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BMC Research Notes

Open Access

Perinatal transmission of dengue: a case report

  • Vindika Prasad Sinhabahu1,
  • Rajeev Sathananthan1 and
  • Gathsaurie Neelika Malavige2, 3Email author
BMC Research Notes20147:795

https://doi.org/10.1186/1756-0500-7-795

Received: 9 July 2014

Accepted: 23 October 2014

Published: 14 November 2014

Abstract

Background

Dengue in pregnancy is associated with many maternal and foetal outcomes including perinatal transmission of dengue infection.

Case presentation

A baby was born by emergency caesarean section due to foetal distress and meconium stained liquor, to a 27-year old primi-gravidae, Sinhalese female, who was febrile during and 2 days prior to labour. The baby had evidence of respiratory distress due to meconium aspiration and was cared for in the special care baby unit for 3 days. On the 4th day he developed fever and serial blood counts showed a gradual rise in the haematocrit (>20% of baseline value) and lowering of platelet counts. The baby was treated for sepsis and as Sri Lanka was experiencing a massive dengue epidemic was also tested for dengue. His dengue NS1 antigen test was strongly positive and the dengue IgM antibodies weakly positive on day 3 of illness. The mother was positive for both dengue IgM and IgG antibodies.

Conclusion

Although rare, vertical transmission of the dengue virus has been reported and the baby most likely developed dengue due to perinatal transmission of dengue.

Keywords

Maternal denguePerinatal dengueVertical transmission

Background

Dengue viral infections are estimated to infect 390 million annually resulting in significant morbidity and mortality in resource poor countries [1]. Infection can occur due to any of the four dengue viruses which may manifest as asymptomatic infection, undifferentiated fever, dengue fever or result in severe clinical disease manifestations in the form of dengue haemorrhagic fever (DHF)/ dengue shock syndrome (DSS) or dengue infection complicated with organ failure [2]. Although majority of individuals infected with the dengue virus develop asymptomatic disease, infection during pregnancy has shown to be associated with more severe disease and higher incidence of death [3]. Dengue in pregnancy is associated with preterm delivery, intra-uterine death, miscarriages and acute foetal distress during labour [4]. Apart of foetus adversely been affected by complications due to maternal dengue, the foetus can directly be infected with the virus due to perinatal transmission.

Dengue in the newborn has shown to cause a range of clinical symptoms from asymptomatic infection, mild disease, DHF or DSS [5]. We report a baby who was born by an emergency caesarean section due to foetal distress developing dengue due to perinatal transmission of the virus.

Case presentation

A baby was born by emergency caesarean section due to foetal distress and meconium stained liquor, to a 27- year old primi gravid, Sinhalese female. The mother had fever during delivery and had been febrile 2 days prior to delivery. The baby had respiratory distress at birth and his umbilical cord was stained with meconium. The chest radiograph revealed evidence of meconium aspiration. The baby was given incubator care and was started on intravenous crystalline penicillin and gentamycin. Initially as the baby had features of meconium aspiration syndrome, he was kept off any fluids by mouth and was given intravenous 10% dextrose 60 ml/kg/day with Calcium Gluconate. The baby’s respiratory distress gradually resolved and he weaned off and sent to cot care on day 3. At this point the baby was commenced on expressed breast milk every 3 hours. He remained afebrile in first 4 days. On day 5 of life, he developed fever spikes (102°F). The baby’s C-reactive protein was normal. Serial full blood counts showed gradual decline in platelet counts and a >20% rise in the PCV. At this stage, total intravenous fluids were gradually increased to 150 ml /kg and continued at a rate of 150 ml/kg/day. The baby’s pulse rates, capillary refilling time, warmth of peripheries, urine output were closely monitored to detect any haemodymanic instablity. Breast feeding was started on day 5 of illness and was fully established by day 8 of illness. IV fluids were gradually reduced and omitted on day 8 of illness. The baby’s serial full blood counts are shown in Table 1. As sepsis or a viral infection was suspected the baby was given cefotaxime intravenously.
Table 1

Results of serial haematological parameters and other laboratory investigations of the patient

Date

At birth

D1

D2 morning

D2 evening

D3

D4

D5

D7

D8

D11

WBC

17300

3930

16870

21790

15300

12360

10180

14030

12280

12630

N%

82%

74%

60

68

46

36

36

38

24

23

L%

14%

16

38

27

43

51

52

49

64

64

Platelets

202

38

23

18

25

16

16

30

31

212

Hb

14.9

14.8

15.4

14.7

15.6

25.2

20.3

14

14.5

12.3

PCV

42.7

43.2

41.9

42.8

44.5

75.5

65.2

40.7

45

38

D1 indicates day 1 of illness which is the 4th day of life.

As the mother was febrile during delivery, possible perinatal dengue was suspected. The baby’s dengue NS1 antigen test was strongly positive on day 3 of fever and the dengue specific IgM antibodies were weakly positive. The PCR was negative. The mother was also tested at the same time and both dengue IgM and IgG were positive. The baby’s blood culture did not yield a bacterial growth and the blood picture showed evidence of viral infection. The liver enzymes were elevated. He was managed as having dengue haemorrhagic fever according to the 2011 WHO guidelines [6]. During the clinical course, he did not develop any evidence of haemorrhage or pleural effusions or ascites. He was discharged on Day 14 of life.

Discussion

Fever in a newborn especially following intensive care due to meconium aspiration is usually considered to be due to sepsis. However, especially in dengue endemic countries maternal dengue in common [3] but could be potentially not diagnosed as an acute dengue infection, especially if the clinical symptoms are that of a non specific febrile illness. Sri Lanka has been affected by epidemics of dengue infection for almost three decades and many maternal dengue infections were initially misdiagnosed as complications due to pregnancy and even pulmonary embolism [7, 8]. Apart from miscarriages in 2 women, perinatal dengue was not reported in both of these case series.

Perinatal transmission of dengue although rare, has been reported previously [4, 5, 9, 10]. Perinatal dengue was thought to be transmitted via the placenta as the virus has been isolated in placentas and in cord blood of such infants [5]. However, recently it was also shown that the dengue virus may be transmitted by breast milk, as the virus was detected in breast milk but not in cord blood [11]. Once the dengue virus infects a human, the incubation period is thought to be between 3–10 days [12]. Since this baby developed dengue infections four days following delivery, he is most likely to have been infected perinatally. Although the mother did not have a severe clinical disease, the dengue infection could have resulted in foetal distress leading to meconium aspiration. Virus isolation or dengue antibody detection was not carried out on cord blood or placenta in this instance, as dengue infection was not suspected at the time of delivery.

Conclusion

In conclusion, although perinatal dengue is a rare entity, it should be suspected in neonates whose mothers were suffering from a febrile illness during or just before delivery. Since perinatal dengue has been shown to associate with foetal distress, preterm delivery and intra uterine death, early identification of this condition is crucial to prevent development of complications.

Consent

Written informed consent was obtained from the patient’s father for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Declarations

Acknowledgements

Funding was provided by the Centre for Dengue Research.

Authors’ Affiliations

(1)
Special Care Baby Unit, Colombo South Teaching Hospital
(2)
Centre for Dengue Research, Faculty of Medical Sciences, University of Sri Jayawardanapura
(3)
Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura

References

  1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar JJ, Hay SI: The global distribution and burden of dengue. Nature. 2013, 496 (7446): 504-507. 10.1038/nature12060.PubMedPubMed CentralView ArticleGoogle Scholar
  2. Malavige GN, Ogg GS: T cell responses in dengue viral infections. J Clin Virol. 2013, 58 (4): 605-611. 10.1016/j.jcv.2013.10.023.PubMedView ArticleGoogle Scholar
  3. Machado CR, Machado ES, Rohloff RD, Azevedo M, Campos DP, de Oliveira RB, Brasil P: Is pregnancy associated with severe dengue? A review of data from the Rio de Janeiro surveillance information system. PLoS Negl Trop Dis. 2013, 7 (5): e2217-10.1371/journal.pntd.0002217.PubMedPubMed CentralView ArticleGoogle Scholar
  4. Basurko C, Carles G, Youssef M, Guindi WE: Maternal and fetal consequences of dengue fever during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2009, 147 (1): 29-32. 10.1016/j.ejogrb.2009.06.028.PubMedView ArticleGoogle Scholar
  5. Ribeiro CF, Lopes VG, Brasil P, Coelho J, Muniz AG, Nogueira RM: Perinatal transmission of dengue: a report of 7 cases. J Pediatr. 2013, 163 (5): 1514-1516. 10.1016/j.jpeds.2013.06.040.PubMedView ArticleGoogle Scholar
  6. Comprehensive guidelines for prevention and control of dengue fever and dengue haemorrhagic fever. 2011, SEARO, New Delhi, India: World Health OrganizationGoogle Scholar
  7. Waduge R, Malavige GN, Pradeepan M, Wijeyaratne CN, Fernando S, Seneviratne SL: Dengue infections during pregnancy: a case series from Sri Lanka and review of the literature. J Clin Virol. 2006, 37 (1): 27-33. 10.1016/j.jcv.2006.06.002.PubMedView ArticleGoogle Scholar
  8. Kariyawasam S, Senanayake H: Dengue infections during pregnancy: case series from a tertiary care hospital in Sri Lanka. J Infect Dev Ctries. 2010, 4 (11): 767-775.PubMedView ArticleGoogle Scholar
  9. Sirinavin S, Nuntnarumit P, Supapannachart S, Boonkasidecha S, Techasaensiri C, Yoksarn S: Vertical dengue infection: case reports and review. Pediatr Infect Dis J. 2004, 23 (11): 1042-1047. 10.1097/01.inf.0000143644.95692.0e.PubMedView ArticleGoogle Scholar
  10. Tan PC, Rajasingam G, Devi S, Omar SZ: Dengue infection in pregnancy: prevalence, vertical transmission, and pregnancy outcome. Obstet Gynecol. 2008, 111 (5): 1111-1117. 10.1097/AOG.0b013e31816a49fc.PubMedView ArticleGoogle Scholar
  11. Barthel A, Gourinat AC, Cazorla C, Joubert C, Dupont-Rouzeyrol M, Descloux E: Breast milk as a possible route of vertical transmission of dengue virus?. Clin Infect Dis. 2013, 57 (3): 415-417. 10.1093/cid/cit227.PubMedView ArticleGoogle Scholar
  12. Chan M, Johansson MA: The incubation periods of Dengue viruses. PLoS One. 2012, 7 (11): e50972-10.1371/journal.pone.0050972.PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© Sinhabahu et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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