{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:02:44Z","timestamp":1787806964536,"version":"build-2784847793"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>This retrospective observational study assesses the clinical characteristics, atypical manifestations, and treatment outcomes in pediatric patients hospitalized with chikungunya virus (CHIKV) infection during the Bangkok outbreak in 2019. Children &lt;18 years old hospitalized from January 1 to December 31, 2019, and confirmed positive for CHIKV infection by RT-PCR or IgM antibodies were included in this study at a tertiary care center in Bangkok, Thailand. Patient demographics, clinical manifestations, and laboratory findings at the time of hospitalization were collected from de-identified medical records. Of 31 included children, seven (22.6%) were &lt;1 year old, 22 (71.0%) were male, nine (29.0%) had underlying medical conditions, four (17.4%) tested positive for dengue coinfection, and four (12.9%) had multi-organ involvement. The median age was 9.5 (IQR 6.9\u201312.5) years. Most (90.3%) had atypical clinical manifestations, four (12.9%) had life-threatening manifestations. Two (6.5%) neonates had congenital CHIKV. The most common manifestations included fever (100.0%), rashes (77.4%), myalgia (41.9%), and arthralgia (35.5%). The three most involved organ systems presenting atypical manifestations included gastrointestinal (32.3%), dermatologic (32.3%), and neurological (22.6%) systems. Of those with dermatologic involvement, 67.7% had maculopapular rashes, 19.4% bullous skin lesions, and 6.5% generalized erythroderma. At the time of presentation, 25 (80.6%) children had lymphopenia, five (16.1%) had anemia, and none had thrombocytopenia. Five (16.1%) children required intensive care and four (12.9%) developed shock. Thirteen (41.9%) children, five with neurological involvement, fully recovered at discharge. Among the remaining children, five (16.1%) still had musculoskeletal conditions, 11 (35.5%) had skin lesions, and two (6.5%) with congenital CHIKV had skin lesions and neurological sequelae. Despite the small cohort, the observed frequency of neurological complications attributed to CHIKV infection justifies long-term follow-up in children with neurological manifestations and complications. CHIKV should be suspected in endemic countries and tested for in febrile children, particularly those with rash and neurological involvement.<\/jats:p>","DOI":"10.1371\/journal.pone.0330527","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:49:26Z","timestamp":1758822566000},"page":"e0330527","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Re-emerging outbreaks of chikungunya virus infections of increased severity: A single-center, retrospective analysis of atypical manifestations in hospitalized children during the 2019 outbreak in Bangkok, Thailand"],"prefix":"10.1371","volume":"20","author":[{"given":"Artchavit","family":"Boonanek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulkanya","family":"Chokephaibulkit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanatpreeya","family":"Phongsamart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keswadee","family":"Lapphra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supattra","family":"Rungmaitree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navin","family":"Horthongkham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0551-3847","authenticated-orcid":true,"given":"Orasri","family":"Wittawatmongkol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"issue":"3","key":"pone.0330527.ref001","first-page":"238","article-title":"An epidemic of virus disease in southern province, Tanganyika territory, in 1952-53. 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