Severe bullous skin lesions associated with Chikungunya virus infection in small infants

  • Stéphanie Robin
  • Duksha Ramful
  • Julie Zettor
  • Léon Benhamou
  • Marie-Christine Jaffar-Bandjee
  • Jean-Pierre Rivière
  • Jacques Marichy
  • Khaled Ezzedine
  • Jean-Luc Alessandri
Original Paper

Abstract

Introduction

The aim of this study was to describe a pediatric case series of Chikungunya infection associated with extensive bullous skin lesions, a severe and unknown form of the disease, during the 2005–2006 outbreak in La Réunion Island.

Materials and methods

Retrospective descriptive hospital-based study in children presenting blisters ≥10% of total body surface area with laboratory-confirmed Chikungunya infection.

Results

Eight boys and five girls with a mean age of 3.4 months were included. Blistering began after an average of 2 days after onset of fever and affected 21.5% (10% to 35%) of the total body surface area. Reverse transcription-polymerase chain reaction of blister fluid (n = 5) was positive with a mean viral load sometimes higher than in concurrent serum. Histopathologic examination (n = 10) showed intraepidermal blisters. Hospitalization and repeated dressing changes under general anesthesia were required. No death occurred. On follow-up, long term repigmentation was excellent with sometimes cosmetic sequelae.

Conclusion

Chikungunya should be included in the differential diagnosis of febrile blistering dermatoses in small infants in epidemic areas.

Keywords

Chikungunya Pediatric Blisters Arbovirus Skin Bullous dermatosis 

Notes

Conflict of interests

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bachot N, Roujeau JC (2003) Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol 4:561–572. doi: 10.2165/00128071-200304080-00006 CrossRefPubMedGoogle Scholar
  2. 2.
    Carey DE, Myers RM, DeRanitz CM et al (1969) The 1964 chikungunya epidemic at Vellore, South India, including observations on concurrent dengue. Trans R Soc Trop Med Hyg 63:434–445. doi: 10.1016/0035-9203(69)90030-3 CrossRefPubMedGoogle Scholar
  3. 3.
    Couderc T, Chrétien F, Schilte C et al (2008) A mouse model for Chikungunya: young age and inefficient type-I interferon signaling are risk factors for severe disease. PLoS Pathog 4:e29. doi: 10.1371/journal.ppat.0040029 CrossRefPubMedGoogle Scholar
  4. 4.
    Economopoulou A, Dominguez M, Helynck B et al (2009) Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005–2006 outbreak on Reunion. Epidemiol Infect 137:534–541. doi: 10.1017/S0950268808001167 CrossRefPubMedGoogle Scholar
  5. 5.
    Herbin G, Houdon-Nguyen L, Gerardin P et al (2006) Absence de relation entre prise d’ibuprofène et dermatose bulleuse chez les enfants atteints du chikungunya. Bull Soc Pathol Exot 99:140Google Scholar
  6. 6.
    Hettiaratchy S, Papini R (2004) Initial management of a major burn: II–assessment and resuscitation. BMJ 329:101–103. doi: 10.1136/bmj.329.7457.101 CrossRefPubMedGoogle Scholar
  7. 7.
    Inamadar AC, Palit A, Sampagavi VV et al (2008) Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol 47:154–159. doi: 10.1111/j.1365-4632.2008.03648.x CrossRefPubMedGoogle Scholar
  8. 8.
    Moore DL, Reddy S, Akinkugbe FM et al (1974) An epidemic of chikungunya fever at Ibadan, Nigeria, 1969. Ann Trop Med Parasitol 68:59–68PubMedGoogle Scholar
  9. 9.
    Nimmannitya S, Halstead SB, Cohen SN, Margiotta MR (1969) Dengue and chikungunya virus infection in man in Thailand, 1962–1964. I. Observations on hospitalized patients with hemorrhagic fever. Am J Trop Med Hyg 18:954–971PubMedGoogle Scholar
  10. 10.
    Pastorino B, Bessaud M, Grandadam M et al (2005) Development of a TaqMan RT-PCR assay without RNA extraction step for the detection and quantification of African Chikungunya viruses. J Virol Methods 124:65–71. doi: 10.1016/j.jviromet.2004.11.002 CrossRefPubMedGoogle Scholar
  11. 11.
    Pialoux G, Gaüzère BA, Jauréguiberry S, Strobel M (2007) Chikungunya, an epidemic arbovirosis. Lancet Infect Dis 7:319–327. doi: 10.1016/S1473-3099(07)70107-X CrossRefPubMedGoogle Scholar
  12. 12.
    Ramful D, Carbonnier M, Pasquet M et al (2007) Mother-to-child transmission of Chikungunya virus infection. Pediatr Infect Dis J 26:811–815. doi: 10.1097/INF.0b013e3180616d4f CrossRefPubMedGoogle Scholar
  13. 13.
    Rezza G, Nicoletti L, Angelini R et al (2007) Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet 370:1840–1846. doi: 10.1016/S0140-6736(07)61779-6 CrossRefPubMedGoogle Scholar
  14. 14.
    Robin S, Ramful D, Le Seach’ F et al (2008) Neurologic manifestations of pediatric chikungunya infection. J Child Neurol 23:1028–1035. doi: 10.1177/0883073808314151 CrossRefPubMedGoogle Scholar
  15. 15.
    Robinson MC (1955) An epidemic of virus disease in Southern Province, Tanganyka Territory, in 1952–1953. I. Clinical features. Trans R Soc Trop Med Hyg 49:28–32. doi: 10.1016/0035-9203(55)90080-8 CrossRefPubMedGoogle Scholar
  16. 16.
    Sagi L, Sherer Y, Trau H, Shoenfeld Y (2008) Pemphigus and infectious agents. Autoimmun Rev 8:33–35. doi: 10.1016/j.autrev.2008.07.021 CrossRefPubMedGoogle Scholar
  17. 17.
    Sam IC, AbuBakar S (2006) Chikungunya virus infection. Med J Malaysia 61:264–269PubMedGoogle Scholar
  18. 18.
    Surveillance active des formes émergentes hospitalières de chikungunya. La Réunion, avril 2005-mars 2006. Available via http://www.invs.sante.fr/publications/2007/chik_surveillance_2007. Accessed 12 Oct 2008
  19. 19.
    Talarmin F, Staïkowsky F, Schoenlaub P et al (2007) Skin and mucosal manifestations of chikungunya virus infection in adults in Reunion Island. Med Trop 67:167–173Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Stéphanie Robin
    • 1
  • Duksha Ramful
    • 2
  • Julie Zettor
    • 1
  • Léon Benhamou
    • 3
  • Marie-Christine Jaffar-Bandjee
    • 4
  • Jean-Pierre Rivière
    • 5
  • Jacques Marichy
    • 3
  • Khaled Ezzedine
    • 6
  • Jean-Luc Alessandri
    • 2
  1. 1.Service de PédiatrieCentre Hospitalier Félix GuyonSaint-DenisFrance
  2. 2.Service de Réanimation Néonatale et InfantileCentre Hospitalier Félix GuyonSaint-DenisFrance
  3. 3.Service des Grands BrûlésCentre Hospitalier Félix GuyonSaint-DenisFrance
  4. 4.Laboratoire de BiologieCentre Hospitalier Félix GuyonSaint-DenisFrance
  5. 5.Service d’AnatomopathologieCentre Hospitalier Félix GuyonSaint-DenisFrance
  6. 6.Service de DermatologieCentre Hospitalier Universitaire St-AndréBordeauxFrance

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