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Severe bullous skin lesions associated with Chikungunya virus infection in small infants

Stéphanie Robin1, Duksha Ramful, Julie Zettor

  • 1Service de Pédiatrie, Centre Hospitalier Félix Guyon, CHR Réunion, Allée des Topazes, 97405 Saint-Denis, La Réunion, France. stephanie.robin@chr-reunion.fr

European Journal of Pediatrics
|April 30, 2009
PubMed

Insights

Chikungunya infection can cause severe blistering in infants, affecting over 20% of their skin. This study highlights this rare presentation during an epidemic, emphasizing its inclusion in infant dermatological diagnoses.

Area of Science:

  • Pediatric Infectious Diseases
  • Dermatology
  • Virology

Background:

  • Chikungunya virus (CHIKV) outbreaks can present with unusual manifestations.
  • Extensive bullous lesions in infants are a severe, previously underreported form of Chikungunya infection.
  • This case series occurred during the 2005-2006 CHIKV outbreak on La Réunion Island.

Purpose of the Study:

  • To describe a pediatric case series of Chikungunya infection presenting with extensive bullous skin lesions.
  • To characterize this severe and unknown form of the disease in infants.
  • To raise awareness among clinicians regarding this presentation.

Main Methods:

  • Retrospective descriptive hospital-based study.
  • Inclusion criteria: children with blisters covering >= 10% of body surface area and laboratory-confirmed Chikungunya infection.
  • Data collected included clinical presentation, viral load in blister fluid, histopathology, and patient outcomes.

Main Results:

  • Eight boys and five girls (mean age 3.4 months) were included.
  • Blistering affected a mean of 21.5% of total body surface area, starting 2 days after fever onset.
  • Reverse transcription-polymerase chain reaction (RT-PCR) of blister fluid was positive, sometimes with higher viral loads than serum; histopathology revealed intraepidermal blisters.

Conclusions:

  • Chikungunya infection should be considered in the differential diagnosis of febrile blistering dermatoses in infants.
  • Prompt recognition and management are crucial for this severe presentation.
  • While requiring hospitalization and intensive care, outcomes were generally favorable with good long-term skin repigmentation.
Abstract

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