Ramful Duksha, Carbonnier Magali, Pasquet Marlène, Bouhmani Brahim, Ghazouani Jamal, Noormahomed Tahir, Beullier Gilles, Attali Tania, Samperiz Sylvain, Fourmaintraux Alain, Alessandri Jean-Luc
Service de Réanimation Néonatale et Pédiatrique, CHD Félix Guyon, Saint-Denis de La Réunion, La Réunion, France.
Pediatr Infect Dis J. 2007 Sep;26(9):811-5. doi: 10.1097/INF.0b013e3180616d4f.
In 2005-2006 Reunion Island experienced a massive outbreak of chikungunya, a mosquito-borne alphavirus infection. During this epidemic, early neonatal cases were observed with a highly probable mother-to-child transmission.
A retrospective descriptive study was conducted in 5 neonatal medicine departments. Chikungunya virus infection was confirmed by reverse transcription-polymerase chain reaction or specific serology in mothers and their newborns. Mothers were screened if they presented signs at delivery or if their neonates became ill on the first days of life.
Thirty-eight neonates were enrolled. All mothers, except 2 asymptomatic mothers, presented signs during the perinatal period (range, day(D) -4 to D+1). All neonates were symptomatic and presented symptoms on D3 to D7 (mean, D4). The mean interval between onset of maternal illness and onset of neonatal illness was 5 days (range, 3-9). The most frequent clinical signs in neonates were fever (79%), pain (100%), rash (82%), and peripheral edema (58%). Thrombocytopenia (76%), lymphopenia (47%), decreased prothrombin value (65%), and elevation of aspartate aminotransferase (77%) were detected. Complications included seizures (6), hemorrhagic syndrome (6), and hemodynamic disorders (10). Reverse transcription-polymerase chain reaction in cerebrospinal fluid was positive in 22 of 24 cases, and abnormal findings on brain magnetic resonance imaging (14 of 25) with white matter lesions or intraparenchymal hemorrhages or both were found. Echocardiography (16) showed myocardial hypertrophy (5), ventricular dysfunction (2), pericarditis (2), and coronary artery dilatation (6). One neonate died of necrotizing enterocolitis.
The chikungunya epidemic that occurred on La Reunion Island revealed for the first time the possibility of mother-to-child transmission in the perinatal period with a high rate of morbidity.
2005 - 2006年，留尼汪岛经历了基孔肯雅热的大规模爆发，这是一种由蚊子传播的甲病毒感染。在此次疫情期间，观察到了早期新生儿病例，母婴传播的可能性很大。
在5个新生儿医学科室进行了一项回顾性描述性研究。通过逆转录 - 聚合酶链反应或特异性血清学方法确诊母亲及其新生儿的基孔肯雅病毒感染。如果母亲在分娩时出现症状或其新生儿在出生后的头几天生病，则对母亲进行筛查。
纳入了38名新生儿。除2名无症状母亲外，所有母亲在围产期（范围为第 - 4天至第 + 1天）均出现症状。所有新生儿均有症状，在第3天至第7天（平均第4天）出现症状。母亲发病至新生儿发病的平均间隔时间为5天（范围为3 - 9天）。新生儿最常见的临床体征为发热（79%）、疼痛（100%）、皮疹（82%）和外周水肿（58%）。检测到血小板减少（76%）、淋巴细胞减少（47%）、凝血酶原值降低（65%）和天冬氨酸转氨酶升高（77%）。并发症包括惊厥（6例）、出血综合征（6例）和血流动力学障碍（10例）。24例中有22例脑脊液逆转录 - 聚合酶链反应呈阳性，25例中有14例脑磁共振成像有异常发现，表现为白质病变或脑实质内出血或两者皆有。超声心动图检查（16例）显示心肌肥厚（5例）、心室功能障碍（2例）、心包炎（2例）和冠状动脉扩张（6例）。1名新生儿死于坏死性小肠结肠炎。
留尼汪岛发生的基孔肯雅热疫情首次揭示了围产期母婴传播的可能性以及高发病率。
