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Clinical profile of Chikungunya in infants
Joseph J Valamparampil1, Shibi Chirakkarot, S Letha
1Department of Pediatrics, Institute of Child Health, Government Medical College, Kerala, India.
Insights
Chikungunya infection in infants presents uniquely with fever, acrocyanosis, and distinct skin lesions, differing from older children. Close monitoring and rational treatment can prevent severe outcomes in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Chikungunya virus (CHIKV) infection is a significant public health concern.
- Clinical manifestations of CHIKV infection in infants are not well-defined.
Purpose of the Study:
- To define the clinical manifestations of Chikungunya infection in infants.
- To differentiate infant CHIKV presentation from older children.
Main Methods:
- Prospective study of 56 infants (<1 year) with fever and specific clinical features.
- Clinical examination, daily follow-up, and IgM antibody capture ELISA for CHIKV confirmation.
- Serial order of clinical feature appearance documented.
Main Results:
- Fever was universal; common symptoms included lethargy, irritability, and excessive cry.
- Characteristic findings were acrocyanosis and superficial vesicobullous lesions.
- Maculopapular rashes progressed to morbilliform, sparing the face and oral cavity.
Conclusions:
- Infants exhibit a distinct clinical spectrum of Chikungunya compared to older children.
- Vigilant monitoring and appropriate management are crucial to reduce infant morbidity and mortality.
- Early recognition of unique infant symptoms aids in timely intervention.
Objective:
To define the clinical manifestations of Chikungunya infection in infants.
Methods:
The inclusion criteria was fever (defined as axillary temperature > 99.6 degrees F) with any one of the following features; seizure, loose stools, peripheral cyanosis, skin manifestations or pedal edema in children less than one year. Details of disease from onset of illness till admission were noted and a thorough clinical examination was done at the time of admission. Daily follow-up was performed and the serial order of appearance of clinical features was noted till complete recovery. The sera collected from patients after the 7th day of onset of fever was analyzed for specific chikungunya antibody by IgM antibody capture enzyme linked immunosorbent assay (ELISA).
Results:
Fifty six (56) infants were laboratory confirmed for chikungunya, consisting of 34 (60.71%) males and 22 (39.29%) females. 4 (7.14%) infants were less than 1 month of age, 39 (69.64%) 2-6 months old and 13 (23.21%) 7-12 months old. Fever was invariably present, but associated constitutional symptoms in infants consisted of lethargy or irritability and excessive cry. The most characteristic feature of the infection in infants was acrocyanosis and symmetrical superficial vesicobullous lesions were noted in most infants. Erythematous asymmetrical macules and patches were observed which later progressed to morbiliform rashes. The face and oral cavity was spared in all observed patients.
Conclusion:
An entirely different spectrum of disease is seen in infants with chikungunya as compared to older children who need to be carefully observed for. The morbidity and mortality of the disease may be avoided by the rational use of drugs and close monitoring of all infants.
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