clinico-biological characteristics of an emerging
TRANSCRIPT
Clinico-biological characteristics of an emerging arbovirus : the Mayaro
virus. A retrospective study in French Guiana 2003-2016.
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R. Mutricy,L. Epelboin, E. Mosnier, S. Matheus, F. Djossou, D. Rousset
french Guiana
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Mayaro Virus
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The arbovirus
Alphavirus
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Semliki Forest Complex
Les alphavirus
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Reservoir: primatesVector: Haemagogus spp
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Human literature•Clinical studies in epidemics or epidemiological
surveillance in Brazil, Peru and Venezuela
•One study of seroprevalence in French Guiana (Talarmin,
Am J Trop Med Hyg, 1998)
• 1 fatal case described in Mexico when investigating probable cases of dengue haemorrhagic fever (Navarrete-
Espinosa J, Rev Med Inst Mex Seguro Soc,2006)
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• Seroprevalence in French Guiana : 6,3%
• Clinical : o Fever,
o Headache,o Myalgia, o Retro orbital
pain,o Chills, o Arthralgia,o Rash, o Nausea,o Cough, o Odynophagia
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• Seroprevalence in French Guiana : 6,3%
• Clinical : o Fever,
o Headache,o Myalgia, o Retro orbital
pain,o Chills, o Arthralgia,o Rash, o Nausea,o Cough, o Odynophagia
Aim of the study
• Clinico-biological description of MAYV infection
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Material and Methods• Observational study, retrospective, monocentric,
descriptive.
• The study period is from 01/01/2003 to 31/07/2016
• All the patients passed by the Cayenne hospital center or the Cayenne French Army medical center with a TONV or MAYV positive IgM were included.
• Data from the patient files found from the Cayenne hospital software(DMU ®, CORA ®, SRI®)
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Material and Methods
• Exlusion criteria:
– duplicates
– Cross reactivity between alphaviruses
– Presence of IgM TONV
– absence of available medical chart
– absence of consultation one month before and one month after the serology was performed
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Material and Methods
• All patients who did not have these exclusion criteria were then re-evaluated by an adjudication committee composed of 2 infectious diseases specialist and a virologist and classified in 5 categories :
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Certain Diagnosis : compatible clinicalpicture and biologicaldiagnosis carried out by PCR (PolymeraseChain Reaction) or viral isolation
High Probability :
typical clinical pictureof arbovirus and IgM seroconversion, or significant elevationof the ratio on 2 successive serology
Medium Probability : typical clinicalpicture of arbovirus and positive IgM on a single sample
Low Probability :
atypical clinicalpicture of arbovirus but positive IgM on a single sample
Excluded Diagnosis : certain alternative diagnosis or a clinical picture not compatible with a previously knownarboviral or IgM TONV or MAYV positive, or clinicalinformation little contributory
Material and Methods
• All patients who did not have these exclusion criteria were then re-evaluated by an adjudication committee composed of 2 infectious diseases specialist and a virologist and classified in 5 categories :
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Certain Diagnosis : compatible clinicalpicture and biologicaldiagnosis carried out by PCR (PolymeraseChain Reaction) or viral isolation
High Probability :
typical clinical pictureof arbovirus and IgM seroconversion, or significant elevationof the ratio on 2 successive serology
Medium Probability : typical clinicalpicture of arbovirus and positive IgM on a single sample
Low Probability :
atypical clinicalpicture of arbovirus but positive IgM on a single sample
Excluded Diagnosis : certain alternative diagnosis or a clinical picture not compatible with a previously knownarboviral or IgM TONV or MAYV positive, or clinicalinformation little contributory
Included inthe analysis
Results MAYV : Flow Chart
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Patients seen in the Cayenne hospitalor the
interarmy medical centre with IgM TONV and/or
MAYV positivesn=412
Single patientn=326
Duplicatesn= 86
Patient IgM MAYV positiven=46
Cross reactivityalphavirus
n=16
Patient IgM TONV positive
n=264
Files foundn=38
Absence of file n=4
no consultation n=4
Files submitted to the adjudication committee
n=15
Anotherdiagnosis n=23- Non
infectious4
n=4- Infectious5
n=19
highprobability
n=4
Included in the analysis
n=9
mediumprobability
n=4
Excludeddiagnosis
n=3
lowprobability
n=3
Certaincasen=1
Results: characteristics of MAYV participants
Characteristics of patients with MAYV infection
Age (years) Median= 28 yearsFrom 1 to 54 years old
Age ≤ 15 years 1/9 (11,1%)
Sex ratio M/W 0,8 (M = 4, W = 5)
Atypical presentations or complications:• Meningoencephalitis• Persistent Headaches• Arthralgia for 2 months
4/9 (44,4%)
1/9 (11,1%)1/9 (11,1%)2/9 (22,2%)
Hospitalization 3/9 (33,3%)
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Clinical features of MAYV infection
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Biological characteristics of MAYV infection
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Discussion MAYV
Symptoms Synthesis of the various studies1
Fever n(%) 134/135 (99,2)
Arthralgia n(%) 115/135 (85,2)
Headache n(%) 112/135 (82,9)
Rash n(%)64/129 (49,6)
Myalgia n(%) 96/129 (74,4)
Low back pain n(%) 2/9 (22,2)
Asthénia n(%) 2/9 (22,2)
Chills n(%) 51/80 (63,5)
retro-orbital pain
n(%)62/129 (48,1)
Confusion n(%) 1/9 (11,1)
Vomiting n(%) 31/129 (24)
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SymptomsSynthesis of the various
studies
Nausea n(%) 32/96 (33,3)
Diarrhea n(%) 4/74 (5,4)
abdominal pain n(%)14/53 (28,3)
Cough n(%) 6/37 (16,2)
Pharyngitis n(%) 11/53 (20,8)
Dizziness n (%) 36/92 (39,1)
Anorexia n(%) 20/58 (34,5)
Gingivorrhagia n(%)1/22 (4,5)
Photophobia n(%) 5/74 (6,7)
Pruritus n(%) 11/42 (26,2)
1 Azevedo and al,2009; Vieira and al, 2015;Pinheiro and al,1981; Hasley and al,2013; Auguste and al 2015; Tesh and al, 1999
Discussion
• Second study on MAYV in French Guiana
• 2 clinical cases of cases imported into Europe on return from Guyana (Llagonne-Barets M and al,
2016 ; Friedrich-Jänicke B, 2014)
• 1 case of meningoencephalitis
• Important immune reactivation (23/38, 60,5%)
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Discussion
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• Bias Information and Recruitment• Setting up viral culture• Aedes albopictus and Aedes aegypti are
competent vectors for the Mayaro virus(Long KC and al, 2011; Smith GC, 1991)
Conclusion
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• Geographical distribution: forest• Vector: mosquito of the genus
Haemagogus• Clinical sign: Fever, headache, arthralgia,
myalgia, rash, retro-orbital pain• Possible Central Nervous System
Impairment
