Chikungunya Infection Can Be Severe in Children

Most international travelers know infected mosquitoes transmit chikungunya, dengue, and Zika viruses. However, when an infected person seeks medical care, it can be challenging to identify which arbovirus they have contracted.

The recent outbreak of chikungunya virus (CHIKV) outbreaks in India has gained attention because of its unusual symptoms, the increased need for hospitalization, and the high level of morbidity associated with the illness.

According to a recent Case-Report, the clinical manifestations that were particularly worrying included seizures, signs of raised intracranial pressure, shock, and respiratory distress.

Published by the Journal of Pediatric Critical Care in April 2025, this is a case series of 36 children hospitalized with acute severe CHIKV infection requiring intensive care in tertiary care centers in Pune, Maharashtra.

Diagnosis was confirmed by reverse transcription–polymerase chain reaction or IgM level. Among severe presentations, the majority of children had neurological manifestations that included seizures in 20 (56%), irritability in 16 (44%), and drowsiness in 7 (19%) cases.

Twelve (33%) children had respiratory distress, 6 (16%) had hypotensive shock and required inotropic support, and 3 (8%) had acute liver cell failure, of which one child required liver transplantation. Two (5%) had hemophagocytic lymphohistiocytosis. All children were successfully discharged.

The neurological manifestations we observed were seizures, irritability, and drowsiness in 21 (60%).

Hypotensive shock was observed in 6 (16%) patients.

Also observed respiratory distress in 12 (33%) patients.

Since CHIKV can cause temporary liver damage, the virus will likely persist in liver endothelial cells. It causes inflammation, steatosis, and necrosis of hepatocytes.[13] We observed acute hepatic failure in 3 patients; Samra et al. observed that 14 CHIKV patients had meningoencephalitis, 29% of these 11 had acute hepatitis, and two children died due to meningoencephalitis and myocarditis.

They observed severe thrombocytopenia in 3 (8%) children, and 2 of them needed platelet transfusions.

These researchers wrote, 'despite all the above, CHIKV is a self-limiting illness with good recovery.

We found that all children completely recovered without any residual sequelae at the time of discharge. Analysis of the recent outbreak suggests that the increased severity of the disease may be due to a change in the genetic sequence, altering the virus's coat protein, and potentially allowing it to multiply more quickly in mosquito cells.'

To conclude, CHIKV had severe manifestations with neurological, respiratory, cardiac, hepatic, and hematological involvement. The condition appears to be more severe in infants, but with vigilant management, there were no mortalities. Thus, treating physicians must be aware of the unusual presentations, particularly during a disease outbreak, to ensure a favorable outcome.'

As of May 11, 2025, chikungunya is a vaccine-preventable disease. U.S. FDA-approved CHIKV vaccines are commercially offered in travel clinics and pharmacies throughout the United States.