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Réanimation

, 20:211 | Cite as

Infection à virus Chikungunya à La Réunion en 2005–2006 : formes graves émergentes de l’adulte en réanimation

  • B. -A. Gaüzère
  • M. Bohrer
  • D. Drouet
  • P. Gasque
  • M. -C. Jaffar-Bandjee
  • L. Filleul
  • D. Vandroux
Mise Au Point / Update / Dossier
  • 95 Downloads

Résumé

L’épidémie de Chikungunya, arbovirose transmise par les moustiques, est apparue à La Réunion et à Mayotte en avril 2005, les premiers cas ayant été importés des Comores. À l’automne 2005 apparaissaient des formes graves de cette maladie, qui n’avaient pas été décrites jusqu’alors. À la faveur de l’été austral, le début de l’année 2006 a été marqué par une progression exponentielle de l’épidémie, qui a connu un pic à 45 000 cas par semaine. Au total, le virus du Chikungunya (vCHIK) a touché près de 270 000 personnes à La Réunion depuis le mois d’avril 2005. Nous rapportons une série de 43 cas graves d’infection à vCHIK admis dans le service de réanimation polyvalente du centre hospitalier Félix-Guyon à Saint-Denis, de mai 2005 à mai 2006, et analysons l’impact de cette épidémie sur le fonctionnement du service. Les modes de présentation ont été des formes neurologiques graves (méningoencéphalite, n = 5; polyradiculonévrite, n = 2), des atteintes hépatiques graves (n = 5), une décompensation d’un état pathologique antérieur (cardiopathie des décompensations, n = 7; arrêt cardiaque, n = 4; autres décompensations, n = 18). Vingt et un décès sont survenus. Sur le plan organisationnel, la moitié des lits était occupée par des patients infectés par le vCHIK. L’activité s’est maintenue à flux tendu, 20 % du personnel ayant été touché par l’épidémie. Nous avons ainsi été confrontés à la nécessité d’ouvrir des lits supplémentaires dans l’unité. Cette étude décrit des formes cliniques émergentes graves jusqu’alors inconnues d’infection à vCHIK, la gravité étant liée aux comorbidités des patients. Le Chikungunya n’est plus seulement une maladie tropicale après ses incursions en Italie, en 2007 et dans le sud de la France, en 2010. Il doit donc être connu des réanimateurs des pays tempérés.

Mots clés

Chikungunya Infection virale Réanimation Forme grave La Réunion 

Chikungunya virus infection in Reunion Island in 2005–2006: severe emerging adult forms in the intensive care unit

Abstract

In April 2005, an outbreak of Chikungunya fever, an arthralgic disease caused by a mosquito-borne alphavirus, spread over a number of islands in the Indian Ocean including Reunion Island and Mayotte, imported from cases in Comoros. In Reunion Island, 270,000 cases occurred resulting in an incidence of 34%, including severe clinical patterns unknown at that time. Here, we describe the characteristics of forty-three severe cases of Chikungunya virus (CHIKv) infection admitted between May 2005 and May 2006, in our 16-bed intensive care unit (ICU) in Saint-Denis as well as the organizational impact of the outbreak on the day-to-day operations in the ICU. Clinical presentations included severe neurological involvement (meningo-encephalitis, N = 5; Guillain-Barré syndrome, N = 2), liver failure (N = 5), organ failure related to co-morbidities (chronic cardiac failure, N = 7; cardiac arrest, N = 4; other failures, N = 18). Twenty-one patients (49%) died. ICU reorganization was difficult given the small number of beds available in Reunion Island (44 beds/million) and CHIKv infection affecting 20% of the health workers. Half of the ICU beds were devoted to CHIKv-infected patients, resulting in a dramatic shortage of means for patient admission. The study highlights the emergence of severe clinical forms of CHIKv infections, not yet described and related to patients’ comorbidities. CHIKv infection should no longer be considered as a rare exotic tropical disease. Its spread in Italy in 2007 and in the South of France in 2010 showed that CHIKv may impact European clinical practice in the future. Due to the severity of CHIK-vrelated diseases as assessed in our series, medical systems in Europe should be aware of the potential consequences of such an outbreak in an ICU.

Keywords

Chikungunya Viral infection ICU Severe form Reunion Island 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2011

Authors and Affiliations

  • B. -A. Gaüzère
    • 1
    • 2
  • M. Bohrer
    • 3
  • D. Drouet
    • 1
  • P. Gasque
    • 2
  • M. -C. Jaffar-Bandjee
    • 2
    • 4
  • L. Filleul
    • 5
  • D. Vandroux
    • 1
  1. 1.Service de réanimation polyvalente, CHR de La Réunionsite centre hospitalier Félix-GuyonSaint-DenisFrance
  2. 2.Groupe de recherche « Immunopathologies et maladies infectieuses » (GRI), EA4517université de la RéunionSaint-DenisFrance
  3. 3.Service d’information médicale, CHR de La Réunionsite centre hospitalier Félix-GuyonSaint-DenisFrance
  4. 4.Service d’hématomicrobiologie, CHR de La Réunionsite centre hospitalier Félix-GuyonSaint-DenisFrance
  5. 5.Cellule de l’InVS en région Océan Indien ARS Océan IndienSaint Denis Cedex 9France

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