NEONATAL CHIKUNGUNYA
Dr. Vikram Hirekerur D.C.H, M.D., D.N.B *
Department of Pediatrics.*
Chikungunya is described as a benign disease. Deaths usually do not occur. However in newborn and in presence of hemorrhagic manifestations it can be fatal. Two such cases are reported.
Case 1
Two neonates presented as neonatal as sepsis on day 4 of life during the same period of time. Treatment was initiated for sepsis. Only on appearance of hemorrhagic manifestations and suggestive maternal symptoms was the possibility of Viral Hemorrhagic Fever suspected. The first case was thoroughly investigated. Serum samples of mother and baby sent to National Institute of Virology, Pune tested positive for Chikungunya lgM Antibodies. One baby succumbed inspite of aggressive management. The other baby survived.
History
Two neonates presented as neonatal as sepsis on day 4 of life during the same period of time. Treatment was initiated for sepsis. Only on appearance of hemorrhagic manifestations and suggestive maternal symptoms was the possibility of Viral Hemorrhagic Fever suspected. The first case was thoroughly investigated. Serum samples of mother and baby sent to National Institute of Virology, Pune tested positive for Chikungunya lgM Antibodies. One baby succumbed inspite of aggressive management. The other baby survived.
EPIDEMIOLOGY
Chikungunya is a dengue-like disease caused by Group A Arbovirus, the Chikungunya virus. In Asia, Aedes Aegypti is the principle vector, Outbreaks are associated with high attack rates (as much as 80%). In South-east Asia, Dengue and Chikungunya outbreaks occur concurrently. In past, outbreaks of Chikungunya have occurred in Calcutta, Madras, Pondicherry, Vellore, Vishakhapatnam, Rajmundry, Kakinada, and in Nagpur. The last outbreak in India was recorded in Barshi, Solapur district in 1973. Vertical transmission has been observed. No second attacks have been recognized.

Chikungunya virus has spread to many parts of the world. A variant of East/Central African strain is suspected to be in transmission. The virus has undergone genomic microevolution. Unusually high levels of viremia have been demonstrated in the patients resulting in person-to- person transmission via peridomestic mosquitoes. The virus can also be directly transmitted to healthcare workers. It is observed in the past that Chikungunya virus penetrated into regions where the population was immunologically inexperienced and where Aedes mosquito proliferated abundantly. This resulted in devastating outbreaks. In future too, such outbreaks are possible.
Clinical features
After an incubation period of 3 to 12 days, there is sudden onset of fever. The fever rapidly rises to 39.4°C- 41°C. It is associated with rigor and headache. Joint pain involves knees, ankles, shoulders, wrists and proximal interphalangeal joints. A maculopapular eruption occurs any time during the course. Fever continues for 1 to 10 days. In some patients, an afebrile interval of 1 to 3 days is followed by a secondary rise in temperature. Joint pains may continue after fever has subsided. A mild form of hemorrhagic fever is seen in Asiatic children. Although the risk of serious disease is low, in certain groups mortality is seen, viz. pregnant women, elderly people, newborn, people with weakened immune systems (such as patients living with cancer or HIV/AIDS) and people suffering from severe chronic illness (such as heart, lung or kidney disease and diabetes).

Treatment: There is no specific antiviral treatment. Treatment is limited to analgesics and anti-inflammatory drugs, bed rest, maintaining fluid and electrolyte balance and sedation when required.

Prevention: There is currently no vaccine. Hence, vector control is the only way of prevention.
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