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 Table of Contents  
IMAGES IN CLINICAL NEONATOLOGY
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 145-146

Chikungunya in a newborn


1 Department of Paediatrics, Neonatal Unit, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Kalapet, Puducherry, India
2 Department of Dermatology, Pondicherry Institute of Medical Sciences, Ganapathychettykulam, Kalapet, Puducherry, India

Date of Web Publication6-Apr-2015

Correspondence Address:
Dr. Lalitha Krishnan
Department of Paediatrics, Neonatal Unit, Pondicherry Institute of Medical Sciences, Pondicherry - 605 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.154134

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  Abstract 

Vertical transmission of Chikungunya has been described in neonates but postnatal chikungunya has rarely been reported. We report a neonate from South India, who presented with apnea, seizures and hypotonia followed by typical visceral and peri-oral skin hyperpigmentation. Chikungunya infection was suspected and confirmed by serology (IgM) which was positive in the baby and negative in mother. It is important to remember viral infections in the differential diagnosis of neonatal seizures and apnea.

Keywords: Chikungunya, encephalopathy, hyperpigmentation, newborn


How to cite this article:
Peter R, Krishnan L, Anandraj V, Kuruvila S. Chikungunya in a newborn. J Clin Neonatol 2015;4:145-6

How to cite this URL:
Peter R, Krishnan L, Anandraj V, Kuruvila S. Chikungunya in a newborn. J Clin Neonatol [serial online] 2015 [cited 2020 Apr 5];4:145-6. Available from: http://www.jcnonweb.com/text.asp?2015/4/2/145/154134


  Introduction Top


Chikungunya fever is transmitted by the bite of the infected Aedes mosquito and was first recognized as an epidemic in East Africa in 1953. [1] Perinatal transmission was reported from Reunion island in 2007 [2] and subsequently by others. [3] We present a case of postnatally acquired Chikungunya encephalopathy, with devastating neurologic sequelae


  Case Report Top


A 6 days old, full term, female infant, presented with lethargy, profound apnea and seizures on day 5 of life. There were bullous lesions and edema over the extremities Investigations showed hemoglobin of 16.3 g/dL, white cell count of 15,600/cumm (91% polymorphs,), platelets 55,000/cumm with C-reactive protein 55 mg/L, serum calcium 7 mg/dL, sodium 119 meq/L, potassium 5.8 meq/L, chloride 94 meq/L. Cerebrospinal fluid (CSF) analysis showed protein 160 mg/dL, sugar - 44 mg/dL, cells - 15/cu mm with neutrophils 10 and lymphocytes 5. Liver function tests were normal. Blood and CSF cultures were sterile. Ultrasound brain was normal. She developed marked peri-oral hyperpigmentation starting over the face and progressing to rest of the body [Figure 1]. IgM for chikungunya, sent on day 12 was positive in baby and negative in mother. At 9 parents brought her for assessment of delayed development. Magnetic resonance imaging scan showed fronto-parietal cerebral atrophy, dilated lateral ventricles, prominence of CSF space and delayed myelination [Figure 2].
Figure 1: Generalised and peri-oral pigmentation on day 8 of life

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Figure 2: Magnetic resonance imaging changes in brain at follow-up at 9 months of age

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  Discussion Top


Chikungunya is a viral disease transmitted by the bite of infected Aedes mosquitoes. The first report of vertical transmission during the perinatal period was reported in 2006. [1] Fetal risks appear to be rare before 22 weeks of gestation [1] The greatest risk of transmission of chikungunya is during birth if mother has acquired infection days before delivery. [1] Diagnosis is made by chikungunya virus real-time-polymerase chain reaction in the 1 st week when viremia occurs, which is specific. Serum IgM levels are detectable as early as 2 days after infection and persist for beyond 3 months.

The clinical findings in our case were an unexplained apnea, seizures, hypotonia and bullous lesions over the extremities. Extensive generalized and peri-oral hyperpigmentation developed on day 8 of life and was present even at the time of discharge. Hyponatremia, thrombocytopenia, raised C-reactive protein was seen in our case as has also been reported in a case series by Mangalgi et al. [2]

There are reports that encephalitis was one of the commonest presentations in neonates [2],[3] This was seen in our neonate who presented with seizures followed by profound apnea, requiring mechanical ventilation, and elevated protein levels in CSF (normal <120 mg/dL). On the follow-up, infant had microcephaly, severe neurodevelopmental delay and vision loss due to optic atrophy.

Chikungunya IgM was positive in baby, but negative in mother. This probably represents primary infection in the baby due to bite of an infected mosquito soon after birth.

 
  References Top

1.
Lenglet Y, Barau G, Robillard PY, Randrianaivo H, Michault A, Bouvaret A, et al. Chikungunya infection in pregnancy: Evidence for intrauterine infection in pregnant women and vertical transmission in the parturient. Survey of the Reunion Island outbreak. J Gynecol Obstet Biol Reprod (Paris) 2006;35:578-83.  Back to cited text no. 1
    
2.
Mangalgi SM, Shenoy S, Maralusiddappa PG, Aprameya IV. Neonatal chikungunya - A case series. J Pediatr Sci 2011;3:e74.  Back to cited text no. 2
    
3.
Arpino C, Curatolo P, Rezza G. Chikungunya and the nervous system: what we do and do not know. Rev Med Virol 2009;19:121-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]


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