Which arboviruses will be encountered in Metropolitan France’s Intensive Care Units in 2011?

Abstract

Arboviruses (arthropode-borneviruses) form a heterogeneous group of viruses transmitted by hematophagous arthropod vectors such as mosquitoes and ticks. Clinical presentation can be classified into three categories: 1) acute and uncomplicated fever (dengue-like); 2) encephalitis; 3) haemorrhagic fever. As encephalitis and chikungunya are detailed elsewhere in this issue, this state-of-the art paper focuses on the four arboviruses that are most likely to be encountered in Metropolitan France’s intensive care units (ICU) in 2011. First, dengue fever dramatically emerged in most parts of the world over the last two decades. Human cases of autochtonous, vector-transmitted dengue have been reported in Nice in 2010. Usually benign, dengue fever requires ICU admission when it evolves into dengue haemorrhagic fever and/or dengue with shock syndrome (1–3% of symptomatic cases). Yellow fever may be imported by unvaccinated travellers returning from endemic areas (Africa, South America). After an initial dengue-like syndrome, 15–25% of patients will develop multiple organ failure and haemorrhages. Crimean-Congo Haemorrhagic Fever (CCHF) was responsible for the only case of viral haemorrhagic fever reported in Metropolitan France (Rennes, 2004). CCHF has dramatically emerged in Southern Europe (Turkey, Greece, Bulgaria), Asia, and Africa over the last decade. Lastly, Rift valley fever spread throughout Africa over the last decades, including Madagascar and Mayotte, and extended outside Africa since 2000 (Saudi Arabia, Yemen). Although haemorrhagic complications remain rare (3–4% of symptomatic cases), the efficacy of its transmission and its rapid emergence suggest that Rift valley fever may be encountered in French ICUs.