基孔肯雅病毒相关脑炎：2005 - 2009年留尼汪岛队列研究

Chikungunya virus-associated encephalitis: A cohort study on La Réunion Island, 2005-2009.

作者信息

Gérardin Patrick, Couderc Thérèse, Bintner Marc, Tournebize Patrice, Renouil Michel, Lémant Jérome, Boisson Véronique, Borgherini Gianandrea, Staikowsky Frédérik, Schramm Frédéric, Lecuit Marc, Michault Alain

机构信息

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.

出版信息

Neurology. 2016 Jan 5;86(1):94-102. doi: 10.1212/WNL.0000000000002234. Epub 2015 Nov 25.

DOI:10.1212/WNL.0000000000002234

PMID:26609145

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.

摘要

目的

估计留尼汪岛疫情期间基孔肯雅病毒（CHIKV）相关中枢神经系统疾病的累积发病率（CIR），并评估3年后的疾病负担和患者预后。

方法

对一组脑脊液中CHIKV逆转录酶聚合酶链反应（PCR）阳性或抗CHIKV免疫球蛋白M抗体阳性且符合国际脑炎联盟脑炎或脑病标准的患者进行回顾性分析，以确定CHIKV相关中枢神经系统疾病的特征。3年后评估神经后遗症。

结果

2005年9月至2006年6月，57例患者被诊断为CHIKV相关中枢神经系统疾病，其中24例为CHIKV相关脑炎，后者的CIR为每10万人8.6例。各年龄段极端情况均观察到脑炎患者。1岁以下和65岁以上患者每10万人的CIR分别为187例和37例，均远高于美国这些年龄段脑炎累积病因的发病率。CHIKV相关脑炎的病死率为16.6%，出院时仍有持续性残疾的儿童比例估计在30%至45%之间。除新生儿期外，婴儿的临床表现和预后比成人轻。