HAEMORRHAGIC FEVER AND TICKBITE FEVER

Question 1

clinical manifestation of Crim-congo HF

Answer 1

• N&V
• sore throat
• jaundice with 50% hepatomegaly
  -conjunctivitis
• splenomegaly
• photophobia
• flushing of the face
• dry tongue , with a coating of dry blood
• capillary toxicosis
• incubation period of 3-6 days

Question 2

what are the poor prognostic markers of Crim-Congo HF?

Answer 2

 WCC ≥10 x 109/l
 Platelet count ≤ 20 x 109/l
 AST ≥ 200 U/l
 ALT ≥150 U/l
 PTT ≥ 60 seconds
 Fibrinogen ≤ 110 mg/dl
 Any one of these during the first 5 days are highly predictive of a fatal outcome
 little evidence of an antibody response

Question 3

differential diagnosis of CRIM-Congo HF

Answer 3

• meningococ- septicameia
• malaria
• typhoid
• gram negative septicaemia
• severe rickettsial diseasees (tick bite fever)
• hepatitis (fulminant)
• DIC/anticoagulant therapy
• systemic herpes, VZ, CMV, EBV, and haemorrhagic measels
• snake bite

Question 4

CCHF: barrier precautions to prevent skin or mucous membrane exposure

Answer 4

1. Double gloves
2. Caps and gowns
3. Protective eye wear
    goggles or eyeglasses
4. Face shields or surgical masks 5. Waterproof aprons
5. Leg and shoe coverings
    if copious amounts of blood, other body fluids, vomit, or feces

Question 5

what is the treatment of CCHF treatment?

Answer 5

1. it is mainly supportive
   - fluid and electrolyte balance
   - Intensive care/ventilation:
   
   • support of specific organ failure
   • intensive supportive: sometimes for prolonged periods
     - Management of severe bleeding
     - multiple platelet transfusions
   • fresh frozen plasma

Question 6

treatment of CCHF (medication)

Answer 6

• secondary infections should be aggressively treated with broad spectrum antibiotics
• Convalescent immune serum (1st 3 days)
• Ribavirin : 2g stat then 1g 6 hourly for 2 days
  + 500mg q 6 hourly x 3days
• convalescence is often slow
  discharge
• discharge of patient (+/- after 3 weeks)
• observation of contact persons (2-3 weeks)

Question 7

features of rift valley fever

Answer 7

• fever and features of: encephalitis , haemorrhage, hepatitis and/or ocular pathology (retinitis)

Question 8

lab tests that confirmed rift valley fever diagnosis

Answer 8

• virus indication be PCR &/or virus isolation
• demonstration of anti RVF virus IgM by ELISA

Question 9

complications of RIFT VALLLEY fever

Answer 9

• Retinitis
• ## meningo-encephalitis dveloped

Question 10

treatment for rift valley fever

Answer 10

• supportive, ribavirin is not indicated
• patients don’t need to isolate, no human to human transmission has been demonstrated
• vaccinate livestock ahead of occurrence of outbreak

Question 11

BUNYA VIRUSES

Answer 11

• rift valley fever - mosquitoes
• hantavirus - rodents
• crimean congo HF - ticks

Question 12

Bunyaviridae

Answer 12

• Bunyavirus : LaCrosse encephalitis
• phlebovirus: rift valley fever
• tospovirus: plant virus
• hnatavirus: Hemorrhagic fever with renal syndrome + Hantavirus pulmonary syndrome