Systemic involvements and fatalities during Chikungunya epidemic in India, 2006
Introduction
Chikungunya infection usually causes a self-limited febrile illness,1 but there are anecdotal reports of severe Chikungunya infection in India, including neurologic manifestations reported during the first Indian outbreak.2, 3 Atypical clinical features, noted in the 2005–2007 outbreaks from Reunion Island,4 included neurologic manifestations in adults, fetuses and neonates, mother-to-child transmission, meningoencephalitis, myocarditis, hepatitis, and extensive dermal lesions,5 and a number of deaths were attributed,6 directly or indirectly, to Chikungunya.
The current outbreak, caused by the central/east African genotype,7 caused 1,400,000 cases in India during 2006.8 Chikungunya-associated meningoencephalitis in Pune9 and Kota,10 and acute flaccid paralysis in the Andaman and Nicobar Islands11 were reported. Ahmedabad city reported 60,777 Chikungunya hospitalizations in 2006 with 50,000 between August and November 2006 and increased all-cause mortality during the period.12, 13 Chikungunya infections in Ahmedabad and Pune resulted in systemic complications during that outbreak. We describe the clinical manifestations of laboratory-confirmed Chikungunya cases hospitalized with systemic syndromes and their association with risk groups.
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Patients and procedures
Prospective investigation of suspected Chikungunya cases hospitalized in 10 hospitals in Ahmedabad was undertaken between September and October 2006. Cases in general wards and neurologic, cardiac, intensive/critical care, or high dependency units were enrolled. We interviewed and examined the patients, documented their clinical course, and reviewed and abstracted their hospital records. Retrospective investigation of laboratory-confirmed Chikungunya cases hospitalized with neurologic syndromes
Systemic syndromes in Ahmedabad
First we describe all the 114 hospitalized suspected Chikungunya cases from Ahmedabad. Clinical specimens included 14 CSF, 114 acute phase sera and 17 convalescent phase sera. Chikungunya was confirmed in 90 (78.9%) cases (Table 1) with diagnostic criteria as depicted in Table 2. Clinical syndromes among 90 laboratory-confirmed hospitalized Chikungunya cases in Ahmedabad are described in the following sections.
- A.
Classical Chikungunya
Classical Chikungunya was noted in 25 (27.8%) hospitalized cases
Discussion
This report documents the diverse clinical syndromes in 149 hospitalized laboratory-confirmed Chikungunya cases during the recent outbreak in India. A study in Madras17 as early as 1964 showed severe manifestations in 14 (16.3%) of 86 hospitalized cases, which included 3 cases with neurologic manifestations; 6 cases with cardiovascular manifestations; and 5 cases with hemorrhages. In contrast, the proportion of cases with severe manifestations (65; 72.2%), particularly of a neurologic nature
Funding
Indian Council of Medical Research.
Conflicting interests
None.
Ethical approval
Not required.
Acknowledgements
We acknowledge Dr Amit Bhatt and Dr Shalin Shah for clinical investigations, Dr Y.K. Gurav and Mr P.A. More for collecting data, Mr B.N. Tilekar for collecting samples, Mrs. S.L. Hundekar for serological testing, Mrs A.Y. Ramadasi for viral genome detections, Mr S.M. Jadhav for statistical analysis and Mrs Vasanthy Venkatesh for data entry and typing the manuscript.
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