Chikungunya virus is an arthropod-borne virus that shares the same vectors, namely Aedes albopictus and Aedes aegypti with dengue. Clinical features of the disease mostly include acute febrile arthralgia and maculopapular rashes on the body.
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Clinical manifestation in the neonatal period is reported to be variable and nonspecific. At the acute stage, the treatment is only supportive, and antivirals have not been proven to be effective.
2 We have reported a rare case of serologically confirmed chikungunya infection in 30 days old male neonate, born to mother having intrapartum flu-like symptoms.
Mother-to-child transmission of the chikungunya virus was first documented during the 2005–2006 outbreak in La Réunion. Neonates born to mothers with intrapartum viremia showed transmission rate of 48.7%. Maternal infections were classified as intrapartum if symptoms appeared two days before delivery or up to three days after.
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Most infected newborns are generally asymptomatic at birth, with symptoms typically developing after three days of life.
4 A French study reported that infected neonates exhibited fever, poor feeding, and pain, while petechiae and rubella-like rashes were observed in 47.3% and 52.6% of cases, respectively. Common laboratory findings included thrombocytopenia with lymphopenia, mild transaminitis, and hypocalcaemia. A similar study found that fever, poor feeding, and irritability were the most common symptoms in neonates with chikungunya.
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Chikungunya virus diagnosis can be confirmed serologically using IgM antibodies, but this method poses challenges in neonates as the virus is typically detectable only from five days after symptom onset (range: 1-12 days). Treatment during the neonatal period is primarily supportive, focusing on close monitoring of body temperature, feeding, hydration, pain, and skin condition, along with antipyretics and fluid management. Antiviral medications are not indicated for this condition.
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RT-PCR is the gold standard for early-stage diagnosis, recommended by the Centre for Disease Control and Prevention (CDC)
5,6, with sensitivity and specificity rates of 100% and 98.4% respectively, within the first eight days of illness. In La Réunion, 52.6% of infected neonates had severe disease. The two primary complications observed were encephalopathy with cerebral oedema and haemorrhagic fever. While all the affected infants’ survived, persistent neurological disabilities were reported in 45% of those with complications.
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Present neonate was asymptomatic at birth with normal CBC and raised CRP. On day 7 of life developed intermittent fever, rash, petechiae, and moderate thrombocytopenia. Vertical mosquito-borne infection was initially overlooked due to the mother’s negative dengue serology and the local prevalence of bacterial early-onset sepsis. The diagnosis of congenital chikungunya was confirmed via RT-PCR.
7 The infant was discharged on day 45 of life with normal neurological findings and was thriving on breastfeeding with satisfactory weight gain.
The placental barrier is typically impermeable to the virus during the antepartum period, and the vertical transmission is rare if maternal infection occurs more than seven days before delivery.
8 Transmission primarily occurs trans-placental during labour due to contact between maternal viremia and placental barrier gaps. Consequently, most affected newborns are asymptomatic at birth. Delivery by caesarean section does not prevent transmission. Although chikungunya is not inherently neurotrophic, perinatal transmission can lead to encephalitis in neonates. Thrombocytopenia and elevated C-reactive protein levels, as seen in this case, are almost universally reported. Similar findings were documented in a case series by Mangalgi et al.
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Chikungunya should be considered in the differential diagnosis of neonates presenting with high-grade fever and hyperpigmentation, especially in endemic regions.
9 Thus careful maternal history plays a leading role in suspecting the possible perinatal infection. Thus, this clinical problem explained about vertical transmission of congenital chikungunya virus infection.
10| References : |
- Weaver SC M. Chikungunya virus and the global spread of a mosquito- borne disease. N Engl J Med.2015;372(13):1231-1239.
- Ferreira PC, da silva AS Rechat J, et al. Vertical transmission of chikungunya virus: a systematic review PLoS One. 2021:16(4)
- Gerardin P, Barau G, Michault A, et al. Multidisciplinary prospective study of mother to child chikungunya virus infections on the island of La Reunion. PLoS Medicine. 2008;5(5): e60.
- Torres JR, Fallerios- arlant LH Duenas L, Pleitez Navarrete J, Salgado DM, Brea, - Del Castillo J. Congenital and perinatal complications of chikungunya fever: a Latin American experience. Int J Dis. 2016;51: 85-88.
- Centres for disease control and prevention (CDC). Chikungunya outbreak- Combodia February - March 2012.
- Centres for disease control and prevention Chikungunya virus - diagnostic testing http://www.cdc.gov/chikungunya/hc/dignostic.html.
- Cloherty and stark's Manual of neonatal care, Second south Asian edition ISBN: 978-93 pg. no 536.
- Mangalgi SM, Shenoy S, Maralusiddappa PG, Aprameya IV. Neonatal Chikungunya - A case series. J Pediatric science. 2011;3: e74.
- Gopakumar H, Ramachandran S. Congenital chikungunya. J Clin Neonatol. 2012;1: 155-16
- Ramful D, Carbonnier M, Pasquet M, et al. Mother-to-child transmission of chikungunya virus infection. Paediatric Infect Dis J. 2007;26(9):811-815.
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