Transmission materno-fœtale précoce du virus Chikungunya

doi:10.1016/S0755-4982(06)74874-6

La Presse Médicale

Volume 35, Issue 11, Part 1, November 2006, Pages 1656-1658

https://doi.org/10.1016/S0755-4982(06)74874-6 Get rights and content

Summary

Introduction

Since the onset of the Chikungunya outbreak in Reunion Island, vertical maternal-fetal transmission of the virus has been observed in newborns, but no such transmission has been demonstrated early during pregnancy. We report here the first three cases of maternal-fetal transmission of the Chikungunya virus (CHIKV) before 16 weeks' gestational age.

Cases

Maternal infections occurred at terms of 12 weeks and 4 days, 15 weeks and 5 days, and 15 weeks and were confirmed by positive findings for specific anti-CHIKV IgM. Fetal deaths were subsequently observed, and at that point, CHIKV RT-PCR was negative for all three maternal blood samples. Amniocentesis preceded rupture of membranes in all three cases. RT-PCR showed viral genome in the amniotic fluid of the three fetuses, in the placentas of two, and in the brains of two. Autopsy found no malformations, and all other bacterial and viral test results were negative.

Discussion

These findings demonstrate early maternal-fetal transmission of CHIKV, which is suspected to be directly linked to the fetal deaths. This vertical transmission, probably abortifacient, should be considered in the light of human and animal responses to other arboviruses.

Résumé

Introduction

Depuis le début de l'épidémie de Chikungunya à la Réunion, des cas de transmission materno-fœtale ont été observés chez des nouveau-nés, mais n'ont pas été décrits à un terme précoce de la grossesse. Nous rapportons les 3 premières observations de transmission materno-fœtale du virus Chikungunya (CHIKV) avant 16 semaines d'aménorrhée (SA).

Observation

Les 3 patientes ont été atteintes par le Chikungunya à 12 SA et 4 jours, 15 SA et 5 jours et 15 SA. Le diagnostic clinique a été confirmé par l'apparition d'IgM sériques spécifiques anti CHIKV. Lors de la constatation de la mort fœtale (MIU), la RT-PCR a montré la disparition du génome viral du sang de chaque mère. Une amniocentèse a été réalisée avant la rupture des membranes. Le génome viral a été mis en évidence par la RT-PCR dans le liquide amniotique (LA) des 3 fœtus, dans le placenta de 2 fœtus et dans le cerveau de 2 fœtus. L'autopsie n'a trouvé aucune malformation chez aucun des 3 fœtus et le reste du bilan bactériologique et viral était négatif.

Discussion

La transmission materno-fœtale précoce du CHIKV est prouvée et son rôle dans les 3 MIU suspectés. Cette transmission verticale, peut-être abortive, est à rapprocher des observations faites pour d'autres arbovirus chez l'homme et l'animal.

Section snippets

Observations

Au 31 mars 2006, le nombre de cas de Chikungunya dans toute l'île a été estimé à 230 000, soit 30 % de la population. Du 1^er décembre 2005 au 28 février 2006, dans le bassin sud de la Réunion, 1 370 grossesses étaient en cours. Durant cette période, 23 fœtus ont été adressés au laboratoire de Fœtopathologie du GHSR. Seize des 23 mères avaient des sérologies CHIKV négatives. Sept morts fœtales (MIU) étaient contemporaines d'une infection maternelle à Chikungunya survenue entre 12 et 18 SA. Parmi ces

Discussion

Des transmissions verticales humaines ont été décrites lors d'infections par d'autres arbovirus : en 2002, aux États-Unis avec le West Nile Virus (WNV), du groupe des flavivirus [4] ; auparavant en 1953 et 1959 avec le Western Equine Encephalitis Virus (WEEV), du groupe des alphavirus 5, 6. Les observations et les expérimentations animales ont prouvé l'existence d'infections transplacentaires avec les virus Getah, Ross River (RRV) et Semliki Forest (SFV), 3 autres alphavirus 7, 8, 9, 10.

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Cas cliniqueTransmission materno-fœtale précoce du virus ChikungunyaEarly maternal-fetal transmission of the chikungunya virus

Summary

Introduction

Cases

Discussion

Résumé

Introduction

Observation

Discussion

Section snippets

Observations

Discussion

Vet Microbiol

Vet Microbiol

Epidémiologie de l’infection par le virus Chikungunya à l’Ile de la Réunion : point de la situation au 8 janvier 2006

Chikungunya virus disease

Alphaviruses associated primarily with fever and polyarthritis

Cas clinique
Transmission materno-fœtale précoce du virus ChikungunyaEarly maternal-fetal transmission of the chikungunya virus