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Chikungunya Infection in Hospitalized Febrile Infants Younger Than 3 Months of Age

Elenga, Narcisse MD, PhD*; Folin, Marion MD*; Vandamme, Yves-Marie MD; Cuadro-Alvarez, Emma MD*; Long, Laurence MD*; Njuieyon, Falucar MD*; Martin, Elise MD*; Kom-Tchameni, Rémi MD*; Defo, Antoine MD*; Herinantenaina Razafindrakoto, Sitraka MD*; Mrsic, Yajaira MD*; Couppie, Pierre MD, PhD; Nacher, Mathieu MD, PhD§; Dufour, Julie MD

Pediatric Infectious Disease Journal: August 2017 - Volume 36 - Issue 8 - p 736–740
doi: 10.1097/INF.0000000000001541
Original Studies

Background: Fever in infants younger than 3 months is generally a cause for concern because of the risk for a serious bacterial infection. The aim of this study was to describe clinical and biologic features of Chikungunya infection in infants <3 months of age hospitalized in Cayenne Hospital during the 2014–2015 outbreak.

Methods: We performed a preliminary retrospective study followed by a prospective study from March 2014 to February 2015. All infants younger than 3 months presenting with fever and hospitalized in Cayenne Hospital were included. The main diagnostic criteria were fever and positive Chikungunya polymerase chain reaction.

Results: One hundred and twenty infants were hospitalized with fever. The mean age was 46 days (standard deviation ± 22 days). The mean hospitalization duration was 7.4 days (standard deviation ± 6.1 days). Chikungunya infection was diagnosed in 26 children. The most important clinical findings were high [80.8% (77.5–84)] and prolonged fever [76.9% (73.4–80.4)], irritability [96.2% (94.5–97.7)] and skin rash [69.2% (65.4–73)]. Half of the infants presented edema of the extremities (hands and feet principally). However, in 15% of infants, Chikungunya infection was associated with a serious bacterial infection. Infants who presented with irritability, high fever and elevated PCT were at high risk for Chikungunya: OR 39 (9.2–243; P < .001), with a specificity of 96.7% and a negative predictive value of 89.4%. The area of the receiver operating characteristic curve was 0.96.

Conclusions: Our results confirm that Chikunguyna infection is a cause of high fever in infants younger than 3 months. Our data should be confirmed by larger studies.

From the *Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana; Department of Infectious Disease, University Hospital of Angers, France; Department of Dermatology, and §Centre d’Investigation Clinique Antilles-Guyane, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306 Cayenne Cedex, French Guiana.

Accepted for publication September 28, 2016.

The authors received no specific funding for this work. They have no conflicts of interest to disclose.

Address for correspondence: Narcisse Elenga, MD, PhD, Department of Pediatrics, Regional Hospital, Cayenne, French Guiana, Rue des Flamboyants BP 6006–97306 Cayenne Cedex. E-mail: elengafr@yahoo.fr.

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