Clinical manifestations and ischemic lesions of neonatal chikungunya in a neonatal unit in the state of Rio de Janeiro: Report of two cases
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Abstract
Introduction: The Chikungunya virus (Chikv) causes serious infectious conditions. The first vertical transmission case was identified in 2005. Currently, this viral infection represents a serious risk for the neonates of symptomatic mothers. Objective: To describe clinical and radiological manifestations in two cases of neonatal chikungunya by vertical transmission. Case Description: Neonates children of mothers who presented at the end of pregnancy chikv infection confirmed in laboratory. Case 1: Male newborn presented perioral cyanosis, evolving on the 6th day with crying and irritability. Performed magnetic resonance of skull (MRI), which showed acute encephalitis with parenchymal lesion and areas of necrosis / periventricular liquefaction and extension for subsequent members of internal capsules. There was evolution for early neonatal sepsis. Case 2: Female newborn began on the 4th day of life irritability, fever and maculopapular fever in the back region. The disease has evolved to surgical necrotizing enterocolitis. MRI has also evidenced signs of acute encephalitis by Chikv. Both cases presented positive IgM serology for Chikv. Both were submitted to antimicrobial treatment associated with human immunoglobulin therapy and symptomatic support. After clinical improvement, they received hospital discharge, respectively, on the 25th and 47th day of life. Discussion: Chikv encephalitis is a serious neurological manifestation, with implications of neurodevelopment. The propaedeutical approach of this disease should involve a whole set of clinical support and analysis by imaging examinations, and it is imperative to evaluate brain neurodevelopment, since this guides the therapeutic decision / support sockets in order to avoid sequels in the long run. The use of human immunoglobulin in both cases was safe and protective.
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