Serious acute chikungunya virus infection requiring intensive care during the reunion island outbreak in 2005-2006
Serious acute chikungunya virus infection requiring intensive care during the reunion island outbreak in 2005-2006
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DOI：
10.1097/ccm.0b013e318183f2d2
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发表时间：
2008-09-01
影响因子：
8.8
通讯作者：
Michault, Alain
中科院分区：
文献类型：
--
作者：
Lemant, Jerome;Boisson, Veronique;Michault, Alain
目的：报告重症监护病房住院的严重基孔肯雅病毒急性感染成人的临床和实验室检查结果。设计：2005年8月至2006年5月的病例系列研究。地点：南留尼旺医院重症监护室。患者：我们观察了入住重症监护室的33例确诊的急性基孔肯雅病毒感染（血清中基孔肯雅病毒-IgM或逆转录聚合酶链反应阳性）。干预措施：我们从重症监护病房疑似基孔肯雅热的患者身上采集了脑脊液、血清，有时还采集了组织样本。这些样本接受了病毒检测，以寻找急性基孔肯雅病毒感染的证据。测量和主要结果：在 33 名患者中，19 名 (58%) 具有基孔肯雅病毒特定表现，8 名 (24%) 患有相关急性传染病，6 名 (18%) 先前主诉恶化。在基孔肯雅病毒的具体表现中，我们发现了14例脑病，心肌炎、肝炎和格林巴利综合征各1例。 85% 的患者的 McCabe 评分 = 1（非致命或无基础疾病）。死亡率为 48%。结论：基孔肯雅病毒感染可能导致非常严重的临床表现，包括没有特殊病史的年轻患者。基孔肯雅病毒感染被强烈怀疑具有神经、肝脏和心肌趋向性，导致严重的并发症和高死亡率。
Objective: To report the clinical and laboratory findings of adults with serious chikungunya virus acute infection hospitalized in an intensive care unit.Design: Case series study from August 2005 to May 2006.Setting: Medical intensive care unit, South Reunion Hospital.Patients: We observed 33 episodes of confirmed acute chikungunya virus infection (chikungunya virus-IgM or reverse transcription-polymerase chain reaction positive in the serum) admitted to the intensive care unit.Interventions: We collected cerebrospinal fluid, serum, and sometimes tissue samples from patients with suspected chikungunya fever in our intensive care unit. These samples underwent viral testing for evidence of acute chikungunya virus infection.Measurements and Main Results: Of the 33 patients, 19 (58%) had chikungunya virus specific manifestations, 8 (24%) had associated acute infectious disease and 6 (18%) exacerbations of previous complaints. Among the chikungunya virus specific manifestations, we identified 14 cases of encephalopathy, one case each of myocarditis, hepatitis and Guillain Barre syndrome. Eighty-five percent of patients had a McCabe score = 1 (for nonfatal or no underlying disease). Mortality was 48%.Conclusions: Chikungunya virus infection may be responsible for very severe clinical presentation, including young patients with unremarkable medical histories. Chikungunya virus infection is strongly suspected to have neurologic, hepatic, and myocardial tropism leading to dramatic complications and high mortality rate.