kkcth cme viral slide cme and case scenario

Case scenario

2. B/o ABC born at 38 weeks of gestation with a birth weight of 3.14 kg presented
on Day 5 with
poor feeding
Lethargy
left focal seizures
Maternal history of fever 2 days before delivery

3. PRESENTATION TITLE 3
Examination findings
Febrile
Encephalopathic
Hemodynamically stable
No organomegaly

4. PRESENTATION TITLE 4
Late onset neonatal bacterial sepsis
Meningitis
IEM

5. Initial Evaluation
Septic screen Hb 12.1WBC 4200 Platelet 1.5 lakhs
CRP 20
LFT – Bil T/D 4.1/0.5 AST / ALT 23/34 Alb 4.3
CSF sugar 73, protein 23; cell count – 10 (lymphocytic predominance)
Cultures(blood, CSF, urine)-sterile
CXR - normal

6. PRESENTATION TITLE 6
Started on antibiotics – Piperacillin Tazobactam and amikacin
Started on leviteracetam – seizures controlled
Day 7 - Baby developed erythematous blanchable rash followed by brownish
discoloration especially of face and limbs along with peripheral edema

7. Viral sepsis
PRESENTATION TITLE 7

8. PRESENTATION TITLE 8
Further evaluation
Day 7 – Thrombocytopenia (Platelet – 30,000)
Serum Dengue IgM and Chikungunya – Positive
CSF Chikungunya PCR – Positive
EEG – encephalopathic changes with bilateral epileptiform discharges
USG cranium – Increased cerebral parenchymal echogenicity
MRI brain – restricted diffusion in white matter region

9. Maternal history –
Travel to endemic region during pregnancy
Fever
Myalgia
Arthralgia
Petechiae

10. Incidentally dengue came positive
Is there a possibility of co-infection?
PRESENTATION TITLE 10

11. Shock
Capillary leak
Encephalitis
Hepatitis.
Prolonged recovery more than 10 days
PRESENTATION TITLE 11

12. Dengue can be suspected in a neonate with maternal history of
fever with thrombocytopenia with borderline elevated CRP and
negative culture
Chikungunya has to be suspected in a neonate with fever,
erythema, rash and peripheral edema
Viral infections mostly require symptomatic management and there
is no specific therapy
PRESENTATION TITLE 12