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Chikungunya is a mosquito-borne infectious disease that has emerged as a global pathogen. The virus can pass vertically from mother to child especially during the perinatal period, with an intrapartum vertical transmission rate of 50%. Approximately half of the neonates infected with chikungunya present with severe symptoms and infrequently death. This report summarizes two severe cases of vertically transmitted neonatal chikungunya infection. One case was confirmed by real-time reverse transcription polymerase chain reaction and the other fulfilled clinical and epidemiological criteria. Both infants presented on day 3 with abdominal distension, reduced perfusion pressure, and hypotension; acrocyanosis progressing to ischemic digits; and respiratory distress. Both died within 24-48 hours of presentation. The severity of symptoms observed is likely due to a combination of contamination of the fetal blood from highly viremic mothers during delivery and a low innate antiviral type-1 interferon response. Further examination of the neonate's innate immune response to chikungunya may provide clues for the development of potential treatment or vaccine interventions.
Chikungunya (CHIKV), Zika (ZIKV), and Dengue viruses (DENV) exhibit similar epidemiological and clinical patterns but have different pathophysiological mechanisms of disease manifestations. Differences occur in the severity of clinical presentations with the highest mortality in the general population attributed to DENV and neurological morbidity due to ZIKV. ZIKV and DENV infections can cause fetal loss with ZIKV exhibiting teratogenesis. CHIKV is associated with severe complications in the newborn. Co-circulation of the three viruses and the cross-reactive immune response between ZIKV and DENV viruses has implications for an attenuated clinical response and future vaccine development. Co-infections could increase due to the epidemiologic synergy, but there is limited evidence about the clinical effects, especially for the vulnerable newborn. The purpose of this paper is to review the pathophysiological basis for vertically transmission manifestations due to CHIKV, DENV, and ZIKV, to determine the potential effects of co-circulation on newborn outcomes and the potential for vaccine protection. Inflammatory cytokines are responsible for placental breaches in DENV and ZIKV; Hofbauer cells facilitate the transfer of ZIKV from the placenta to the fetal brain, and high viral loads and mechanical placental disruption facilitate the transmission of CHIKV. Co-infection of these viruses can present with severe manifestations, but the clinical and serologic evidence suggests that one virus predominates which may influence fetal transmission. All three viruses are in different stages of vaccine development with DENV vaccine being fully licensed. Antibody-enhanced infections in seronegative vaccinated candidates who develop natural infection to dengue limit its use and have implications for ZIKV vaccine development. Targeting transmission capacity in the vector could prevent transmission to all three viruses, and breast milk immunity could provide further clues for vaccine development.
Eosinophilic meningitis caused by Angiostrongylus cantonensis is an endemic and emerging disease that affects adults and children in Jamaica. Most cases resolve without sequelae, but young children are at high risk of neurological damage and death. Treatment with corticosteroids and albendazole is considered safe for adults and children, but protocols for its use in children have not been established. A 19-month-old infant with permanent neurological sequlae caused by Angiostrongylus cantonensis meningitis is reported, and five other Jamaican cases are summarized. A review of the literature of children with permanent neurological sequlae and death is presented. Children <5 years (especially <2) were at increased risk of incomplete recovery and death if they presented with bulbar signs, flaccid paresis and coma. None of the severe or fatal cases received early intervention with anthelminthics, and disease progression was not altered with corticosteroids. In view of the pathophysiology, necropsy reports and animal studies, it seems that the early use of larvicidals may change the course of severe presentations.
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