Very High Mortality and Morbidity due to Chikungunya Encephalitis in Neonates

Prakash C. Vaghela; Naresh B. Gohel

doi:https://

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

Show affiliations

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

Male	14(93%)
Skin manifestation	15(100%)
Fever, excessive crying.	15(100%)
Seizure	14 (93%)
Apnea	13 (86%)
Shock	10 (66%)
DIC	4 (26%)
Encephalitis	15(100%)

Table 2: Laboratory parameters of chikungunya encephalitis in neonates

Low platelets	7(46%)
Band cell/neutrophil>0.2	1(7%)
Elevated CRP (>6mg/dl) ;	2(13%)
Normal CSF	15(100%)
Negative Blood Bactec	15(100%)
Mother Chik IgM positive	10(66%)
Ventilatory support	4(26%)
Mortality	4 (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.

Compliance with Ethical Standards

Funding None

Conflict of Interest None

References

CD Alert, the Monthly News Letter of National Institute of Communicable Disease, Directorate General of Health Services, Govt. of India, February 2006; 10(2).
Global pulse: Chikungunya infection and pregnancy Accessed 2 may 2006. Permalink.
Chikungunya in Mauritius, Seychelles, Mayotte (France) and La Reunion island (France) WHO, March -1-2006.
Enserink M. Infectious diseases. Massive outbreak draws fresh attention to little-known virus. Science 2006; 311 (5764) : 1085. [CrossRef] [PubMed]
Shah KV, Gibbs CJ, Jr., Banerjee G. Virological Investigation of the Epidemic of Hemorrhagic Fever in Calcutta: Isolation of Three Strains of Chikungunya Virus. Indian J Med Res 1964; 52: 676-83. [PubMed]
Chikungunya, Wikipedia, http:// en.wikipedia.org/wiki/chikungunya, accessed on 20 September 2006.
Neogi DK, Bhattacharya N, Mukherjee KK, et al. Serosurvey of chikungunya antibody in Calcutta metropolis. J Commun Dis 1995; 27 (1): 19-22. [PubMed]
Schuffenecker I, Iteman I, Michault A, et al. Genome microevolution of chikungunya viruses causing the Indian ocean outbreak. PLoS Med 2006; 3 (7): e263.
Mishra B, Ratho RK. Chikungunya re-emergence: possible mechanisms. Lancet 2006; 368 (9539): 918. [CrossRef]
Chikungunya Fever Fact Sheet Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, U.S.A http://www.cdc.gov/NCI/DOD/DVBID/chikungunya/chickvfact.htm accessed on 5 august, 2006.
Quatresous I. E-alert 27 January: Chikungunya outbreak in Reunion, a French overseas department. Euro Surveill 2006; 11 (2): E060202 1.
Mourya DT, Mishra AC. Chikungunya fever. Lancet 2006; 368 (9531): 186-7. [CrossRef]