Last updated on February 2018

Cohort of Patients Infected by an Arbovirus

Brief description of study

Arbovirus is term used to refer to a group of viruses that are transmitted by blood-feeding arthropods. The word arbovirus is an acronym (Arthropod-Borne virus). There are hundred which have been shown to cause disease in humans. The incubation period is short usually limited between 1 and 15 days. Among case in which symptoms do appear, the most common clinical features of infection are 4: algo-eruptive (dengue, chikungunya, Zika virus disease...), hemorrhagic fever (dengue, yellow fever, Crimean-Congo hemorrhagic fever), neurological (West Nile virus disease, Zika virus disease, Japanese encephalitis.) or arthritic afflictions, (Chikungunya, O'nyong nyong).

Dengue is a mosquito-born viral disease caused by four different serotypes of dengue virus (DENV). Dengue fever (DF) is defined by the sudden onset of fever associated with non specific constitutional symptoms, recovery occurring spontaneously after three to seven days.

The infection can sometimes progress to dengue hemorrhagic fever (DHF), a disease characterized by a transient increase in vascular permeability provoking a plasma leakage syndrome. DHF can be complicated by shock and internal hemorrhage. Other rarer but potentially life-threatening complications include encephalitis, hepatitis, rhabdomyolysis, and myocarditis.

There is currently no way of predicting the outcome of DF or DHF, and the World Health Organisation (WHO) classification lacks sufficient sensitivity and specificity to recognize and guide the management of severe forms of dengue. The pathophysiology of these severe forms is also poorly known, but it involves both host characteristics (immunological facilitation in case of new infection by a different serotype, and genetic factors), and viral factors.

. Since the early 2000s, the French West Indies and French Guiana have become hyperendemic for dengue, with simultaneous circulation of the four serotypes, regular large outbreaks, and severe dengue including fatalities.

Chikungunya is a re-emerging alphavirus causing massive epidemics in Africa, in the Indian Ocean, and Southeast Asia. The first autochthonous cases of chikungunya were described in French Antilles in November 2013. The disease typically consists of an acute illness like dengue fever, characterized by abrupt onset of a high-grade fever, followed by constitutionals symptoms, poly-arthritis and skin involvement. Usually, the illness resolves within few weeks: four to six weeks. However, severe clinical forms in early stage (encephalopathy, exacerbation of previous complaints..) may appear and chronic forms such as incapacitating arthralgia which affect 40 to 60% of patients with confirmed chikungunya.

In France, others arboviruses may cause severe emerging and re-emerging infectious diseases like Zika or West Nile. In non-immunized population these emerging diseases may cause outbreaks with specific severe clinical complications from each arbovirus (polyradiculoneuritis for Zika virus infection, encephalitis for West Nile virus infection)

West Indies- French Guiana French interministerial mission on emerging infectious diseases, coordinated by Professor Antoine Flahault, recommended such studies and underlined the excellent situation of Guyana for this type of study, and as an interface for clinical and basic research.

This epidemiological situation calls for large prospective multicenter cohort studies to characterize severe forms of arbovirus infections, to seek predictive factors, and to investigate the pathophysiology of the diseases .

Detailed Study Description

Principal objective To identify demographic, clinical, biological, virologic, immunologic and genetic factors associated with or predictive of severe complications of arbovirus infections (shock, internal bleeding, organ failure, death) in a cohort of children and adults with confirmed arbovirus infections, in France.

Secondary objective

To identify demographic, clinical, biological, virologic, immunologic and genetic factors predictive of altered quality of life after confirmed an acute arbovirus infection. Onset of specific complications:

  • Hemorrhagic fever (dengue :WHO criteria..)
  • Neurological disorders (West Nile virus infection, Zika virus infection, Japanese encephalitis)
  • Chronic chikungunya (persistent musculoskeletal symptoms for more than three months after symptoms onset)

Clinical Study Identifier: NCT01099852

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Recruitment Status: Open

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