Severe and unusual presentation of Chikungunya virus infections in patients hospitalized in adult intensive care. San Lorenzo, Paraguay

Chikungunya virus infection is transmitted by vectors such as Aedes aegypti and Aedes albopictus. It is characterized by a febrile clinical presentation, associated with arthromyalgia, with infrequent severe manifestations, which would imply the failure of organic systems with a significant increase in morbidity and mortality. These cases require admission and management in Intensive Care Units (ICU). 10 serious cases of patients infected by the Chikungunya virus admitted to the Intensive Care Unit of the Hospital de Clínicas in January and February 2023 are presented. Demographic and clinical data, complications of the disease and mortality of those involved were analyzed. The diagnosis of 70% of the cases were confirmed by RT-PCR serum (reverse transcription polymerase chain reaction), the others (30%) by serum immunoglobulin ‑ Mantibodies. In our population, 50% corresponded to the male sex. The mean age was 62 years, with a range between 36 and 87 years. Nine patients (90%) suffered from comorbidities such as hypertension, diabetes mellitus, obesity, chronic kidney disease, rheumatoid arthritis, osteoarthritis, and obstructive sleep apnea syndrome. Mean admission APACHE II and SOFA scores were 16,5 ± 6 and 7 ± 4 respectively. On admission, the most frequent clinical manifestations were fever (100%), arthralgia, myalgia and asthenia (50%), anorexia (30%); more rarely, altered sensorium (20%), dizziness (10%), dyspnea (20%), legs weakness and difficulty in swallowing (10%) and diarrhea (10%). The main reasons for admission to the ICU were shock (70%) and requirement of mechanical ventilation (30%). 80% of the cases presented acute renal failure; other atypical presentations were encephalitis (10%) and Guillain-Barré syndrome (10%), myocarditis (10%) and acute respiratory distress syndrome (10%). During hospitalization, mechanical ventilation (MV) was required in 80%, with a mean number of days of 6 ± 5; vasopressors support in 70% and hemodialysis in 40% of cases. The mean length of stay in the ICU was 9 ± 4 days. Mortality was 60%. Of the deceased, 83.3% presented renal failure. Patients who develop severe atypical forms of the disease have a higher probability of organ failure. We emphasize that the most frequent complication observed in this group of patients was renal involvement, with a high mortality.