Neurocognitive outcome of children exposed to perinatal mother-to-child Chikungunya virus infection: The CHIMERE cohort study on Reunion Island
Autor(es): Gérardin Patrick, Sampériz Sylvain, Ramful Duksha, Boumahni Brahim, Bintner Marc, Alessandri Jean-Luc, Carbonnier Magali, Tiran-Rajaoefera Isabelle, Beullier Gilles, Boya Irénée, Noormahomed Tahir, Okoï Jocelyn, Rollot Olivier, Cotte Liliane, Jaffar-B-jee Marie-Christine, Michault Alain, Favier François, Kaminski Monique, Fourmaintraux Alain, Fritel Xavier
Resumo: Little is known about the neurocognitive outcome in children exposed to perinatal mother-to-child Chikungunya virus (p-CHIKV) infection. The CHIMERE ambispective cohort study compared the neurocognitive function of 33 p-CHIKV-infected children (all but one enrolled retrospectively) at around two years of age with 135 uninfected peers (all enrolled prospectively). Psychomotor development was assessed using the revised Brunet-Lezine scale, examiners blinded to infectious status. Development quotients (DQ) with subscores covering movement/posture, coordination, language, sociability skills were calculated. Predictors of global neurodevelopmental delay (GND, DQ ? 85), were investigated using multivariate Poisson regression modeling. Neuroradiologic follow-up using magnetic resonance imaging (MRI) scans was proposed for most of the children with severe forms. The mean DQ score was 86.3 (95%CI: 81.0-91.5) in infected children compared to 100.2 (95%CI: 98.0-102.5) in uninfected peers (P<0.001). Fifty-one percent (n = 17) of infected children had a GND compared to 15% (n = 21) of uninfected children (P<0.001). Specific neurocognitive delays in p-CHIKV-infected children were as follows: coordination - language (57%), sociability (36%), movement/posture (27%). After adjustment for maternal social situation, small for gestational age, - head circumference, p-CHIKV infection was found associated with GND (incidence rate ratio: 2.79, 95%CI: 1.45-5.34). Further adjustments on gestational age or breastfeeding did not change the independent effect of CHIKV infection on neurocognitive outcome. The mean DQ of p-CHIKV-infected children was lower in severe encephalopathic children than in non-severe children (77.6 versus 91.2, P<0.001). Of the 12 cases of CHIKV neonatal encephalopathy, five developed a microcephaly (head circumference <-2 st-ard deviations) - four matched the definition of cerebral palsy. MRI scans showed severe restrictions of white matter areas, predominant in the frontal lobes in these children. The neurocognitive outcome of children exposed to perinatal mother-to-child CHIKV infection is poor. Severe CHIKV neonatal encephalopathy is associated with an even poorer outcome.
Imprenta: PLoS Neglected Tropical Diseases, v. 8, n. 7, p. e2996, 2014
Identificador do objeto digital: 10.1371/journal.pntd.0002996
Descritores: Chikungunya virus - Pathogenesis ; Chikungunya virus - Immunopathology ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Transmission ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemiology ; Chikungunya virus - Head circumference ; Chikungunya virus - Microcephaly ; Chikungunya virus - Public health
Data de publicação: 2014
