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Senior - ID 2 > 9 - Viral Hemorrhagic Fevers > Flashcards

9 - Viral Hemorrhagic Fevers Flashcards

1
Q

Bunyavairidae virus?

A

Crimean-congo hemorrhagic fever (CCHF)

Hanta virus

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2
Q

Flavivirade viruses?

A

Dengue

Yellow fever

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3
Q

Arenaviridae fever?

A

Lassa fever

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4
Q

Filoviridae viruses?

A

Ebola

Marburg virus diseases

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5
Q

All of the viral hemorrhagic fevers are?

A

RNA viruses
- they are enveloped in a fatty (lipid) coating

Damage the microvasculature

Dependent on host for survival

Geographically restricted

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6
Q

Dengue fever is actually 4 differenet viruses, what are they?

A

DEN - 1
DEN - 2
DEN - 3
DEN - 4

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7
Q

Cross protective immunity from the different DEN viruses?

A

Nope

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8
Q

Where are the dengue fevers found?

A

The tropics

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9
Q

What spreads dengue fever?

A

Mosquito: aedes aegypti (or albopictus)

A day bighting mosquito that prefers humans

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10
Q

What is dengue fever (DF)

A

Symptom complex caused by the infection

Can be asymptomatic

Non-specific febrile illness

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11
Q

Symptoms of dengue hemorrhagic fever (DHF)?

A

Bleeding complications

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12
Q

What is dengue shock syndrome?

A

Good question, she just listed it

Maybe look it up later

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13
Q

Dengue fever in the US?

A

Yeah, down in southern texas, hawaii and key west

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14
Q

How many cases of dengue fever have been found in iraq and afghanistan?

A

None, just socom in their various missions

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15
Q

S/S of dengue fever?

A 
Very High fever (105.8)
HA
Retro-orbital pain 
N/V
Truncal sclaratinaform rash
Sever myalgias/arthralgias/malaise
Hemorrhagic manifestations
Abdominal pain
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16
Q

Hemorrhagic manifestations of dengue fever?

A

Petechiae and bleeding at venipuncture site (MC)

Nose and gum bleeding
Melena/ hematemesis

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17
Q

What is a saddleback fever?

A

Dengue fever sometimes has abates for a day then comes back

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18
Q

If you see the saddle back fever what do you need to worry about?

A

This is the time that they are at risk for developing DHF or DSS

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19
Q

Physical findings or dengue fever?

A
  • Rash (1/2 of pts)
  • petechiae/purpura
  • conjunctival injection
  • pharyngeal injection
  • generalized lymphadenopathy
  • hepatomegaly
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20
Q

MC manifestation of dengue fever?

A

Petechiae and bleeding at venipuncture

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21
Q

In office test for dengue fever?

A

Tourniquet test

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22
Q

How is the tourniquet test conducted?

A

Inflate BP cuff on upper arm

Pump to Midwaybetween diastolic and systolic
- hold x 5 min

POS = 20 petechiae per sq inch

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23
Q

Labs for dengue fever?

A 
CBC
Platelet count (thrombocytopenia)
BMP - hyponatremia 
LFT - low albumen
Coagulation studies
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24
Q

MC metabolic change with dengue fever?

A

Haponaturemia

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25
Q

CBC findings for dengue fever?

A

End of febrile phase
- leukopenia

Before defervescence or shock
- lympohcytosis

Rise in HCT (> 20%)

  • precedes chock
  • monitor q 3-4 hrs
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26
Q

What happens with a heme concentration (HCT > 20%)

A

Seeping of plasma

Red cells still circulate

Blood “oozes out”

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27
Q

HCT < 10%?

A

Significant hemorrhage

Real bleeding - not oozing

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28
Q

Lab diagnostics findings for dengue fever?

A

Approx 1 week

  • DENV RT-PCR
  • NS1

Approx 5 days

  • IGM,
  • anti DENV
  • ELISA
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29
Q

Tx for DF?

Thx for dhf/Dss?

A

DF: Self-limited (acetaminophen)

DHF/DSS

  • IV fluids
  • blood transfusions
  • gamma globulin
  • steroids (controversial)
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30
Q

What blood product is preferred?

A

Fresh whole blood

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31
Q

Best method for dealing with DF?

A

Prevention

  • 20-30% deet
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32
Q

Dont give high % deet to?

A

Kids

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33
Q

Dengue fever vaccine?

A

Degavaxia
Recommended in 2016

But its under investigation and is currently suspended

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34
Q

Complications of dengue fever?

A

Neurologic manifestations

  • encephalitis/encephalopathy
  • guillin-barre syndrome
  • transverse myelitis

liver failure
- DHF/DSS

Overhydration

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35
Q

Zika

A

It says just FYI but its on slide 33 so maybe read it a time or 3

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36
Q

Types of yellow fever?

A

Epidemic/urban (ades aegypti)

Sylvatic/jungle (various mosquitos)

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37
Q

Where is yellow fever found?

A

Originated in africa but…

Has had many outbreaks world wide

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38
Q

Yellow fever vaccine”?

A

Yes, its from 1937

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39
Q

How does yellow fever spread? (Pathophysiology)

A 
Female mosquito regurgitates the virus 
- infects the vascular endothelia cells
- hits the reticuloendothelial system
 — secondary viremia, immune system is overwhelmed
- reticuloendothelial = liver = jaundice
- mucosal and GI bleeding
- saddle back pattern
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40
Q

What is black water vomit?

A

Mucosal and GI tract bleeding that leads to black emesis

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41
Q

S/S of acute phase of yellow fever?

A 
Fever
HA
Nausea
Billious vomiting
Conjunctival injection

*May be the only symptoms

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42
Q

How long does the acute phase of yellow fever last?

A

Approx 3 days

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43
Q

How long is the remission stage?

A

24hrs

44
Q

S/S of toxic phase of yellow fever?

Liver specific

A 
Jaundice
Oliguria
Dark urine
Stool color change
Hepatomegaly (tender)
45
Q

S/S of toxic phase of yellow fever?

Skin specific

A

Petechiae

46
Q

S/S of toxic phase of yellow fever?

Abdominal

A 
Epistaxis
Coffee ground emesis
Hematemeis 
Melena
Bright blood PR
Hematuria
47
Q

S/S of toxic phase of yellow fever?

Cardiac/neural

A 
Relative bradycardia
Myocardial depression
Various arrhythmias
Anascara
Mental status changes
48
Q

Labs for yellow fever?

A

CBC - leukopenia/thrombocytopenia; HCT changes

Coagulation studies

chemestries

LFT

ECG and cardiac monitoring

Serologic studies

49
Q

Serologic studies for yellow fever?

A

Acute and convalescent titers
- 4 fold increase

Specific IgM - 7-10 days post infection

50
Q

What blood product is preferred for yellow fever?

A

Fresh frozen plasma

51
Q

Tx of yellow fever?

A
  • Supportive therapy (critical)
  • get central venous access
  • FFP
  • isolate pt (mosquito net)

NO effective antivirals

52
Q

Prevention of yellow fever?

A

Immunization and education

Avoid mosquitos

53
Q

Complications of yellow fever?

A
  • liver failure
  • renal failure
  • pulmonary edema
  • myocarditis
  • encephalitis
  • hemorrhage
  • DIC
  • Shock
  • Death
54
Q

How are ebola and marburg carried?

A

Humans and nonhuman primates

55
Q

Natural reservoir for ebola and marburg?

A

Bats

56
Q

How are ebola and marburg spread?

A

Usually spread in the healthcare/lab setting

57
Q

What stage of ebola and marburg spread human-to-human?

A

Human-to-human in acute stage only

58
Q

Eboal is a filovirus

Filo =

A

Thread

59
Q

Ebola rash?

A

A hemorrhagic rash over the entire body

60
Q

Physical findings of ebola and marburg?

Early in disease

A

Early in the disease

  • sever HA
  • pharyngitis
  • arthralgias/myalgias
  • fever w/ or w/o chills
  • anorexia
  • asthenia
  • maculopapular rash
  • bilateral conjunctival injection
61
Q

Physical findings of ebola and marburg?

Following the early symptoms?

A

GI symptoms

  • abdominal pain
  • N/V
  • diarrhea
  • odynophagia/dysphagia
62
Q

Physical findings of ebola and marburg?

Late in disease

A

Expressionless hippocratic “ghostlike” facies

Bleeding from mucous membranes and puncture sites

Bleeding from GI tract

Tachypnea

63
Q

Physical findings of ebola and marburg?

Terminally ill

A
  • obtunded
  • anuric
  • tachypneic
  • normothermic
  • shock
  • hiccups
  • tachypnea (poor prognostic indicator)
64
Q

Hiccups?

A

Have been noted in fatal cases of ebola and marburg

65
Q

Lab findings for ebola nad marburg?

A

CBC

  • thrombocytopenia
  • leukpenia
  • pronounced lymphopenia

Chem panel/liver panel

  • multiple organ failure
  • metabolic acidosis
  • increased BUN and creatinine

IGM ELISA IgG ELISA
PCR

66
Q

Tx of ebola and marburg?

A 
No specific therapy
- supportive
- Human convalescent plasma
- ZMAPP (compassionate use)
- trial vaccine
-
67
Q

The rVSU-EBOV vaccine works against which strain in trials?

A

Only the zaire subtype

68
Q

Complications of ebola and marburg?

A
  • Death ebola (80%) margurg (25%)
  • ocular manifestions uveitis/scleritis
  • tinnitus
  • unilateral orchitis
  • supportive parotitis
  • asymmetric and migratory arthralgias
69
Q

How is the recovery for ebola and marburg?

A

Complain of

  • joint pain
  • inflammation of palms/soles
  • generalized pain and stiffness
  • seizures
  • ocular burning
  • eye pain
70
Q

Ebola and marburg virus is found?

A

On PCR lurking in anterior chamber 3 months post illness

Also semen for several weeks

71
Q

How is Lassa spread?

A

Primary
- Rodent to human

Secondary is
- human to human

72
Q

Lassa is particularly bad in?

A

Pregnancy (3rd trimester)

73
Q

Unlike the others with lassa?

A

Bleeding manifestations are rare

74
Q

To prevent lassa people were asked to?

A

Stop burning bushes b/c it drove the rats into their homes

75
Q

Stats for Lassa?

A

20% develop multisystem disease

50% fatality rate

76
Q

S/S of Lassa

A
  • insidious onset
  • fever
  • weakness
  • joint and or lumbar pain
  • cough
  • sever HA
  • prostration
  • abdominal pain’
  • facial or neck edema
  • dead babies
  • deafness
77
Q

How long is the onset of lassa?

A

Sx develope over 1-3 weeks

78
Q

MC sequella for lassa?

A

Deafness (1/3 of cases)

79
Q

What is the major cause of pediatric hospitalizations in west africa?

A

Lassa fever in kids and infants

80
Q

swollen baby syndrome

A

Lassa fever in kids and infants

  • edema
  • anascara (whole body edema)
  • abdominal distention
  • bleeding
  • poor prognosis
81
Q

Labs for lassa?

A

LFT: AST&raquo_space;ALT
CBC: lymphopenia, thrombocytopenia
ELISA
PCR (research only)

82
Q

Tx for lassa?

A

Ribavarin : start w/in 6 days

Aggressive supportive therapy

83
Q

Complications of lassa?

A

Fatality 15-20%
Maternal mortality in 3rd trimester >30%
Fetal and neonate >85%

84
Q

Hantavirus is aka?

A

Hemorrhagic fever w renal failure syndrome

  • HFRS
85
Q

HFRS is not?

A

Hantavirus pulmonary syndrome (the US one)

86
Q

HFRS is found?

A

Far east

87
Q

Triad of HFRS?

A

Fever
Hemorrhage
Renal insufficency

88
Q

Reservior species of hanta?

A

Rodents

89
Q

Children under 15 w HFRS?

A

It is mild in kids under age 15

90
Q

Stages of HFRs?

A 
Febrile 
Hypotensive
Oliguric 
Diuretic
Convalescent
91
Q

Febrile phase S/S

A 
HA
Chills
Abdominal pain
Malaise
Flushing
Petechia
Subconjunctival hemorrhage

ABSOLUTE BRADYCARDIA

92
Q

Hypotensive stage S/S

/

A 
11% of pts
Tachycardia (impending shock)
Acute abdomen (paralytic ileus)
Convulsions
Purposeless movements
93
Q

Oliguric stage S/S

A

Oliguria
HTN
Bleeding (uremia)
Edema

Thrombocytopenia resolves

94
Q

Dieuretic stage

A

Oththe symptoms resolve

Rapid dehydration

95
Q

Convalescent stage lasts?

A

3-6 months

96
Q

Labs for HFRS?

A 
UA 
- hematuria
- proteinuria (lasts yrs)
CBC
- leukocytosis
- H hematocrit
- thrombocytopenia
Abnormal LFT and metabolic panel
- hyponatremia 
- hyperkalemia
ELISA is diagnostic
97
Q

Tx for HFRS?

A

Maitain fluids
Supportive
Ribavirin

98
Q

Complications of HFRS?

A

Pulmonary edema
Metabolic dysfunction
- hypercalciuria
Mortality and morbidity rates vary (5-15%)

Complications are rare

99
Q

Crimean-congo hemorrhagic fever is aka?

A

Central asian hemorrhagic fever

Congo fever

100
Q

How is crimean-congo hemorrhagic fever spread?

A

Ticks that bite livestock

Found in africa, asia, middle ease, eastern europe

101
Q

S/S of crimean-congo hemorrhagic fever?

A
  • Flue like (initially)
  • hemorrhage (after 3-5 days)
  • massive ecchymosis
  • epistaxis
  • hematomegaly (50%)
  • substantial mucosal and GI bleeding
  • erythemia of EENT areas
102
Q

Labs for crimean-congo hemorrhagic fever?

A 
CBC
- leukopenia
- thrombocytopenia
ELISA
PCR
103
Q

Tx for crimean-congo hemorrhagic fever?

A

Ribavirin

Supportive care

104
Q

Besides ticks how do you get crimean-congo hemorrhagic fever?

A 
Needlesticks
Cesarean wound care
Indirect
- aerosolization from glove removal
- failure to use N95 respirator
105
Q

Complications of crimean-congo hemorrhagic fever?

A

Encephalitis - rare

Mortality rate 13-50%

106
Q

what do you give a dog with a fever?

A

Mustard, its the best thing for a hot dog…

Senior - ID 2 (6 decks)

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