Exam 3 - Vectors-Emerging

Question 1

Arbovirus

Definition

Answer 1

• arthropod vector
• vertebrate host
• humans usually incidental (“dead end”)
• St Lous Encephalitis Virus Transmiss Cycle?

Question 2

Arbovirus

morph

Answer 2

-spherical RNA

Question 3

Arbovirus

4 imp’t families

Answer 3

• flaviviridae
• togaviridae
• bunyaviridae
• reoviridae

Question 4

Arbovirus

imp’t togaviridae

Answer 4

-chikungunya

Question 5

Arbovirus

imp’t flaviviridae

Answer 5

• dengue
• yellow fever
• west nile

Question 6

Arbovirus

epidem. defintions

Answer 6

• endemic: habitual presence
• epidemic: higher than usual
• pandemic: worldwide
• hyper-epidemic: several strains co-infect.

Question 7

Arbovirus

NA encephalitic

Answer 7

• moquitoe vector (except Colorado Tick)
• bird, small mammal res
• asx, flu-like, meningitis (CNS), flacc paralysis
• dx CSF IgM

Question 8

Arbovirus
Flavivirus
West Nile epi

Answer 8

• ‘squito (culex pipens….. umm, okay)
• bird res, Long Island horsies
• don’t be old or have AIDS
• intro’d to US in 1999 (Queens)
• moves N in spring, S in winter
• less fatal in tropics

Question 9

Arbovirus
Flavivirus
West Nile clin/sx

Answer 9

• 2-14 day incubation
• 80% asx
• West Nile Fever (nausea, vomit, neck stiff, macpap rash)
• West Nile Meningitis (CN palsy, elevated CSF protein, normal glc)
• West Nile Encephalitis (20% fatal, arrhythmia, resp failure, neuro sequelae)
• West Nile Neuroinvasive Dz (eith WMN or WNE) rare
• West Nile Flaccid Paralysis (w/ enceph, assymetric, prolonged recovery)

Question 10

Arbovirus
Flavivirus
West Nile dx

Answer 10

• CSF IgM (WNND) or blood IgM

- IgM after onset of encephalitis

Question 11

Arbovirus
Flavivirus
West Nile tx

Answer 11

supportive

Question 12

Arbovirus
Flavivirus
Dengue epi

Answer 12

• human are main res! that’s weird!
• peri-domestic transmission (urban)
• ‘squito vector (female aedes aegypti, day feeder)
• can also persist in sylvatic habitat
• tropical

Question 13

Arbovirus
Flavivirus
Dengue path

Answer 13

-ADE: antibody-dependent enhancement
-heterologous subsequent infx’n complexes w/
old antibodies
-complexed virus enhanced entry to monocytes
-vasoactive mediators released by monocytes

Question 14

Arbovirus
Flavivirus
Dengue Fever clin pres

Answer 14

• 20-50% asx
• Dengue Fever Syndrome
• Dengue Hemorrhagic Fever
• Dengue Shock Syndrome

Question 15

Arbovirus
Flavivirus
Dengue Fever

Answer 15

-fever, nausea, retro-orbital pain,
diffuse erythematous macpap rash,
rash blanches

Question 16

Arbovirus
Flavivirus
Dengue Hemorrhagic Fever

Answer 16

-fever, hemorrhages, thrombocytopenia (s)

Question 17

Arbovirus
Flavivirus
Dengue Shock Syndrome

Answer 17

-DHF plus circulatory failure

Question 18

Arbovirus
Flavivirus
Dengue DHF/DSS tx

Answer 18

ADMIT TO ICU!

-volume replacement, avoid overload

Question 19

Arbovirus
Flavivirus
Dengue Dx

Answer 19

• tourniquet test (>20 petechiae)
• RT-PCR
• IgM after 5 days of onset

Question 20

Arbovirus
Flavivirus
Yellow Fever epi

Answer 20

-equatorial spread in Africa, S America

Question 21

Arbovirus
Flavivirus
Yellow Fever clin/sx

Answer 21

• 3-6 day incubation
  1) 3 day fever, back myalgia, conjunctival suffusion
• biphasic recurrence
  2) severe hemorrhage, hepatitis, renal failure blk hematemesis

Question 22

Arbovirus
Flavivirus
Yellow Fever dx

Answer 22

-IgM

Question 23

Arbovirus
Flavivirus
Yellow Fever tx

Answer 23

-supportive

Question 24

Arbovirus
Flavivirus
Yellow Fever prevention

Answer 24

-very effective live-atten’d vaccine, single dose

Question 25

Arbovirus Togavirus Chikungunya epi

Answer 25

- Aedes 'squito vector - Africa (coastal Kenya epicenter) - in central america, too

Question 26

Arbovirus Togavirus Chikungunya clin/sx

Answer 26

- asx sometimes - biphasic 1) 3 days fever, rash, arthralgia, facial edema 2) polyarthralgias, spinal pain, tenosynovitis, Reynaud's 3) Recovery after months

Question 27

Arbovirus Togavirus Chikungunya dx

Answer 27

IgM or IgG; RT-PCR

Question 28

Arbovirus Togavirus Chikungunya tx

Answer 28

supportive/symptomatic

Question 29

Coronavirus | SARS epi

Answer 29

- ssRNA SARS-CoV - from Chinese bats, civets 2002 - rapid global spread

Question 30

Coronavirus | SARS transmiss

Answer 30

- mucous mem contact w/ droplets, fomites | - nosocomial

Question 31

Coronavirus | SARS clin/sx

Answer 31

- early: fever, myalgia, dry cough | - late:severe atypical pneumonia, diarrhea

Question 32

Coronavirus | SARS dx

Answer 32

RT-PCR from lower resp, stool

Question 33

Coronavirus | SARS tx

Answer 33

supportive

Question 34

Coronavirus | SARS prevention

Answer 34

ISOLATION!!!!!!!!!!!!!!!!! BORDER CONTROL!!! RACIAL PANIC!!!!!!!!!!!!

Question 35

Coronavirus | MERS epi

Answer 35

- MERS-CoV - Arabian peninsula, camels (of course) - spread to healthcare workers

Question 36

Coronavirus | MERS clin/sx

Answer 36

- fever, cough, SOB, diarrhea, vomit | - 45% mortality, esp w/ comorbidity

Question 37

Coronavirus | MERS dx

Answer 37

RT-PCR from lower resp, stool, blood

Question 38

Coronavirus | MERS tx

Answer 38

BLEEEAK!

Question 39

Filovirus | Ebola epi

Answer 39

- 1976 Sudan/DRC - 2014 Liberia/Sierra Leone/Guinea - res unknown (fruit bats?) - person-person transmiss from body fluids - contagious while febrile through post-mortem

Question 40

Filovirus | Ebola clin/sx

Answer 40

- 2-21 day incubation - abrupt fever, chills, malaise, myalgia - multisystem progression ("Ebola Virus Dz") - hemorrhagic petechiae, viscera - macpap rash, desquamates in survivors - shock, seizures, coagulopathy - 59% fatal w/in about 10 days - strong inflamm response-> good prognonis