Chikungunya–dengue co-infection during pregnancy requiring preterm Caesarean section: first case report from Bangladesh

Introduction

Chikungunya, dengue and zika are of increasing global concern. ¹ In Bangladesh, dengue is endemic and chikungunya is an emerging infection. ² Since, both are transmitted by Aedes spp., simultaneous or sequential infections are possible.

Case report

A 23-year-old primigravida presented during her 36th week of pregnancy with a 5-h history of high-grade continuous fever. The mother had a four-day febrile illness, starting ten days previously, along with joint pains involving the hands, feet and lumbar spine, which persisted even after the first disappearance of fever. She had taken paracetamol during her fever and subsequently. On admission, she was flushed, febrile (40℃) and tachycardic (108/min). She was anaemic (Hb 94 g/L), lymphopaenic (8.2%), but with a normal platelet count (162 × 10³/µL) and high erythrocyte sedimentation rate (ESR; 56 mm/1st h). Dengue non-structural protein 1 (NS1) and IgM for chikungunya were positive. She had mildly raised liver enzyme levels (alanine aminotransferase 56 U/L and aspartate aminotransferase 98 U/L).

Signs of fetal distress were evident; amoxicillin, metronidazole and gentamicin were introduced according to our local CS protocol and an emergency CS was performed. The neonate (birth weight 2.4 kg) was meconium-stained, had a respiratory rate of 60/min and a temperature of 39.4℃.

Mother and baby were discharged on the fourth postoperative day in afebrile states. The neonate was treated as having congenital pneumonia as there was no clinical or laboratory evidence of vertical infection.

Discussion

High rates of chikungunya–dengue co-infection have been reported from different countries.^3,4 The Aedes mosquito is responsible for transmission of both diseases as well as zika, and such triple infection in pregnancy has been reported. ¹ Chikungunya is known to cause vertical transmission, premature delivery and maternal death.^4,5 It is uncertain whether our patient had co-infection or sequential infection by chikungunya and dengue. In our case, dengue was diagnosed within two weeks of chikungunya (acute phase), so we consider it a co-infection.

As dengue is endemic in Bangladesh, we are likely to see much more chikungunya–dengue co-infection in forthcoming years, as the incidence of chikunguya is rising. Public health initiatives are required to break disease transmission, which will have even higher benefit when two types of transmissions can be interrupted by suppressing their shared vector.