Autor(es): Boutin Jean-Paul, Simon Fabrice, Oliver Manuela, Gr-adam Marc, Queyriaux Benjamin, Tolou Hugues

Resumo: In recent decades Marseilles, through immigration, has become the largest Comorian city outside the archipelago. It is also home to a faculty of medicine that has made infectious diseases one of its fields of excellence. During the last two years, Marseilles has spearheaded the metropolitan French response to the Chikungunya crisis in the Indian Ocean region, - especially in the Reunion Isl- - Mayotte. Laveran military teaching hospital (Hôpital d'instruction des armées, HIA) has managed one of the largest metropolitan cohorts. Its teams have also reported the broad clinical spectrum of the disease in its later stages, - especially the high incidence of incapacitating tenosynovitis - distal arthritis, as well as the occurrence of a transient acrosyndrome during the second - third months in nearly one-quarter of patients. Importantly, they have also identified a mixed cryoglobulin in more than 90% of patients, the level of which matches clinical symptoms - is sensitive to systemic steroid therapy. This discovery opens the way to a better underst-ing of the pathophysiology of this viral disease. The Tropical Virology laboratory of the Tropical Medicine Institute of the Army health service (IMTSSA), which has close links with the national references center (CNRS) arbovirus laboratory, has developed new diagnostic tools, notably based on RT-PCR. Together with national reference center (CNRS), the laboratory produces - suplies antigens for Chikungunya serological tests in metropolitan France - overseas. It has taken into account the presence of cryoglobulins, which can lead to false-negative results in infected patients, - has considerably increased the diagnostic yield of serological techniques. The laboratory's fundamental research focuses on genomic characterization of viral variants isolated from humans - from the vector, - also on viral protease expression, for functional studies - antiviral c-idate drug selection. The laboratory also collaborates with clinical teams in Reunion - metropolitan France working on humoral - cellular immune responses - on the different clinical forms of the disease. The Epidemiology - Public Health Department of IMTSSA conducted an epidemiological study of all gendarmes working in Reunion at the end of the epidemic (June 2006). This study, done in partnership with the tropical virology laboratory - CNRS, is helping to complete the clinical description of the epidemic, in an unbiased population. In 2007, it will form the basis for a prospective cohort study in which these patients will be monitored for several years to better document the chronic phase of the disease in a population with excellent healthcare access. Finally, the department has provided the civil authorities with advice - support in disease-control operations in Reunion. Communication played an important role in the management of this crisis, showing how crucial it now is for healthcare professionals to develop relevant skills. The Army Health Service in Maarseilles was never isolated from its university partners, as witnessed by clinical collaboration between Laveran HIA - CHU Nord (a Marseilles teaching hospital) - by virological cooperation between the IMTSSA - Etablissement français du sang (EFS) laboratories. This experience is highly encouraging with respect to the creation in Marseilles of a healthcare research network (RTRS) devoted to tropical - emerging infectious diseases.

Imprenta: Bulletin de L'Acade?mie Nationale de Me?decine, v. 191, n. 4-5, p. 785-787, 2007

Descritores: Chikungunya virus - Arbovirus; Chikungunya virus - Immune response; Chikungunya virus - Immune response; Chikungunya virus - Infectious diseases; Chikungunya virus - Viral infections; Chikungunya virus - RT-PCR; Chikungunya virus - Serological diagnosis; Chikungunya Virus - Virus; Chikungunya virus - Epidemic; Chikungunya virus - Epidemiology; Chikungunya virus - Public health

Data de publicação: 2007

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