RESUMO
In 2018, yellow fever with hepatitis was diagnosed for 2 unvaccinated travelers returning to France from Brazil. Hepatitis persisted for >6 months; liver enzyme levels again increased 2 months after disease onset with no detection of yellow fever virus RNA or other pathogens. Persistent hepatitis with hepatic cytolysis rebound probably resulted from immune response.
Assuntos
Hepatite/epidemiologia , Febre Amarela/epidemiologia , Vírus da Febre Amarela , Biópsia , Brasil/epidemiologia , Comorbidade , Hepatite/diagnóstico , Hepatite/etiologia , Humanos , Testes de Função Hepática , Vigilância em Saúde Pública , Febre Amarela/diagnóstico , Febre Amarela/virologiaRESUMO
BACKGROUND: Dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) infections are rapidly expanding across countries and are being diagnosed in returned travellers who represent epidemiological sentinels. The French Territories of America (FTA) such as Guadeloupe and Martinique see high levels of tourism and have experienced three consecutive outbreaks by these viruses in the last decade. OBJECTIVE: This study was performed to evaluate how ill returned travellers could have represented epidemiological sentinels for these three expanding arboviral diseases over eight consecutive years. The degree of correlation between the cases of ill returned travellers arriving at a French tertiary hospital in Paris and the three outbreaks that occurred in the FTA during the study period was estimated. METHODS: All consecutive ill returned travellers diagnosed at the hospital in Paris with imported DENV, CHIKV, or ZIKV infections from January 2009 to December 2016 were included. Epidemiological and clinical variables were evaluated. Data concerning the incidence of arboviruses in the FTA, as well as the temporal relationship between the occurrence of imported cases and outbreaks in the FTA, were analyzed. RESULTS: Overall, 320 cases of arboviral infection were reported: 216 DENV, 68 CHIKV, and 36 ZIKV. Most of the patients presented with fever and exanthema. One hundred and fifteen patients were exposed in Guadeloupe or Martinique, which were the at-risk destinations in 25% of patients with DENV, 59% of patients with CHIKV, and 58% of patients with ZIKV. The occurrence of cases diagnosed in returning travellers followed the same time pattern as the outbreaks in these areas. CONCLUSIONS: A temporal correlation was found between newly diagnosed imported cases of arboviruses and the three corresponding outbreaks that occurred in Martinique and Guadeloupe during 8 consecutive years. Thus, ill returned travellers act as epidemiological sentinels from the beginning up to the end of outbreaks occurring in touristic locations.
Assuntos
Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Dengue/epidemiologia , Dengue/transmissão , Viagem , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/transmissão , Adolescente , Adulto , Idoso , Surtos de Doenças/estatística & dados numéricos , Feminino , Guadalupe/epidemiologia , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Paris/epidemiologia , Vigilância de Evento Sentinela , Adulto JovemRESUMO
A woman with controlled HIV infection developed in late August 2016 a pruritic rash with fever and conjunctival hyperaemia after a trip to the French Caribbean islands. On day 3 after symptom onset, Zika virus RNA was detected in plasma, urine and vaginal samples with respective viral loads of 3.8, 6.1 and 5.3 log copies/mL. Notably, we demonstrated the presence of infectious Zika virus particles in the vaginal samples by isolation in cell culture.
Assuntos
Líquidos Corporais/virologia , Febre/virologia , Vagina/virologia , Infecção por Zika virus/diagnóstico , Zika virus/isolamento & purificação , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , França , Guadalupe , Infecções por HIV/tratamento farmacológico , Humanos , Martinica , Mialgia/etiologia , RNA Viral/sangue , RNA Viral/urina , Viagem , Zika virus/genética , Infecção por Zika virus/virologiaAssuntos
Colo do Útero/virologia , Infecção por Zika virus/virologia , Zika virus/isolamento & purificação , Zika virus/fisiologia , Adulto , Feminino , França/epidemiologia , Humanos , RNA Viral/genética , RNA Viral/isolamento & purificação , Viagem , Índias Ocidentais/epidemiologia , Zika virus/genética , Infecção por Zika virus/epidemiologiaRESUMO
Ten Hepatitis B virus (HBV) genotypes, as well as numerous subgenotypes, have been described in well-characterized ethnogeographical populations. Martinique has been at a crossroads between Africa, Europe, India and the Americas because of the slave trade (17th-19th centuries), followed by an important immigration of Indian and West African workers. In this work, we aimed to study the molecular epidemiology of HBV infection in Martinique according to this unique settlement pattern. To that end, blood samples from 86 consecutive HBV-infected patients from the main hospitals of the island, were retrospectively analysed. Direct sequencing of the pre-S1 or pre-C-C region or complete genome sequencing, followed by phylogenetic analyses were performed. HBV genotypes were: HBV/A1 (68.6â%), HBV/A2 (10.5â%), HBV/D, mainly HBV/D3 and HBV/D4 (8.1â%), HBV/F (3.5â%), and also HBV/E (2.3â%), two strains isolated from two West-African patients. Moreover, 74â% of the HBeAg-negative strains harboured classical pre-C-C mutations, and most HBV/A1 strains also containing specific mutations. Finally, various patterns of deletion mutants in pre-S and pre-C-C regions were found. In conclusion, our findings point to historical and migration-related issues in HBV-genotype distribution suggesting that HBV/A1, but not HBV/E, was imported from Africa during the slave trade, and further supporting the hypothesis that HBV/E has emerged recently in West Africa (<150 years). Potential origins of 'European' HBV/A2 and HBV/D3, 'Amerindian' HBV/F, and HBV/D4 strains are also discussed. Such HBV genetic diversity, beyond its epidemiological interest, may have a clinical impact on the natural history of HBV infection in Martinique.
Assuntos
Vírus da Hepatite B/classificação , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite B/virologia , Adolescente , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Indígena Americano ou Nativo do Alasca , América/epidemiologia , Criança , Europa (Continente)/epidemiologia , Feminino , Genoma Viral , Genótipo , Hepatite B/etnologia , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Dados de Sequência Molecular , Mutação , Filogenia , Estudos Retrospectivos , Carga Viral , Adulto JovemRESUMO
We report data from a prospective observational study performed in Martinique during a co-epidemic of dengue virus serotype 2 (DENV-2) and serotype 4 (DENV-4). Among 70 serum samples from patients with DENV-2 (n = 21) or DENV-4 (n = 49) infections, 47 (67.1%) were positive for dengue nonstructural protein 1 (NS1). Antigenemia correlated with plasma virus load and was independent of immune status and the time of sampling. Increased viremia 4-6 days after onset of illness was associated with NS1 positivity, secondary infection, and severe disease. Testing for NS1 could help identify the potentially most severely ill patients during the critical phase of dengue.