Central nervous system manifestations on the chikungunya disease: series of cases

*Correspondence: [e-mail].

Abstract

Background: The Chikungunya disease is an arboviral infection caused by an alphavirus. The disease was first reported in the 1960’s, but major outbreaks became more evident on the tropics in early 2000’s. Systemic and neurological complications are being increasingly recognized since then.

Objective: To report two different Central Nervous System (CNS) manifestations of the chikungunya virus (CHIKV) in the early infancy and neonatal period.

Methods: The patients were clinically evaluated and had imaging, laboratorial and serology studies performed.

Results: Case 1 – Five-month-old female patient, living on the rural district of a northern Minas Gerais city, first presented with high fever and inconsolable crying. She developed bullous and erythematous skin lesions on the third day. As the disease progressed, pancytopenia, hepatic and renal disfunction became more evident. At this point, dialyses was prescribed. Alongside with ionic instability and systemic disfunctions, the patient presented with Status epilepticus, resolved after a 10mg/kg phenobarbital attack. Head computed tomography presented with cortical atrophy. Cerebrospinal fluid (CSF) analyzes showed no signs of inflammation and was negative for CHIKV. CHIKV disease was confirmed through serology exams which demonstrated high IgM serum levels. Case 2 – Female term newborn, born in Belo Horizonte, presenting with sepsis-like symptoms (respiratory distress) on the first day of life. The mom had a history of fever and erythematous lesions during childbirth. The patient evolved with cardiac arrhythmia, feeding intolerance, glycemic instability and bullous skin lesions. Neonatal seizures controlled with 20mg/kg phenobarbital attack. Transfontanelle ultrasound revealed subependymal hemorrhage on the left side and CSF studies had an inflammation pattern with elevated protein (847mg/dL). CHIKV vertical infection was confirmed through newborn and mother positive serum RT-PCR studies.

Conclusion: CHIKV infection became a common viral disease in South America on the last few years. Hence, knowledge of the various systemic and neurological symptoms is essential for optimal recognition and for guiding the treatment plan. This series of cases shows two pediatric patients, from different age groups. The former fulfilling criteria for CHIKV encephalopathy (Case 1) and the latter (Case 2) the CHIKV encephalitis.

Publication History

Article published online:
12 May 2025