<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-1249</journal-id>
<journal-title><![CDATA[Archivos de Pediatría del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Arch. Pediatr. Urug.]]></abbrev-journal-title>
<issn>1688-1249</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Pediatría]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-12492025000201501</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Factores de severidad en &#8804;15 años hospitalizados con diagnóstico de chikungunya]]></article-title>
<article-title xml:lang="en"><![CDATA[Severity factors in &#8804;15-year-old patients hospitalized with a diagnosis of chikungunya]]></article-title>
<article-title xml:lang="pt"><![CDATA[Fatores de gravidade em pacientes de &#8804;15 anos hospitalizados com diagnóstico de Chikungunya]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lovera]]></surname>
<given-names><![CDATA[Dolores]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alfonso]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Amarilla]]></surname>
<given-names><![CDATA[Sara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aranda]]></surname>
<given-names><![CDATA[Cinthia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bareiro]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Baruja]]></surname>
<given-names><![CDATA[Deisy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brítez]]></surname>
<given-names><![CDATA[Sebastián]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Delgado]]></surname>
<given-names><![CDATA[Vivian]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Duarte]]></surname>
<given-names><![CDATA[Laura]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueredo]]></surname>
<given-names><![CDATA[Juan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[Rosanna]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Galeano]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Genes]]></surname>
<given-names><![CDATA[Larissa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gianninoto]]></surname>
<given-names><![CDATA[Eliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Alejandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Nicolás]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[Jimmy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jojot]]></surname>
<given-names><![CDATA[Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ledesma]]></surname>
<given-names><![CDATA[Raquel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Merlo]]></surname>
<given-names><![CDATA[Óscar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lovera]]></surname>
<given-names><![CDATA[Irma]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreno]]></surname>
<given-names><![CDATA[Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Núñez]]></surname>
<given-names><![CDATA[Débora]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortega]]></surname>
<given-names><![CDATA[Natalia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Osorio]]></surname>
<given-names><![CDATA[Fátima]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Paredes]]></surname>
<given-names><![CDATA[Beatriz]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Quintero]]></surname>
<given-names><![CDATA[Lorena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Mónica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Samudio]]></surname>
<given-names><![CDATA[Gloria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[Ma. José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[Celia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Medicina Tropical Urgencias pediátricas ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Nacional de Itaugua  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Santísima Trinidad  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af4">
<institution><![CDATA[,Cruz Roja Paraguaya Hospital Reina Sofía ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af5">
<institution><![CDATA[,Hospital General Materno infantil San Pablo Depto. Neonatología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af6">
<institution><![CDATA[,Hospital General de Luque Pediatría ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af7">
<institution><![CDATA[,Hospital de Clínicas  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af8">
<institution><![CDATA[,Hospital de Villa Elisa  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af9">
<institution><![CDATA[,Hospital de Policía Rigoberto Caballero  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="A10">
<institution><![CDATA[,Instituto de Previsión Social  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="A11">
<institution><![CDATA[,Hospital Regional de Ciudad del Este  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="A12">
<institution><![CDATA[,Hospital Militar Central  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="A13">
<institution><![CDATA[,Región Sanitaria Laboratorio XVIII Depto. Pediatría]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>96</volume>
<numero>nspe1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-12492025000201501&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-12492025000201501&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-12492025000201501&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[resumen está disponible en el texto completo]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary  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 &#8804;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 &gt;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 &#8804;12-month-olds. The most frequent symptoms were fever, rash, acrocyanosis, and seizures. Prematurity, age &lt;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.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  a Chikungunya é uma doença febril caracterizada por poliartralgias e poliartrites agudas, frequentemente crônicas. Nas crianças, tem manifestações clínicas diferentes e graves, principalmente no lactente menor.  Objetivos:  identificar características clínicas, laboratoriais e fatores de risco de gravidade da Chikungunya em pacientes &#8804;15 anos, internados em 12 hospitais do Paraguai.  Metodologia:  estudo multicêntrico observacional, descritivo, longitudinal, analítico, em pacientes de 0 a 15 anos hospitalizados com Chikungunya confirmado (RT-PCR) ou provável (IgM/nexo) entre novembro/22-maio/23, incluídos no estudo por amostragem de casos consecutivos. Foram coletadas as características demográficas, clínicas, laboratoriais, evolutivas e complicações. Utilizou-se estatística descritiva; as variáveis quantitativas foram expressas em média, e as variáveis qualitativas em porcentagens. Utilizou-se o teste de Qui-quadrado e o teste Z conforme a necessidade. Estudo aprovado pelo Comitê de Ética do Instituto de Medicina Tropical.  Resultados: foram incluídos 454 pacientes, dos quais 201 (44,3%) recém-nascidos, 119 (26,2%) de 1 a 12 meses, 28 (6,2%) de 13 a 24 meses, 31 (6,8%) de 25 a 60 meses, 49 (10,8%) de 61 a 120 meses e 26 (5,7%) &gt;120 meses; do sexo masculino 247 (54,4%). Os sintomas mais frequentes foram: febre 384 (84,6%), exantema 266 (58,6%), acrocianose 93 (20,5%); convulsões 79 (17,4%); exantema maculovesicular 47 (10,4%). Laboratorialmente, leucopenia 124 (27,3%), linfopenia 167 (36,8%), neutropenia 32 (7,0%), PCR (+) 190 (41,9%). A média de dias de hospitalização foi de 9,4 ± 8,0 dias; 164 (32,2%) necessitaram de UTI, permanecendo 7,8 ± 6,4 dias. Apresentaram encefalite 65 (14,3%), miocardite 76 (16,7%), choque 109 (24%), choque séptico 60 (12,2%), falha multiorgânica 25 (5,5%); óbito 13 (2,9%). A necessidade de UTI e ventilação mecânica invasiva foi significativamente mais frequente em recém-nascidos e lactentes, assim como naqueles com acrocianose, convulsões, dificuldade respiratória e convulsões. O óbito foi significativamente associado à acrocianose, convulsões e dificuldade respiratória.  Conclusões: a epidemia de Chikungunya em crianças caracterizou-se pela presença de manifestações clínicas graves e atípicas, principalmente em &#8804;12 meses. Os sintomas mais frequentes foram febre, exantema, acrocianose e convulsões. Prematuridade, idade &lt;12 meses, acrocianose, edema, convulsões, dificuldade respiratória e linfopenia na admissão foram associados a maior gravidade, com choque, necessidade de UTI e ventilação mecânica invasiva. Acrocianose, dificuldade respiratória e convulsões foram fatores associados a maior letalidade.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Virus Chikungunya]]></kwd>
<kwd lng="es"><![CDATA[Fiebre Chikungunya]]></kwd>
<kwd lng="es"><![CDATA[Índice de Severidad de la Enfermedad]]></kwd>
<kwd lng="en"><![CDATA[Chikungunya Virus]]></kwd>
<kwd lng="en"><![CDATA[Chikungunya Fever]]></kwd>
<kwd lng="en"><![CDATA[Disease Severity Index]]></kwd>
<kwd lng="pt"><![CDATA[Vírus Chikungunya]]></kwd>
<kwd lng="pt"><![CDATA[Febre Chikungunya]]></kwd>
<kwd lng="pt"><![CDATA[Índice de Gravidade da Doença]]></kwd>
</kwd-group>
</article-meta>
</front>
</article>
