Chikungunya: children at higher risk for vertical transmission, significant nervous system morbidity
Takeaway
- As chikungunya virus (CHIKV) infections continue to spread globally (including in North America/the United States), epidemiologic/clinical surveillance is key to predicting outbreaks.
- This is particularly important for vulnerable children aged 0-12 mo, whose clinical presentation is vastly different than for adults.
Why this matters
- CHIKV has been linked to significant nervous symptom morbidity, including meningoencephalitis, seizures, Guillain-Barre, myelopathy, and/or myeloneuropathy, especially in small children <12 mo.
- In very young infants (<3 mo), poorly tolerated fever is prognostic for CHIKV.
- Clinicians should familiarize themselves with risk for vertical transmission, atypical complications found in pediatric CHIKV, and differences vs adult cases to optimize management/outcomes.
Study design
- 235 children with CHIKV were evaluated.
- 128 children were identified by reverse transcription-polymerase chain reaction, and 107 by epidemiologic criteria.
- Funding: None.
Key results
- 52% patients were aged 1-12 mo.
- 53 patients presented with severe complications; most common were seizures, meningoencephalitis, and acute hepatitis.
- All patients with meningoencephalitis were aged 1-12 mo; the most common clinical manifestations were fever (100%), rash (100%), irritability (100%), and hyperalgesia (93%).
- Neurological assessment showed mild-moderate brain edema in 7 patients and elevated levels of leukocytes and protein in all 14 patients.
- 8 patients had vertical transmission Chikungunya virus.
Limitations
- Retrospective study.
Coauthored with Chitra Ravi, MPharm
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