Patrick Gérardin1, Thérèse Couderc2, Marc Bintner2, Patrice Tournebize2, Michel Renouil2, Jérome Lémant2, Véronique Boisson2, Gianandrea Borgherini2, Frédérik Staikowsky2, Frédéric Schramm2, Marc Lecuit2, Alain Michault2. 1. From the Centre Hospitalier Universitaire (CHU) (P.G., M.B., P.T., M.R., J.L., V.B., G.B., A.M.) and Centre d'Investigation Clinique-Épidémiologie Clinique (CIC1410) de La Réunion (Inserm, CHU, Université de La Réunion, Union Régionale des Médecins Libéraux de la Réunion) (P.G.), Saint Pierre, La Réunion; UMR PIMIT (Inserm U 1187, CNRS 9192, IRD 249, Université de La Réunion) (P.G., A.M.), CYROI, Saint-Denis, La Réunion; Biology of Infection Unit (T.C., M.L.), Institut Pasteur, Paris; Inserm U1117 (T.C., M.L.), Paris; CHU Henri Mondor (F. Staikowsky), Créteil; Université de Strasbourg (F. Schramm), EA 7290, Faculté de Médecine, Strasbourg; and Université Paris Descartes (M.L.), Sorbonne Paris Cité, Division of Infectious Diseases and Tropical Medicine, Necker Enfants Malades University Hospital, Institut Imagine (M.L.), Paris, France. patrick.gerardin@chu-reunion.fr. 2. From the Centre Hospitalier Universitaire (CHU) (P.G., M.B., P.T., M.R., J.L., V.B., G.B., A.M.) and Centre d'Investigation Clinique-Épidémiologie Clinique (CIC1410) de La Réunion (Inserm, CHU, Université de La Réunion, Union Régionale des Médecins Libéraux de la Réunion) (P.G.), Saint Pierre, La Réunion; UMR PIMIT (Inserm U 1187, CNRS 9192, IRD 249, Université de La Réunion) (P.G., A.M.), CYROI, Saint-Denis, La Réunion; Biology of Infection Unit (T.C., M.L.), Institut Pasteur, Paris; Inserm U1117 (T.C., M.L.), Paris; CHU Henri Mondor (F. Staikowsky), Créteil; Université de Strasbourg (F. Schramm), EA 7290, Faculté de Médecine, Strasbourg; and Université Paris Descartes (M.L.), Sorbonne Paris Cité, Division of Infectious Diseases and Tropical Medicine, Necker Enfants Malades University Hospital, Institut Imagine (M.L.), Paris, France.
Abstract
OBJECTIVE: To estimate the cumulative incidence rate (CIR) of Chikungunya virus (CHIKV)-associated CNS disease during the La Réunion outbreak, and assess the disease burden and patient outcome after 3 years. METHODS: CHIKV-associated CNS disease was characterized retrospectively in a cohort of patients with positive CHIKV reverse transcriptase PCR or anti-CHIKV immunoglobulin M antibodies in the CSF and fulfilling International Encephalitis Consortium criteria for encephalitis or encephalopathy. Neurologic sequelae were assessed after 3 years. RESULTS: Between September 2005 and June 2006, 57 patients were diagnosed with CHIKV-associated CNS disease, including 24 with CHIKV-associated encephalitis, the latter corresponding to a CIR of 8.6 per 100,000 persons. Patients with encephalitis were observed at both extremes of age categories. CIR per 100,000 persons were 187 and 37 in patients below 1 year and over 65 years, respectively, both far superior to those of cumulated causes of encephalitis in the United States in these age categories. The case-fatality rate of CHIKV-associated encephalitis was 16.6% and the proportion of children discharged with persistent disabilities estimated between 30% and 45%. Beyond the neonatal period, the clinical presentation and outcomes were less severe in infants than in adults. CONCLUSIONS: In the context of a large outbreak, CHIKV is a significant cause of CNS disease. As with other etiologies, CHIKV-associated encephalitis case distribution by age follows a U-shaped parabolic curve.
OBJECTIVE: To estimate the cumulative incidence rate (CIR) of Chikungunya virus (CHIKV)-associated CNS disease during the La Réunion outbreak, and assess the disease burden and patient outcome after 3 years. METHODS:CHIKV-associated CNS disease was characterized retrospectively in a cohort of patients with positive CHIKV reverse transcriptase PCR or anti-CHIKV immunoglobulin M antibodies in the CSF and fulfilling International Encephalitis Consortium criteria for encephalitis or encephalopathy. Neurologic sequelae were assessed after 3 years. RESULTS: Between September 2005 and June 2006, 57 patients were diagnosed with CHIKV-associated CNS disease, including 24 with CHIKV-associated encephalitis, the latter corresponding to a CIR of 8.6 per 100,000 persons. Patients with encephalitis were observed at both extremes of age categories. CIR per 100,000 persons were 187 and 37 in patients below 1 year and over 65 years, respectively, both far superior to those of cumulated causes of encephalitis in the United States in these age categories. The case-fatality rate of CHIKV-associated encephalitis was 16.6% and the proportion of children discharged with persistent disabilities estimated between 30% and 45%. Beyond the neonatal period, the clinical presentation and outcomes were less severe in infants than in adults. CONCLUSIONS: In the context of a large outbreak, CHIKV is a significant cause of CNS disease. As with other etiologies, CHIKV-associated encephalitis case distribution by age follows a U-shaped parabolic curve.
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