A Child with Serious Chikungunya Virus (CHIKV) Infection Requiring Intensive Care, After an Outbreak

Abstract

A 5 1/2-yr-old boy presented with high grade fever for 4 days, and cervical adenitis, body ache, arthralgia, followed by sudden onset of breathlessness. He had clinical, electrocardiographic and echo evidence of myocarditis and congestive cardiac failure. An enzyme-linked immunosorbent assay (MAC-IgM ELISA) with serum collected 5 days after disease onset showed IgM antibodies to CHIKV. He was managed conservatively and started showing symptomatic improvement by 3 days. At discharge, a repeat Echocardiogram (a week later) showed normal left ventricular (LV) function with mild Mitral regurgitation. On follow up, after 2 months, child remains asymptomatic. Other common aetiological agents were screened for and found negative. This may indicate a probable cardiac tropism for the virus.

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

“…mentioned and delimited specific and very valid diagnostic criteria to what is called CHIKV-induced myopericarditis in their case report. They demonstrated clinical, biological and morphological evidence of myocarditis, with serologically documented CHIKV infection and no serologic evidence of another recent infection, then linking that the cardiovascular compromise was associated with CHIKV 18, 28 . Results like these are very useful but it is always advisable to always look at these criteria in the context of the patients and their previous comorbidities.…”

“…The most documented electrocardiographic changes were T wave inversion in DII, III, aVF and V5-V6, and ST elevation 18, 23, 28, 29 . These are relatively nonspecific findings, which are encouraged to be interpreted within the whole clinical context so that other compatible differential diagnoses such as acute coronary syndrome, electrolyte disorder, or even digitalis intoxication, can be dismissed 20 .…”

“…Even though the most common extra-articular manifestations reported in the literature involve the nervous system 25– 27 and the eye 17 ; alterations in the gastrointestinal tract, liver 16 , kidney, muscles, mucous membranes and skin and hematologic cells have been evidenced, as well as in hemostasis and coagulation processes. Cardiovascular compromise is worthy of mentioning because of its usually fatal outcomes 10, 28 . Infection can leds to cardiovascular manifestations, but in addition, patients with existing cardiovascular disease can be decompensated consequently altering its clinical control of disease, then worsening the short-term prognosis; as it has been described with diabetes, lupus; or neurological, renal, pulmonary and cardiovascular insufficiency 9, 11, 23 .…”

“…Myocardial biopsy revealed extensive necrosis and cytoplasmic viral inclusions in the cells 29 . Nowadays, evidence shows that, besides the heart, CHIKV may also have tropism for the nervous system and the liver 28 .…”

“…Ejection fraction may be mildly diminished and pericardial effusion is rare. Creatine Phospho-Kinase (CPK) levels may be increased after the first phase 28 .…”