To the Editor, To face the new coronavirus disease 2019 (COVID-19) pandemic, the need for early and accurate diagnosis of the disease among suspected cases quickly became obvious for effective management, and for better control of the spread of the disease in the population. Since the beginning of this disease epidemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), reverse transcriptase-polymerase chain reaction (RT-PCR) has routinely been used to confirm the diagnosis. However, several authors have pointed out the poor performance of this technique, particularly in terms of sensitivity. 1,2 Indeed, according to some authors, sensitivity could be as low as 38% 3 (ie, not better than chance). This made it necessary to find a more sensitive test, given the contagiousness of SARS-CoV-2. We, therefore, read with great interest the article published in your journal by Cassaniti et al. 4 This article deals with the diagnosis of COVID-19 by serology (immunoglobulin m/immunoglobulin G) as a complementary approach to RT-PCR to improve its sensitivity. According to Cassaniti et al 4 and Xiang et al, 5 serology is faster to implement, less expensive, easier to use, and more accessible to staff with no specific laboratory training. 5 The article describes the metrological performances of

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

No abstract

The WHO defined three clinical forms for chikungunya virus infection (CHIKV, namely, acute, atypical, and severe cases) and a chronic form. These definitions seemed inappropriate for the elderly. So, we propose an adapted definition for elderly people. A cross-sectional analysis was performed including patients aged ≥ 65 years, who attended the emergency department with a positive biological diagnosis of CHIKV in 2014. A total of 267 elderly patients (80 ± 8 years) were included. When using the 2015 WHO definitions, 114 patients could not be classified (42.7%) in any of the category, of whom 43 (37.7%) reported absence of fever, 85 (74.6%) reported absence of joint pain, and 14 (12.3%) reported absence of both fever and joint pain. After adaptation of the WHO definitions, the 114 unclassifiable patients were reclassified as follows: eight as typical cases, 50 as atypical cases, 42 as severe cases, and 14 remained unclassifiable. The atypical clinical form was the most common form. The 2015 WHO definitions of the clinical forms at the acute phase of CHIKV are ill suited to the elderly. The adapted definition we propose here appears to be more appropriate and could help improved management of older patients with CHIKV.

No abstract