Pune chikungunya study finds worrying effects in children, one infant needed liver transplant

Time of India

03-05-2025

Pune: There were concerning complications seen in children during last year's chikungunya outbreak, including one case which may be the first documented instance of a patient needing a new liver to recover, a study from Pune has now said.
The 2024 chikungunya outbreak was one of Maharashtra's worst. Within 11 months, more than 5,000 people were sickened in the state. Pune was among hotspot cities, recording 462 confirmed cases.
Now, in a recently released study of 117 children who were hospitalized between June and September 2024 (during the monsoon) doctors from three city hospitals have said their findings suggest the chikungunya virus (CHIKV) is likely evolving genetically to cause potentially life-threatening complications, beyond the typical symptoms of fever and joint pain. All the 117 kids recovered, but 36 needed ICU admission.
"These children presented with serious neurological issues, respiratory distress and even organ failure that required intensive care," said Dr Sagar Lad, neonatologist and paediatric intensivist at Jehangir Hospital and Sahyadri Hospital (Shastrinagar), and one of the study's authors. The research, recently published in the Journal of Pediatric Critical Care, was conducted by doctors from Jehangir Hospital, Sahyadri Hospital and Shaishav Children's Hospital in Sadashiv Peth.
Dr Lad said: "One infant required liver transplantation to survive. To our knowledge, this was the most unusual complication of the infection, causing fulminant hepatic failure. After an extensive search online, we felt it was probably the first case in literature that required liver transplantation followed by successful (chikungunya) recovery."
Two children also developed hemophagocytic lymphohistiocytosis (HLH), a rare and potentially fatal immune disorder. Six children went into shock requiring emergency cardiovascular support, the researchers said.
Additionally, Dr Lad said over half the children in the ICUs (56%) experienced seizures, with some developing status epilepticus, a medical emergency characterized by prolonged seizure activity — either continuous or recurrent — that can lead to serious complications and potentially even death.
The doctors said this meant that some of the children with chikungunya didn't just have ordinary seizures, but developed a more severe, persistent seizure that required urgent medical intervention. The study specifically mentioned both status epilepticus and RSE (refractory status epilepticus) among the neurological complications observed in the 117 children. RSE is an even more serious form of status epilepticus that doesn't respond to standard anti-seizure medications.
Such severe manifestations, the doctors added, may be linked to genetic changes in the virus, allowing it to multiply more rapidly and trigger even more complicated health issues than just a fever.
"The findings suggest chikungunya, often dismissed as less dangerous than dengue, may be evolving into a more serious threat to public health," said Dr Lad, adding that physicians must remain vigilant for atypical presentations, especially during outbreaks.
The other doctors involved in the study included Dr Pradeep Suryawanshi from Sahyadri Hospital and Dr Ashish Dhongade, from Shaishav Children's Hospital.