VERY HIGH MORTALITY AND MORBIDITY DUE TO CHIKUNGUNYA ENCEPHALITIS IN NEONATES
Prakash C Vaghela, Naresh B Gohel
Kushal Neonatal Nursery, Akar Complex, Bhavnagar, India.
Address for Correspondence
Dr Prakash C Vaghela, Neonatal intensivist, Kushal Neonatal Nursery, Akar Complex, Bhavnagar 364001, Gujarat, India.
Email
prakash_vghl@yahoo.co.in
CHIK virus is member of genus Alpha virus in the family of Togaviridae transmitted to humans by vector like Aedes aegypti and Aedes albopictus. The word chikungunya has been derived from a Makonde word meaning "that which bends up". Repeated outbreak has been observed in west, central and southern Africa and many areas of Asia. During present outbreak in India 11 lakh cases of chikungunya have been reported. The time of greatest risk of transmission of CHIK virus from mother to fetus appears during birth if mother acquired the disease days before delivery. Viral chikungunya perinatally transmitted leads to encephalitis in newborn. Infection during pregnancy may lead to abortion and preterm labor. Neonates present at 3-5 days of life with fever, excessive crying, dermatological manifestations like maculopapular rash, nasal blotchy erythema, freckle like pigmentation over centrofacial area, vesiculobullous lesions, apnea, shock, DIC, and neurological manifestation like seizures, disturbed level of sensorium etc. Diagnosis is made by CHIK IgM and PCR.

A prospective study was carried out in Kushal territory neonatal care, Bhavnagar from 1st October 2006 to 31 December, 2006. 15 neonates out of 100 admitted had chikungunya encephalitis (Table 1). Diagnosis was based on history of chikungunya to mother before 2-4 day of delivery and clinical examination. Mean age of presentation was 4th day of life. Average duration of stay in NICU was 15 days. Treatment was symptomatic as no specific treatment is available. Four babies (26%) expired due to multi organ failure and DIC or encephalopathy.

Table1: Clinical features of chikungunya encephalitis in neonates
Male14(93%)
Skin manifestation15(100%)
Fever, excessive crying.15(100%)
Seizure14 (93%)
Apnea13 (86%)
Shock10 (66%)
DIC4 (26%)
Encephalitis15(100%)

Table 2: Laboratory parameters of chikungunya encephalitis in neonates
Low platelets7(46%)
Band cell/neutrophil>0.21(7%)
Elevated CRP (>6mg/dl) ;2(13%)
Normal CSF15(100%)
Negative Blood Bactec15(100%)
Mother Chik IgM positive10(66%)
Ventilatory support4(26%)
Mortality4 (26%)


This report shows that viral chikungunya can be transmitted from mother to babies. Transmission of viral chikungunya from mother to fetus may lead encephalitis in neonates. Clinical presentation is similar to septicemia or pyogenic meningitis or metabolic encephalopathy. Vector control by use of various measures prevent chikungunya to pregnant mother can help to decrease neonatal mortality.
Funding
None
Conflict of Interest
None
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Last Updated : Friday, June 01, 2007 Vol 4 Issue 6 Art #23
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Vaghela C P, Gohel B N. VERY HIGH MORTALITY AND MORBIDITY DUE TO CHIKUNGUNYA ENCEPHALITIS IN NEONATES. Pediatric Oncall [serial online] 2007[cited 2007 January 1];4. Art #23. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=162&type=J&tid=&imgid=&reportid=318&tbltype=
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