Severe Sepsis and Septic Shock Associated With Chikungunya Virus Infection, Guadeloupe, 2014

Amélie Rollé; Kinda Schepers; Sylvie Cassadou; Elodie Curlier; Benjamin Madeux; Cécile Hermann-Storck; Isabelle Fabre; Isabelle Lamaury; Benoit Tressières; Guillaume Thiery; Bruno Hoen


Emerging Infectious Diseases. 2016;22(5):891-894. 

In This Article


Although chikungunya usually has a mild course, severe life-threatening complications can develop during the acute phase of the disease.[6,7] Previous studies indicate that the disease can be complicated by severe multiple organ failure and lead to death.[8,9] Very recently, the first cases of severe sepsis and septic shock that could be attributed to CHIKV infection were reported.[10,11] In some of these cases, acral skin necrosis was observed.[11]

The replication of viruses, especially of the family Herpetoviridae, has been shown to occur frequently during the course of septic shock syndromes of bacterial origin, not only as a stress-induced reactivation but also as a superinfection causing additional morbidity.[12] By contrast, cases of virus-triggered septic shock have been reported only rarely,[13] although a recent cross-sectional study of septic shock syndromes in a pediatric population suggested that viruses might be the only etiology in up to 10% of cases.[14] On the other hand, genuine acute severe viral infections might be complicated with a bacterial septic shock, which is well known to occur in cases of influenza but has also been reported in cases of arboviral diseases, such as dengue fever.[15]

In our study, none of the 25 patients who had a positive CHIKV RT-PCR test result and a severe sepsis or septic shock syndrome early in the course of chikungunya had another organism identified as a potential cause of sepsis. This finding strongly suggests that CHIKV can, in rare cases, cause severe sepsis and septic shock syndromes, an observation that had not been reported until very recently. Additional studies are needed to identify any background characteristics that might be associated with the onset of severe sepsis or septic shock.