Haemorrhagic fevers /Crimean Congo hemorrhagic fever and Hemorrhagic fever with renal involvement/. Differential diagnosis in patients with hemorrhagic fevers. Flashcards
what are the family , the viruses and the disease name that causes hemorrhagic fever
family - arenaviridae
virus - lassa virus
disease - lassa fever
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family - HANTAVIRIDAE virus - HANTAVIRUS disease - hantavirus cardiopulmonary syndrome and hemorrhagive fever with RENAL SYNDROME!
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family - NAIROVIRIDAE
virus - crimean congo hemorrhagic fever
disease -crimean congo hemorrhagic fever
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family - phenuviridae
virus - rift valley fever virus
disease - rift valley fever
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family - FILOVIRIDAE
virus - ebola virus ,
marburg virus
disease -
ebola
marburg hemorrhagic fever
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family - flaviviridae
virus -
dengue virus
yellow fever virus
disease -
dengue hemorrhagic fever
yellow fever
what is the epidemiology of all the hemorrhagic virus ?
VIRUS - LASSA VIRUS
disease - lassa fever
epi - west africa (Liberia, Sierra Leone, Guine)
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
epidemiology - North and South America
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
Asia, Korea, Russia, Europe
Highest annual incidence in China
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CRIMEAN-CONGO HEMORRHAGIC FEVER
Southeastern Europe, Africa, Middle East, Asia
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RIFT VALLEY FEVER
Eastern and Southern Africa (e.g., Kenya, Tanzania, Somalia)
Sporadic cases also reported throughout Africa and the Middle East
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EBOLA VIRUS DISEASE
Largest outbreak of Ebola to date: 2014–2016 in West Africa
Sub-Saharan Africa
MARBURG HEMORRHAGIC FEVER
epi -
Africa (e.g., Uganda, Zimbabwe, the Democratic Republic of the Congo)
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DENGUE VIRUS
Dengue hemorrhagic fever
Worldwide in tropical regions of Central and South America, the Caribbean, Africa, and Asia
YELLOW FEVER VIRUS
Tropical regions of South America and sub-Saharan Africa
what are the transmission of these hemorrhagic fevers ?
VIRUS - LASSA VIRUS
disease - lassa fever
Ingestion/inhalation of rodent urine or droppings from reservoir hosts of the virus: the multimammate rat
Contact with bodily fluids of other infected animals or humans
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
Contact with infected rodent reservoir hosts or ingestion/inhalation of their blood, urine, droppings, or saliva
The North American deer mouse, Peromyscus maniculatus, is the most important reservoir in US
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
Contact with infected rodent reservoir hosts or ingestion/inhalation of their urine, droppings, or saliva
Various species of field mice are reservoir
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CRIMEAN-CONGO HEMORRHAGIC FEVER
Tick bites from Ixodid tick reservoir hosts
Contact with infected animal or human bodily fluid
Specifically from those of the Hyalomma genus
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RIFT VALLEY FEVER
Contact with infected livestock (i.e., bodily fluids)
Mosquito bites
its transmission to people typically occurs when they care for infected livestock, and not via mosquito bite
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EBOLA VIRUS DISEASE
Contact with bodily fluids of infected people, nonhuman primates (e.g., gorillas, chimpanzees, monkeys), or fruit bats
Direct contact with fomites increases the likelihood of nosocomial spread
MARBURG HEMORRHAGIC FEVER
Contact with the reservoir host of the virus, the African fruit bat
Contact with bodily fluids of infected individuals or animals
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DENGUE HEMORRHAGIC FEVER
Mosquito bites
Most commonly from the vector species Aedes aegypti. Humans are the reservoir hosts for the virus,
YELLOW FEVER
Mosquito bites
from the vector species Aedes aegypti.
Humans are the reservoir hosts for the virus in cities, and monkeys are the reservoir hosts in forested areas
incubation period for thee hemorrhagic viruses ?
VIRUS - LASSA VIRUS
1–21 days
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
1 –8 weeks
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CRIMEAN-CONGO HEMORRHAGIC FEVER
1–13 days
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RIFT VALLEY FEVER
2–6 days
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EBOLA VIRUS DISEASE
2–21 days
MARBURG HEMORRHAGIC FEVER
5–10 days
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DENGUE HEMORRHAGIC FEVER
4–10 days
YELLOW FEVER
3–6 days
what re the classical clinical features of viral hemorrhagic fever?
Initial flu-like illness Headache, dizziness Conjunctivitis High fever Lymphadenopathy Sore throat Myalgia, arthralgia Rash Gastrointestinal symptoms (abdominal pain, diarrhea, nausea, vomiting)
Severe VHF with bleeding diathesis: develops in a variable number of cases, depending on the causative pathogen Diffuse hemorrhage including: Bloody diarrhea, hematuria, hematemesis, melena Mucosal bleeding Petechiae, ecchymoses Hypovolemic shock and multiorgan failure Sepsis DIC Meningoencephalitis
clinical manifestation specific to the virus ?
VIRUS - LASSA VIRUS
80% of those who are infected few or no symptoms occur
initial prodromal symptoms
In 20% of people more severe symptoms such as
facial swelling, fluid in the lung cavity
bleeding gums, dangerously low blood pressure may occur.
Shock, seizures, tremor, disorientation, and coma may be seen in the later stages
Long term complications may include hearing loss
In half of these cases, hearing returns partially after 1–3 months
In those who are pregnant, miscarriage may occur in 95%.
the disease is especially severe late in pregnancy, with maternal death and/or fetal loss occurring in more than 80% of cases during the third trimester
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
Prodromal/febrile phase
clinical features of Viral Hemorrhagic Fever
Syndrome-specific features:
Cardiopulmonary phase (∼ 2–7 days following prodromal/febrile phase)
with lung infiltration (pulmonary edema)
in severe cases, development of acute respiratory distress syndrome (ARDS)
Dry cough
In severe cases: rapidly developing shock, coagulopathy, pulmonary edema
Tachycardia, hypotension
Dyspnea
HANTAVIRUS HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
acute interstitial nephritis occurring mainly in Europe and Asia
Signs of renal failure
Hypotension
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CRIMEAN-CONGO HEMORRHAGIC FEVER
prehemorrhagic phase is sudden
with neck pain and stiffness
sore eyes and photophobia
diarrhea, abdominal pain
sharp mood swings, agitations and confusion.
After several days, agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable liver enlargement
lymphadenopathy
As the illness progresses into the hemorrhagic phase, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about
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RIFT VALLEY FEVER
have either no symptoms or only a mild illnes of the prodromal phase with liver abnormalities
In a small percentage of cases (< 2%), the illness can progress to hemorrhagic fever syndrome, meningoencephalitis
or affect the eye.
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EBOLA VIRUS DISEASE
sudden influenza-like stage
fever is usually higher than 38.3 °C
followed by nausea, vomiting, diarrhoea, abdominal pain, and sometimes hiccups.
severe vomiting and diarrhoea often leads to severe dehydration
shortness of breath and chest pain may occur, along with swelling
half of the cases, the skin may develop a maculopapular rash, a flat red area covered with small bumps, five to seven days after symptoms begin
some cases, internal and external bleeding may occur
Bleeding from mucous membranes or from sites of needle punctures
hemoptyusis
vomiting blood
blood in stool
petechiae
bleeding into the sclera
death can usually occur due to shock
MARBURG HEMORRHAGIC FEVER
sudden and marked by fever, chills, headache, and myalgia
fifth day after the onset of symptoms, a maculopapular rash, most prominent on the trunk (chest, back, stomach),
vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction
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DENGUE HEMORRHAGIC FEVER
causes a high fever - 40 DEGREES and typical prodromal influenza like symptoms Pain behind the eyes Swollen glands rash nausea vomiting
some cases, symptoms worsen and can become life-threatening.
This is called severe dengue, dengue hemorrhagic fever or dengue shock syndrome
Severe dengue happens when your blood vessels become damaged and leaky - blood clots form to cause
thrombocytopenia occurs
which causes
internal bleeding, organ failure
Warning signs of severe dengue fever — which is a life-threatening emergency
The warning signs usually begin the first day or two after your fever goes away, and may include:
Severe stomach pain Persistent vomiting Bleeding from your gums or nose Blood in your urine, stools or vomit Bleeding under the skin, which might look like bruising Difficult or rapid breathing
YELLOW FEVER
Most people will not have symptoms.
initial symptoms including: Sudden onset of fever - up to 41°C Chills Severe headache Back pain
A few people will develop a more severe form of the disease.
there will be a brief remissio that may last only a few hours or for a day, followed severe form of the disease. symptoms include: High fever Yellow skin (jaundice) Bleeding Shock Organ failure
diagnosis of hemorrhagic virus fevers
LASSA FEVER
A combination of pharyngitis, pain behind the sternum, presence of excess protein in the urine and fever can indicate Lassa fever with higher specific
An ELISA test for antigen and Immunoglobulin M
cell cultures,
PCR
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
triad :
1) An increase in the number of immature neutrophils (banded neutrophils, metamyelocytes
2) thrombocytopenia
3) abundance of immunoblasts
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
CBC: thrombocytopenia, leukocytosis
↑ serum creatinine
Urinalysis
Proteinuria
Hematuria
confirmatory in both :
Serology: IgM and/or rising levels of IgG antibodies using ELISA
or
Reverse transcription-polymerase (RT-PCR)
or
Immunohistochemistry
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CRIMEAN-CONGO HEMORRHAGIC FEVER
real time polymerase chain reaction (RT-PCR),
virus isolation attempts,
and detection of antibody by ELISA (IgG and IgM
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RIFT VALLEY FEVER
viral isolation from tissues - cell culture,
serological testing with an ELISA - detecting igm
RT-PCR
Nucleic Acid Testing (NAT)
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EBOLA VIRUS DISEASE
Isolating the virus by cell culture
detecting the viral RNA by polymerase chain reaction (PCR)
and detecting proteins by enzyme-linked immunosorbent assay (ELISA) - igM / IGg
MARBURG HEMORRHAGIC FEVER
(ELISA) testing - IgM
polymerase chain reaction (PCR),
Virus isolation
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DENGUE HEMORRHAGIC FEVER
YELLOW FEVER
Virus detection
PCR
ELISA
x
x
treatment of hemorrhagic fever
VIRUS - LASSA fever
Ribavirin, an antiviral drug, has been used with success in Lassa fever patients. It has been shown to be most effective when given early in the course of the illness
erythrocytes, platelets, and fresh frozen plasma
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
Early but judicious use of fluid resuscitation with crystalloids is indicated.
Administer oxygen by nasal cannula, Venturi, or nonrebreather mask.
Intubation is warranted for severe respiratory distress
erythrocytes, platelets, and fresh frozen plasma
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
iv ribavirin
erythrocytes, platelets, and fresh frozen plasma
careful attention to fluid balance and correction of electrolyte abnormalities, oxygenation and hemodynamic support
Dialysis may be required to correct severe fluid overload
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CRIMEAN-CONGO HEMORRHAGIC FEVER
IV ribavarin
primarily supportive - fluid balance and correction of electrolyte abnormalities, oxygenation and hemodynamic support, and appropriate treatment of secondary infections
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RIFT VALLEY FEVER
most cases of RVF are mild and self-limiting, a specific treatment for RVF has not been established
pain relievers - NSAIDS
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EBOLA VIRUS DISEASE
Providing intravenous fluids (IV) and balancing electrolytes (body salts) Maintaining oxygen status and blood pressure
MARBURG HEMORRHAGIC FEVER
here is no specific treatment for Marburg virus disease. Supportive
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DENGUE HEMORRHAGIC FEVER
There is no specific medicine to treat dengue infection. If you think you may have dengue fever, you should use pain relievers with acetaminophen and avoid medicines with aspirin, which could worsen bleeding
YELLOW FEVER
same as above
what are the preventive measures for hemorrhagic fever
LASSA fever
avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur. Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes
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HANTAVIRUS CARDIOPULMONARY SYNDROME (HCPS)
Seal up holes inside and outside the home to keep rodents out. Trap rodents around the home to help reduce the population
HEMORRHAGIC FEVER WITH RENAL SYNDROME (HFRS)
for both Inactivated vaccines are available in some countries in Asia
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CRIMEAN-CONGO HEMORRHAGIC FEVER
avoiding or minimising exposure to infected ticks by using tick repellents. Wearing protective clothing and early and correct removal of ticks are recommended
An inactivated vaccine has been used on a small scale in Eastern Europe
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RIFT VALLEY FEVER
Avoid unsafe animal products. All animal products (including meat, milk, and blood) should be thoroughly cooked before eating or drinking. Protect yourself against mosquitoes and other bloodsucking insects. Use insect repellents and bed nets, and wear long sleeved shirts and long pants to cover exposed skin
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EBOLA VIRUS DISEASE
stay away from areas where the virus is common. If you are in an outbreak area: Avoid infected people, their body fluids, and the bodies of anyone who has died from the disease. Avoid contact with wild animals, like bats and monkeys, and their meat
Recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV) vaccine (approved in the US
MARBURG HEMORRHAGIC FEVER
Avoid areas of known outbreaks. …
Wash your hands frequently. …
Avoid bush meat. …
Avoid contact with infected people
wearing protective gowns, gloves, and masks; placing the infected individual in strict isolation; and sterilization or proper disposal of needles, equipment, and patient excretions.
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///////// DENGUE HEMORRHAGIC FEVER ///////////
prevention is to avoid mosquito bites.
vaccine Only recommended in individuals who have previously been infected with Dengue as it can increase the risk of severe disease in seronegative individuals
dengue vaccine approved in the US - CYD-TDV
a live attenuated tetravalent chimeric vaccine
////// YELLOW FEVER ////////
prevent mosquito bites. Mosquitoes bite during the day and night. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear, and get vaccinated before traveling
single-dose live-attenuated vaccine for individuals traveling to areas where yellow fever is endemic
