Introduction:

chikungunya is a febrile disease characterized by acute polyarthralgias and polyarthritis, often chronic. In children, it has different and severe clinical manifestations, mainly in young infants.

Objectives:

to identify clinical, laboratory characteristics, and risk factors regarding the severity of Chikungunya in ≤15-year-old patients hospitalized in 12 hospitals in Paraguay.

Methodology:

multicenter, observational, descriptive, longitudinal, analytical study in patients aged 0 to 15 years hospitalized with confirmed (RT-PCR) or probable (IgM/link) Chikungunya between November 2022 and May 2023, included in the study by consecutive case sampling. Demographic, clinical, laboratory, evolutionary characteristics, and complications were collected. Descriptive statistics were used; quantitative variables were expressed as mean, and qualitative variables as percentages. The Chi-squared test and the Z test were used as needed. The study was approved by the Ethics Committee of the Institute of Tropical Medicine.

Results:

454 patients were included, of whom 201 (44.3%) were newborns, 119 (26.2%) were 1 to 12 months old, 28 (6.2%) were 13 to 24 months old, 31 (6.8%) were 25 to 60 months old, 49 (10.8%) were 61 to 120 months old, an 26 (5.7%) were >120 months old; 247 (54.4%) were male. The most frequent symptoms were: fever 384 (84.6%), rash 266 (58.6%), acrocyanosis 93 (20.5%); seizures 79 (17.4%); maculovesicular rash 47 (10.4%). Laboratory findings included leukopenia 124 (27.3%), lymphopenia 167 (36.8%), neutropenia 32 (7.0%), positive PCR 190 (41.9%). The mean length of hospital stay was 9.4 ± 8.0 days; 164 (32.2%) required ICU admission, staying 7.8 ± 6.4 days. Encephalitis occurred in 65 (14.3%), myocarditis in 76 (16.7%), shock in 109 (24%), septic shock in 60 (12.2%), multiorgan failure in 25 (5.5%); death occurred in 13 (2.9%). The need for ICU and mechanical ventilation was significantly more frequent in newborns and infants, as well as in those with acrocyanosis, seizures, respiratory distress, and convulsions. Death was significantly associated with acrocyanosis, seizures, and respiratory distress.

Conclusions:

the Chikungunya epidemic in children was characterized by the presence of severe and atypical clinical manifestations, mainly in ≤12-month-olds. The most frequent symptoms were fever, rash, acrocyanosis, and seizures. Prematurity, age <12 months, acrocyanosis, edema, seizures, respiratory distress, and lymphopenia at admission were associated with greater severity, with shock, need for ICU, and mechanical ventilation. Acrocyanosis, respiratory distress, and seizures were factors associated with higher lethality.

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