Passi et al.(1) have reported the clinical features of Chikungunya infection in 2 neonates.

After a devastating Chikungunya virus (Chik V) infection in Kerala in 2007 (7000 reported cases in Pathanamthitta, Kottayam and Alappuzha districts of South Kerala ), I would like to share our experience with this unexpected infection in neonates. We noticed an increased incidence of meconium stained amniotic fluid and meconium aspiration syndrome associated with this fever in mothers in different parts of Kerala. The risk of transmission of infection is maximum during parturition, especially in a mother who had the disease, days before the delivery. There may even be "silent infection" in the mother without any fever, but with arthralgia and mild erythematous rashes, and the baby developing a fulminant disease.

Manifestation in the neonates included mild to moderate fever (98% cases) with generalized fine erythematous rash (90% cases). A very characteristic finding was the diffuse deep hyperpigmentation, especially over the face, nose and also over abdomen, extremities and knuckles. This hyper-pigmentation may persist for several weeks to months. Other skin manifestations seen were blotchy nasal erythema, freckle-like pigmentation over centre of face, and occasionally vesiculobullous lesions and urticaria. Diffuse edema over the limbs associated with hypoalbuminemia was also seen in a few cases. Excessive crying, apneic episodes, occasional seizures, shock and DIC were seen in a few cases. CRP was positive in 20% of cases. A high WBC count with predominant polymorphs were seen in the early stages of the disease.

Chikungunya infection in a neonate can mimic bacterial septicemia, meningoencephalitis, or a metabolic encephalopathy and can be fatal. Inspite of the acute morbidity, most of the babies recovered with aggressive supportive management.

PMC Nair,
Professor & Head,
Department of Pediatrics &Neonatology,
Sree Gokulam Medical College, Trivandrum, Kerala, India.
E-mail: [email protected]