Maharashtra experienced one of its worst chikungunya outbreaks in 2024, with over 5,000 cases statewide. Pune emerged as a hotspot, reporting 462 confirmed infections. A new study published in the Journal of Pediatric Critical Care analyzed 117 children hospitalized at Jehangir Hospital, Sahyadri Hospital, and Shaishav Children’s Hospital between June and September 2024, revealing unexpected and severe complications.
Genetic Evolution Fuels Severe Disease
Researchers believe that genetic mutations in the chikungunya virus (CHIKV) may be driving its heightened severity. Beyond the typical fever and joint pain, many children developed life-threatening conditions that required intensive interventions.
Neurological and Critical Care Needs
Of the 117 children, 36 required ICU admission. According to Dr. Sagar Lad, neonatologist and pediatric intensivist at Jehangir and Sahyadri Hospitals, over 56% of those in intensive care experienced seizures:
- Many progressed to status epilepticus, characterized by continuous or repeated seizures.
- Some suffered refractory status epilepticus (RSE), which did not respond to standard anti-seizure medications.
These findings indicate that CHIKV can trigger more severe, persistent neurological crises than previously recognized.
Respiratory Distress and Cardiovascular Shock
Besides neurological issues, several children presented with:
- Respiratory distress, requiring ventilatory support.
- Cardiovascular shock, with six patients needing emergency circulatory assistance.
These acute presentations underscored the virus’s potential to compromise multiple organ systems.
Unprecedented Hepatic Failure and HLH Cases
As reported by TOI, remarkably, one infant developed fulminant hepatic failure and underwent liver transplantation to survive—likely the first documented case of its kind in CHIKV infection. Additionally, two children developed hemophagocytic lymphohistiocytosis (HLH), a rare, life-threatening immune disorder that demands prompt, aggressive treatment.
Implications for Public Health and Clinical Vigilance
“Our data suggest chikungunya can evolve into a more dangerous pathogen than dengue,” Dr. Lad warned. He urged clinicians to maintain heightened vigilance for atypical symptoms, especially during outbreaks. As CHIKV continues mutating, healthcare systems must prepare for diverse and severe presentations in pediatric patients.