Chikungunya in Infants and Children: Is Pathogenesis Increasing?

Abstract

Chikungunya virus (CHIKV) was first extensively described in children during outbreaks in India and South Asia during the mid-1960s. Prior to the 2005 emergence of CHIKV on Reunion Island, CHIKV infection was usually described as a dengue-like illness with arthralgia in Africa and febrile hemorrhagic disease in Asia. Soon after the 2005 emergence, severe CNS consequences from vertical and perinatal transmission were described and as CHIKV continued to emerge in new areas over the next 10 years, severe manifestation of infection and sequelae were increasingly reported in infants and neonates. The following review describes the global reemergence and the syndromes of Chikungunya fever (CHIKF) in infants and children. The various manifestations of CHIKF are described and connected to the viral lineage that was documented in the area at the time the disease was described. The data show that certain manifestations of CHIKF occur with specific viral lineages and genetic motifs, which suggests that severe manifestations of CHIKF in the very young may be associated with the emergence of new viral lineages.

Keywords: Chikungunya virus; congenital infection; cutaneous lesions; neuroinvasive disease; pathogenesis; perinatal infection.

Figure 1

Consequences of congenital, perinatal, and pediatric chikungunya infections are increasing. Chikungunya infection in newborns, infants, and children documented since 1960 are plotted against the most severe symptoms or sequelae identified in the associated report.