Clinical and Epidemiological Profile of the Chikungunya and Zika Outbreak in Neonates 2014–2016, Cartagena–Colombia

Abstract

Background. African researchers noted that aedes-transmitted Zika epizootics tended to follow aedes-transmitted Chikungunya virus (CHIKV) epidemics. In 2013 CHIKV spread pandemically from Africa-Asia, and Zika followed (1). Cartagena has been affected since 2014 by arboviruses with the most severe clinical forms in fetus, neonates and pregnant (1-4). Aim(s): To describe clinical, epidemiological profile of CHIKV and ZIKA neonatal (CHIK-neonatal, ZIKA-neonatal) in Cartagena- Colombia, between September 2014 and June 2016. Methods. Case Series, we incluided neonates from 3-NICs were classified as suspected/ confirmed cases of CHIK-neonatal and ZIKA-neonatal by RT-PCR. Results. Between September-December 2014, 12 newborns with mean gestational age 38 weeks +/- 1.2SD were included as CHIK-neonatal cases, 66.8% (8/12) of mothers presented symptoms confirmed by CHIKV four-days before or twodays after the delivery. Neonates had symptoms average 7.7 days +/- 6.9SD, median 5[2,7]. Sign-Symptoms: 100% irritability-pain, 83.3% fever, 66.6% exfoliative dermatitis, 58.3% rash, vomiting, abdominal distension and joint edema 16.6% each, 8.3% meningeal syndrome. All RT-PCR were positive for CHIKV and leukopenia with lymphopenia. Between December-2015 to June-2016, 23 newborns with malformations and/or epidemiological data from mother with Zika-infection confirmed by RT-PCR, were included. 85.7% were controlled pregnancy, Median-maternal age 23 years [17.0-30.0], 42.8% of mothers had Zika symptoms in first trimester, median 10 weeks [10.0-30.0]. 42.9% had vaginal delivery, Median gestational age 37.2weeks [37.0-39.3]. Median weight 2,840 g [2,490-3,420], Size 48cm [45-51], 57.1% female. 85.7% of newborn had microcephaly, 28.6% xeroderma-desquamation, arthrogryposis, perinatal asphyxia each, 28.6% myelomeningocele, ventriculomegaly, microlisencephaly, calcifications and cerebellar hypoplasia, 14.3% ocular alterations. Normal hemograms, positive Zika-RT-PCR, negative Dengue, CHIKV and negative serology for TORCHS. Conclusion. CHIK-neonatal and ZIKA-neonatal are an increasing possibility and must be considered in the approach of TORCHS complex (5). The maternal epidemiological background is fundamental in the diagnostic in endemic areas.