Congenital and perinatal complications of chikungunya fever: a Latin American experience.
BACKGROUND
During the years 2014 and 2015, the Region of the Americas underwent a devastating epidemic of chikungunya virus (CHIKV) of the Asian genotype, resulting in millions of affected individuals. However, epidemiological and clinical information on this experience is scarce. Prior knowledge of congenital and neonatal illness caused by CHIKV is limited and almost exclusively based on data obtained from a single outbreak of the East/Central/South African (ECSA) genotype. The effect of chikungunya fever (CHIKF) on pregnancy outcomes and its consequences for infants born to infected mothers at the peak of the epidemic wave in Latin America are reviewed herein. Epidemiological and clinical data on maternal and neonatal infections were collected prospectively and analyzed.


METHODS
One hundred sixty-nine symptomatic newborns with CHIKF seen at four large regional maternity hospitals in three different Central and South American countries were evaluated prospectively. The outcomes of pregnancies in symptomatic infected mothers at two of these clinical centers were also analyzed.


RESULTS
The observed vertical transmission rate ranged between 27.7% and 48.29%. The incidence of congenital disease was unrelated to the use of cesarean section or natural delivery. The case fatality rate (CFR) at the only center that reported deaths was 5.3%. The most common clinical manifestations included fever, irritability, rash, hyperalgesia syndrome, diffuse limb edema, meningoencephalitis, and bullous dermatitis. Severe complications included meningoencephalitis, myocarditis, seizures, and acute respiratory failure. Leukocytosis with neutrophilia and normal or increased platelets was a common finding, and in those with signs of meningeal involvement, moderate lymphocytic pleocytosis with normal glucose and protein levels was typical.


CONCLUSIONS
This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.
Infectious Diseases Section, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela. Electronic address: torresj@iname.com.
Jaime R
JR
Torres
Marilia Medical School (FAMEMA) and Medical School of the Metropolitan University of Santos (UNIMES), Sao Paulo, Brazil.
Luiza H
LH
Falleiros-Arlant
Department of Infectious Diseases, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador.
Lourdes
L
Dueñas
Department of Pediatrics, Hospital Nacional de la Mujer, San Salvador, El Salvador.
Jorge
J
Pleitez-Navarrete
University Hospital Hernando Moncaleano Perdomo, Neiva, Colombia.
Doris M
DM
Salgado
Centro Médico UCE, Santo Domingo, Dominican Republic.
José Brea-Del
JB
Castillo
D000293:Adolescent; D000328:Adult; D065632:Chikungunya Fever / Q000151:congenital / Q000635:transmission* / Q000821:virology; D002646:Chikungunya virus / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007843:Latin America / Q000453:epidemiology; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D055815:Young Adult
Chikungunya; Complications; Congenital; Latin America; Perinatal