Vertical Transmission of Dengue Fever

Parul Prakash Salunke, Nandkishor Shrikishanji Kabra, Javed Ahmed


Dengue fever is transmitted between humans by the bite of Aedes spp. mosquitoes. Nonvector transmission of dengue virus is infrequently reported. Vertical transmission of dengue virus, although rare, has been reported and is associated with adverse neonatal outcomes.

A 37-week, early-term, male neonate was born by caesarean section to a 37-year-old primigravida, who was febrile during and 2 days prior to delivery. The mother tested positive for dengue NS1 antigen. On day 2 of life, the neonate developed fever spikes; blood culture and sepsis screen tests were negative; and, initially, the neonate tested negative for dengue NS1 antigen. But the neonate continued to have spikes of fever. A repeat dengue NS1 antigen test done on day 5 of life was positive. Complete blood count showed hemoconcentration and decreased platelet count (90,000/mm3). The neonate was managed in a specialized neonatal intensive care unit (NICU) with paracetamol drops for fever and oral hydration. Initially, the neonate was hydrated orally, followed by IV hydration because of worsening hemoconcentration and fall in platelet count. There was no evidence of bleeding and the neonate remained hemodynamically stable throughout the NICU stay. The neonate was given platelet transfusion on day 7 when the platelet count decreased to a minimum of 8000/mm3. Fever subsided by day 10 of life, and there was a gradual recovery in the platelet count, thereafter. The neonate was discharged home on day 16 of life, once platelet count increased above 100,000/mm3. Platelet count at 1-week postdischarge follow-up was normal (415,000/mm3). Vertical transmission of dengue virus, though rare, has been reported and should be suspected in a pregnant woman who develops febrile illness during or just before delivery. In the present case, the neonate most likely developed dengue because of vertical transmission of the virus.

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