Journal of Clinical Virology 77 (2016) 66–68
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case report
A case of Mayaro virus infection imported from French Guiana Marion Llagonne-Barets a,b , Vinca Icard a , Isabelle Leparc-Goffart c , Christine Prat c , Thomas Perpoint d , Patrice André a,b,e , Christophe Ramière a,b,e,∗ a
Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université de Lyon, Lyon, France Centre national de référence Arbovirus, IRBA, Marseille, France d Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France e CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France b c
a r t i c l e
i n f o
Article history: Received 4 September 2015 Received in revised form 19 January 2016 Accepted 16 February 2016 Keywords: Mayaro virus Arbovirus Imported viral diseases Vector-borne infections
a b s t r a c t Emergence of arboviruses is a rising problem in several areas in the world. Here we report a case of Mayaro virus infection that was diagnosed in a French citizen presenting a dengue-like syndrome with prolonged arthralgia following a travel in French Guiana. Diagnosis was based on serological testing, a newly developed specific RT–PCR and sequencing. The real incidence of this viral infection among travelers is poorly known but this case is the first reported in a European area where Aedes albopictus mosquitoes are established, which underscores the necessity to determine the vector competence of the European strain of this mosquito species for Mayaro virus. © 2016 Elsevier B.V. All rights reserved.
1. Why this case is important Mayaro virus (MAYV) is a single-stranded positive RNA virus, first isolated in Trinidad in 1954 [1]. MAYV is a member of the Togaviridae family, genus Alphavirus, and belongs to the Semliki Forest complex, as Chikungunya virus [2]. Two genotypes are described: genotype D which is ubiquitous in Amazonia and genotype L which is present only in Brazil [3]. MAYV is an arthropod-borne virus whose transmission cycle mainly involves mosquitoes of the Culicidae family (in particular genus Haemagogus) as vectors [2]. Hosts are sylvatic vertebrates, mainly non-human primates, but also birds and reptiles as reservoir [2]. Emergence of arboviruses is particularly monitored in Europe as a consequence of the expansion of the vector Aedes albopictus. To date only a limited number of imported cases of MAYV infection have been reported in this continent. Under-diagnosis is very likely, probably due to confusion with Dengue virus infection and the lack of validated and specific diagnostic tests. Indeed the diagnosis of most reported imported cases to date was based on serological testings.
∗ Corresponding author at: Laboratoire de Virologie, Centre de Biologie et de Pathologie Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France. Fax: +33 4 72 00 37 54. E-mail address: [email protected] (C. Ramière). http://dx.doi.org/10.1016/j.jcv.2016.02.013 1386-6532/© 2016 Elsevier B.V. All rights reserved.
Here we report the first confirmed case of imported MAYV infection into a European area where A. albopictus is established. Diagnosis was confirmed by serological, RT–PCR and sequencing techniques. Although A. albopictus is not the natural vector for MAYV, a possible transmission by this species has been suggested by some studies [4,5], underlining the necessity to evaluate the real incidence of MAYV infections among travelers and the vector competence of A. albopictus.
2. Case description Here we report the case of a 30 year-old male, living in Lyon, France, who traveled for vacation in French Guiana for 6 days. During his journey, he went to the city of Cayenne and along the “crique” Gabrielle, a little river coursing across the forest. On the day following his return to France, he developed high fever at 40 ◦ C, joint pain, myalgia, headache, asthenia and some diarrhea. The patient also reported a very transient skin rash that had disappeared at the time of consultation. He was vaccinated against yellow fever, hepatitis A and hepatitis B. He slept under a mosquito net but reported mosquito bites. Standard laboratory tests were performed at day 2 after the onset of symptoms. Results of blood count revealed leucopenia (3.33 G/L) with lymphopenia (0.87 G/L) and thrombocytopenia (platelets at 146 G/L). Liver function testing showed a moderate
M. Llagonne-Barets et al. / Journal of Clinical Virology 77 (2016) 66–68
67
Fig. 1. Phylogenetic tree following alignment with MEGA6 software of available MAYV sequences available in Genbank. The sequence corresponding to the case described in the study is indicated by an arrow.
Table 1 Results of arbovirus serologies at different time points after the onset of symptoms. IgM and IgG were detected using in-house M-capture ELISA and indirect ELISA, respectively, with precipitated and inactivated viruses as antigens. Virus
Dengue West-Nile Mayaro Chikungunya Blank *
Day 2
Day 5
O.D. IgM
Ratio*
O.D. IgG
Ratio*
O.D. IgM
0.074 0.061 0.086 0.059 0.064
1.16 0.95 1.34 0.92 1
0.057 0.046 0.046 0.045 0.047
1.21 0.98 0.98 0.96 1
0.073 0.062 1.163 0.066 0.061
Day 37 Ratio* 1.20 1.02 19.07 1.08 1
O.D. IgG
Ratio*
O.D. IgM
0.058 0.046 0.151 0.065 0.051
1.14 0.90 2.96 1.27 1
0.073 0.062 1.167 0.067 0.067
Ratio* 1.09 0.93 17.42 1.00 1
O.D. IgG
Ratio*
0.061 0.049 0.134 0.049 0.048
1.27 1.02 2.79 1.02 1
Ratio O.D antigen/O.D. blank: >3: presence of antibodies. Between 2.5 and 3: presence of antibodies to comment.
Contents lists available at ScienceDirect
Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv
Case report
A case of Mayaro virus infection imported from French Guiana Marion Llagonne-Barets a,b , Vinca Icard a , Isabelle Leparc-Goffart c , Christine Prat c , Thomas Perpoint d , Patrice André a,b,e , Christophe Ramière a,b,e,∗ a
Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France Université de Lyon, Lyon, France Centre national de référence Arbovirus, IRBA, Marseille, France d Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France e CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France b c
a r t i c l e
i n f o
Article history: Received 4 September 2015 Received in revised form 19 January 2016 Accepted 16 February 2016 Keywords: Mayaro virus Arbovirus Imported viral diseases Vector-borne infections
a b s t r a c t Emergence of arboviruses is a rising problem in several areas in the world. Here we report a case of Mayaro virus infection that was diagnosed in a French citizen presenting a dengue-like syndrome with prolonged arthralgia following a travel in French Guiana. Diagnosis was based on serological testing, a newly developed specific RT–PCR and sequencing. The real incidence of this viral infection among travelers is poorly known but this case is the first reported in a European area where Aedes albopictus mosquitoes are established, which underscores the necessity to determine the vector competence of the European strain of this mosquito species for Mayaro virus. © 2016 Elsevier B.V. All rights reserved.
1. Why this case is important Mayaro virus (MAYV) is a single-stranded positive RNA virus, first isolated in Trinidad in 1954 [1]. MAYV is a member of the Togaviridae family, genus Alphavirus, and belongs to the Semliki Forest complex, as Chikungunya virus [2]. Two genotypes are described: genotype D which is ubiquitous in Amazonia and genotype L which is present only in Brazil [3]. MAYV is an arthropod-borne virus whose transmission cycle mainly involves mosquitoes of the Culicidae family (in particular genus Haemagogus) as vectors [2]. Hosts are sylvatic vertebrates, mainly non-human primates, but also birds and reptiles as reservoir [2]. Emergence of arboviruses is particularly monitored in Europe as a consequence of the expansion of the vector Aedes albopictus. To date only a limited number of imported cases of MAYV infection have been reported in this continent. Under-diagnosis is very likely, probably due to confusion with Dengue virus infection and the lack of validated and specific diagnostic tests. Indeed the diagnosis of most reported imported cases to date was based on serological testings.
∗ Corresponding author at: Laboratoire de Virologie, Centre de Biologie et de Pathologie Nord, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France. Fax: +33 4 72 00 37 54. E-mail address: [email protected] (C. Ramière). http://dx.doi.org/10.1016/j.jcv.2016.02.013 1386-6532/© 2016 Elsevier B.V. All rights reserved.
Here we report the first confirmed case of imported MAYV infection into a European area where A. albopictus is established. Diagnosis was confirmed by serological, RT–PCR and sequencing techniques. Although A. albopictus is not the natural vector for MAYV, a possible transmission by this species has been suggested by some studies [4,5], underlining the necessity to evaluate the real incidence of MAYV infections among travelers and the vector competence of A. albopictus.
2. Case description Here we report the case of a 30 year-old male, living in Lyon, France, who traveled for vacation in French Guiana for 6 days. During his journey, he went to the city of Cayenne and along the “crique” Gabrielle, a little river coursing across the forest. On the day following his return to France, he developed high fever at 40 ◦ C, joint pain, myalgia, headache, asthenia and some diarrhea. The patient also reported a very transient skin rash that had disappeared at the time of consultation. He was vaccinated against yellow fever, hepatitis A and hepatitis B. He slept under a mosquito net but reported mosquito bites. Standard laboratory tests were performed at day 2 after the onset of symptoms. Results of blood count revealed leucopenia (3.33 G/L) with lymphopenia (0.87 G/L) and thrombocytopenia (platelets at 146 G/L). Liver function testing showed a moderate
M. Llagonne-Barets et al. / Journal of Clinical Virology 77 (2016) 66–68
67
Fig. 1. Phylogenetic tree following alignment with MEGA6 software of available MAYV sequences available in Genbank. The sequence corresponding to the case described in the study is indicated by an arrow.
Table 1 Results of arbovirus serologies at different time points after the onset of symptoms. IgM and IgG were detected using in-house M-capture ELISA and indirect ELISA, respectively, with precipitated and inactivated viruses as antigens. Virus
Dengue West-Nile Mayaro Chikungunya Blank *
Day 2
Day 5
O.D. IgM
Ratio*
O.D. IgG
Ratio*
O.D. IgM
0.074 0.061 0.086 0.059 0.064
1.16 0.95 1.34 0.92 1
0.057 0.046 0.046 0.045 0.047
1.21 0.98 0.98 0.96 1
0.073 0.062 1.163 0.066 0.061
Day 37 Ratio* 1.20 1.02 19.07 1.08 1
O.D. IgG
Ratio*
O.D. IgM
0.058 0.046 0.151 0.065 0.051
1.14 0.90 2.96 1.27 1
0.073 0.062 1.167 0.067 0.067
Ratio* 1.09 0.93 17.42 1.00 1
O.D. IgG
Ratio*
0.061 0.049 0.134 0.049 0.048
1.27 1.02 2.79 1.02 1
Ratio O.D antigen/O.D. blank: >3: presence of antibodies. Between 2.5 and 3: presence of antibodies to comment.
