Neonatal Chikungunya Masquerading as Late-Onset Sepsis: A Case Series from North India

Abstract

A BSTRACT Neonatal chikungunya is an increasingly recognized but underdiagnosed infection in endemic regions, frequently presenting with severe thrombocytopenia and a clinical picture closely resembling late-onset neonatal sepsis (LOS), leading to diagnostic delay and unnecessary empirical treatment. We described two term male neonates who presented on day 10 and day 22 of life with fever and persistent severe thrombocytopenia, both initially managed as LOS. In both cases, the mothers had a history of fever, rash, and arthralgia preceding delivery; however, this history was elicited only retrospectively. TORCH, dengue, and malaria testing were negative. Diagnosis was confirmed by the appearance of the characteristic “chik sign” and positive chikungunya immunoglobulin M serology (enzyme-linked immunosorbent assay) in both neonates and their mothers, and both recovered fully with supportive care. In endemic regions, detailed maternal history taken at the time of neonatal admission and early chikungunya serology in neonates presenting with persistent thrombocytopenia can prevent unnecessary interventions and reduce antibiotic overuse.