 5 (13.9) | 3 (23) | 0.44 |
| Vomiting | 15 (41.6) | 5 (38.4) | 0.84 |
| Seizures | 11 (30.5) | 1 (7.7) | 0.14 |
| Bleeding | 3 (8.3) | 4 (30.7) | 0.16 |
| Abdominal pain | 4 (11) | 5 (38.4) | 0.25 |
| Peripheral cyanosis and mottling of skin | 2 (5.5) | 10 (76.9) | 0.00 |
| Encephalopathy |
0 |
3 (23) |
0.01 |
| Laboratory test results, median (range) | |||
| Hemoglobin, g/dL | 12.2 (6.6–17.5) | 11.6 (8–13.5) | 0.08 |
| White cell count/µL | 8,195 (3,700–15,200) | 11,200 (4,100–44,800) | 0.058 |
| Platelet count, × 103/µL) | 203 (25–362) | 192 (13–362) | 0.61 |
| AST, IU/L | 44 (22–174) | 43 (16–8,837) | 0.96 |
| ALT, IU/L | 20 (9–96) | 24 (8–2,311) | 0.26 |
| Albumin | 3.75 (3.5–4) | 3.3 (1.6–3.5) | 0.006 |
| Urea, mg/dL | 21 (11–55) | 36 (13–87) | 0.094 |
| Creatinine, mg/dL | 0.4 (0.3–1.2) | 0.6 (0.2–1.3) | 0.37 |
| APTT, s, control 28.4 s | NA | 41.7 (27–247) | |
| PT, s, control 13.3 s | NA | 22.3 (18.5–117) | |
| International normalized ratio |
NA |
1.77 (1.3–12.4) |
|
| Organ dysfunction | |||
| Cardiovascular | 0 | 11 (84.6) | |
| Respiratory | 0 | 3 (23) | |
| Hematological | 0 | 5 (38.4) | |
| Neurologic | 0 | 3 (23) | |
| Renal | 0 | 2 (15.3) | |
| Hepatic |
0 |
3 (23) |
|
| Course and outcome | |||
| Mechanical ventilation | 0 | 3 (23) | |
| Inotropic support | 0 | 11 (84.6) | |
| Renal replacement | 0 | 2 (15.3) | |
| Hospital stay, d (range) | 3 (2–7) | 5 (2–13) | 0.0015 |
| Death | 0 | 1 (7.7) | |
*Values are no. (%) patients except as indicated. ALT, alaninine aminotransferase; APTT, activated partial thromboplastin time; AST, aspartate aminotransferase; NA, not applicable; PT, prothrombin time.
†Categorical variables were compared using the χ2 test or Fisher exact test, as appropriate, and continuous variables were compared by using the nonparametric Mann-Whitney test. p values <0.05 were considered statistically significant and are shown in bold type.
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Page updated: August 15, 2018
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