Les Hopitaux Universitaires de Strasbourg

Depression in the elderly, or "late life depression" (LLD), is often considered to be homogeneous, legitimizing standardized treatment. Yet the literature suggests that there are different forms of LLD, with different pathophysiology, course and treatment.
Our experience has led us to identify an "anergic" form, marked by adynamia and anhedonia (anergic depression, AnD). Highly represented among LLDs, it readily resists the usual antidepressants, so that its course is often chronic. Thanks to the "Chronic Anergic Depression Open Trial", the investigators were able to show that AnD responds to dopaminergic (DA) molecules. Therefore the invastigators hypothesized a pathophysiology linked to dysfunction of the mesolimbic DA system.
However, not all patients would present the same form: two subgroups could be isolated, each contributing equally. The first corresponds to patients for whom the episode is a recurrence, the so-called "early onset depression" (EOD). The first episode occurs at 34 ±16 years of age and is frequently associated with a personality disorder (73%). The index episode usually lasts 6 ±3 years and is typically associated with anxiety (96%).
The second group corresponds to the onset of primary depression after the age of 60, known as "late onset depression" (LOD). The index episode occurs at around 71 ±6 years of age, in people with no premorbid personality disorders. The episode is shorter (3 ±1 years) and anxiety is frequent (75%) but less marked. These patients showed a high propensity for a course compatible with synucleinopathies, but often less rapid than that of the classic forms of these diseases.
The investigators hypothesize that within AnD, EOD and LOD present different pathophysiologies, and that this difference is observable on functional magnetic resonance imaging (MRI): LOD patients should present a greater reduction in functional connectivity in the mesolimbic system. The investigators make the subsidiary hypothesis that LODs also show a structural alteration observable with other types of MRI measurements, i.e. multiparametric imaging.

Despite the increasing availability and advances in the analysis of high-throughput DNA sequencing, the majority of patients with early-onset or familial parkinsonism remain without a molecular diagnosis.
Studying the genetic forms of parkinsonian syndromes presents numerous clinical, scientific and therapeutic interests. In clinical practice, identifying the genetic cause in a patient allow to provide genetic counseling and estimate the risk of recurrence in their relatives. Establishing correlations between the genotype and phenotype of patients with genetically determined parkinsonism, allow to better anticipate the evolution of the disease, or even to highlight biomarkers during the presymptomatic phases. Finally, the proteins encoded by the genes implicated in familial parkinsonism represent potential therapeutic targets likely to be modulated by neuroprotective pharmacological agents, even in sporadic Parkinson's disease.
In this work,investigators aimed at elucidating the missing genetic causes of parkinsonism through the application of combined RNA and whole genome sequencing.

International travel has increased dramatically in recent years. Vector-borne pathologies such as malaria and arboviruses are common etiologies of post-travel fever, which are prevalent in similar geographical areas (tropical and intertropical). Arboviruses, for "arthropod-borne viruses," are transmitted by the bite of blood-sucking vectors (mosquitoes, ticks, or sandflies). The dengue, chikungunya, and zika viruses are transmitted through the bite of an infected Aedes mosquito (Aedes aegypti and Aedes albopictus).
The establishment of Aedes albopictus (tiger mosquito), competent for transmitting these 3 viruses, since 2004 in mainland France and the transit of travelers carrying a virus allowed the appearance of the first autochthonous cases of dengue and zika. Each year, outbreaks of autochthonous cases of dengue fever are reported in the PACA, Occitanie, and Auvergne-Rhône Alpes regions, and a cluster of 3 Indigenous cases was reported in 2023 in the Paris region.
Since 2014, the tiger mosquito has been established in Bas-Rhin. Between 2014 and 2022, the vector was detected in around thirty municipalities around Strasbourg. In a department where the spread of the tiger mosquito is evolving rapidly, these data remind us that only an early diagnosis, delivered quickly, allows effective vector control measures to avoid generating autochthonous transmission.
In a previous study carried out at the Virology laboratory, we retrospectively analyzed the diagnosis of these 3 arboviruses after the exclusion of malaria in the context of recent travel over a period of 10 years (2014-2023). Among the 913 patients included, for 78% of cases (n=714), no testing for dengue, chikungunya, or zika was carried out, a proportion stable over 10 years.
These three arboviruses seem underdiagnosed, and we assume, given our previous results, that 8 to 10% of patients for whom, in the context of recent travel, a test for malaria comes back negative are imported cases of dengue, chikungunya, or zika. At the end of this retrospective study, we want to evaluate this sub-diagnosis on a larger sample to propose a review of practices and the establishment of Arbovirus-malaria "reflex testing." Currently, no French or similar European data is available, allowing us to evaluate this under-diagnosis, which constitutes a significant risk of the emergence of indigenous clusters in our territory.
The main objective of this study is to determine the infection rate by dengue, chikungunya, and zika viruses identified when the diagnosis is made after the exclusion of negative malaria in the context of recent travel among patients treated at the Strasbourg University Hospitals between January 1, 2024, and December 31, 2025.
The secondary objectives of this work are as follows:
Estimate the prevalence of different clinical symptoms (patient medical records) in retrospectively identified cases of dengue, chikungunya, and zika.
* Evaluate the onset time of symptoms in relation to the date of return/arrival from the area of stay of retrospectively identified cases of dengue, chikungunya, and zika.
* Evaluate the delay in the appearance of symptoms in relation to the date of taking the initial sample (the one leading to the diagnosis of negative malaria) of retrospectively identified cases of dengue, chikungunya, and zika.
* Study the laboratory results associated with the initial management of the patient (biochemical assessment and blood count) of retrospectively identified cases of dengue, chikungunya, and zika.
* Study the distribution of areas, periods, and reasons for staying in retrospectively identified dengue, chikungunya, and zika cases.
Study the municipalities of residence of positive cases in the areas where the tiger mosquito is established.