Chikungunya meningitis: two pediatric case reports

*Correspondence: [e-mail].

Abstract

Case Presentation: Two siblings, female and male, followed at a Child Neurology service. She was admitted at 1y and 8m of age, in treatment with ceftriaxone (100 mg/Kg/day IV) due to a sudden episode of bilateral nocturnal tonic-clonic movements that last 10 minutes, eye version, and persistent high fever of 38 to 40°C associated with headache in the occipital region. On physical examination, she presented mild right hemiparesis, neck stiffness and Brudzinski present. During hospitalization, she had an episode of vomiting and diffuse maculopapular rash on the face, trunk and limbs, suggestive of viral meningitis, and started acyclovir (100 mg/8h). CSF and cranial CT with contrast showed no alterations. EEG suggested cortical/subcortical dysfunction, structural damage, and absence of epileptiform activity. The second patient was admitted to the service at the age of 7, referred from the emergency unit due to the appearance of similar signs to his sister. Evolved during hospitalization with meningeal signs. Then were prescribed Ceftriaxone (2g/day IV), dexamethasone (1.2mL 8/8h) and acyclovir (10 mg/kg/8h). Lumbar puncture showed bloody CSF, culture did not reveal growth of microorganisms. In both cases, viral meningitis was confirmed after a positive IgM serological test for the chikungunya virus.

Discussion: Although a broad spectrum of chikungunya‐associated neurological diseases is known, meningism is one of the less frequently described. Whether the virus affects the nervous system directly or indirectly via a triggered immune‐mediated effect is also unknown. In general, meningitis management includes rapid evaluation and stabilization of cardiorespiratory and hemodynamic status, obtaining initial laboratory studies, and administering empiric antibiotics in a timely manner, until blood culture is negative, or a specific viral diagnosis has been made. The diagnosis of chikungunya is established by detection of chikungunya viral RNA via PCR or chikungunya virus serology. It is said that most children with viral meningitis do not require empiric antiviral therapy pending results of PCR testing. However, it is appropriate in children presenting with clinical signs of viral meningitis.

Final Comments: Clinicians need to be vigilant, since in many cases, viral meningitis never has an aetiological agent identified. Chikungunya and other viral meningitis might be suspected on the basis of epidemiologic data, clinical features, and initial cerebrospinal fluid (CSF) studies.

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Artikel online veröffentlicht:
12. Mai 2025