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Part 2 Revision > Rare and imported pathogens > Flashcards

Rare and imported pathogens Flashcards

1
Q

What is the family and genus of hendra virus?

A

Henipavirus genus in Paramyxoviridae

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2
Q

What is the reservoir host of hendra virus?

What is the risk factor for human infection?

Where does hendra circulate?

A

Flying foxes (Pteropid fruit bats)

Close contact with infected horses (not bats)

Only in Australia

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3
Q

What is the main clinical presentation of hendra?

A

Neurological disease - can be biphasic, encephalitis can occur up to 1 year after acute infection

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4
Q

Is there a vaccine available for hendra?

What treatment has been used?

A

No human vaccine, only vaccine for horses

Ribavirin has been used for treatment and PEP

mAbs are in development for PEP

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5
Q

What is the family and genus of nipah virus?

A

Henipavirus genus in Paramyxoviridae

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6
Q

What is the reservoir host of nipah virus?

What is the risk factor for human infection?

Where does nipah circulate?

A

Flying foxes (Pteropid fruit bats)

Close contact with infected pigs, undercooked horse meat, drinking raw date palm sap

South East Asia (Philippines, Malaysia, Bangladesh, India)

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7
Q

Why is nipah an HCID and hendra not?

A

No evidence of human to human transmission of hendra

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8
Q

What are the transmission routes of nipah?

A

Likely respiratory spread

Direct contact with infected secretions and excretions of pigs, bats, humans ?horses

Possible sexual transmission

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9
Q

What are the clinical symptoms of nipah?

What is the fatality rate?

A

Can be asymptomatic or mild

Sudden onset ILI followed by encephalitis (also meningitis and pneumonia)

Late onset encephalitis (up to 11 years!)

Severe sequalae in survivors

40-70% mortality

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10
Q

What treatment has been used for nipah?

A

… Ribavirin! (little evidence)

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11
Q

What is the family and genus of EEEV/WEEV/VEEV?

A

Togaviridae family, alphavirus genus

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12
Q

What does EEEV cause in horses?

A

Febrile disease leading to encephalitis!

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13
Q

How are humans infected with E/W/VEEV?

A

When bitten by ‘bridging mosquitos’ which are infected from birds

Mostly Aedes sp.

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14
Q

Which is most severe - EEEV, WEEV, VEEV?

A

EEEV

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15
Q

What are the reservoir hosts for:

EEEV?
WEEV?
VEEV?

A

Passerine birds

Passerine birds

Rodents

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16
Q

What is the most severe mosquito borne encephalitides?

A

EEEV

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17
Q

Where are the following found it the world:

EEEV?

WEEV?

VEEV?

A

EEEV = Eastern and North USA and Eastern Canada

WEEV = Western USA and Canada, and some of South America

VEEV = South America (both epidemic and enzootic viruses)

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18
Q

Are horses amplifying hosts in EEV/WEEV or VEEV?

A

VEEV only

Small mammals and rodents are amplifying hosts in EEEV and hares in WEEV

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19
Q

Treatment for EEEV/WEEV/VEEV?

A

Supportive only

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20
Q

How is the UK blood supply protected from EEEV?

A

Default deferral of American returners for 28 d due to risk of WNV

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21
Q

What are the mosquito vectors for:

EEEV?

WEEV?

VEEV?

A

EEEV = Culiseta melanura

WEEV = Culex tarsalis

VEEV = Aedes taeniorhynchus and Culex

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22
Q

Fatality rate of:

EEEV

WEEV

VEEV

A

EEEV - 30%

WEEV 3-4%

VEEV <1%

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23
Q

What is Sindbis virus?

A

A virus in the WEEV complex

Causes rash, fever and arthritis

In Eastern hemisphere - mainly Northern Europe

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24
Q

What are Everglades, Mucambo, Tonate and Cabassou viruses?

A

Viruses of the Venezualean equine encephalitis virus complex

(Alphaviruses)

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25
Q

In which patients is WEEV and VEEV most severe?

A

Children

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26
Q

What disease do the equine encephalitis viruses cause?

A

Acute ILI followed by neurological disease

EEEV is biphasic with neurological signs 1-2 weeks after infection, often severe encephalitis

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27
Q

What is the family and genus of chikungunya virus?

A

Togaviridae family, alphavirus genus

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28
Q

Vector of chikungunya

A

Aedes aegypti (A. albopictus has been associated with infection in Italy)

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29
Q

Is chikungunya present in Europe?

A

No, however sustained outbreaks in France and Italy have occurred due to imported travel case

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30
Q

In which countries are UK travellers most at risk of chikungunya?

A

India, SE Asia, Caribbean

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31
Q

What are the reservoir hosts of chikungunya?

A

Monkeys and humans

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32
Q

What are the risks of chikungunya in pregnancy?

A

No congenital infection but CHIKV infection perinatally can cause neonatal meningoencephalitis

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33
Q

Is there a vaccine available for chikungunya in UK?

A

No, however there is a live attenuated vaccine available in the US

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34
Q

Clinical symptoms of chikungunya

A

Mild or asymptomatic

Sudden onset fever and joint pain - joint pain is debilitating and arthritis can persist for several months or years

Death is rare

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35
Q

Other than joint pain and ILI what are additional symptoms of chikungunya?

A

75% of patients have dermatological compications including:

Pigmented rash
Ulcers in groin or oral mucosa
Haemorrhagic lesions
Desquamation

Joint pain and arthritis can last for several months or years
Severe eye, neurological and heart complaints have also been reported

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36
Q

How is the UK blood supply protected from CHIKV?

A

Blood donors are deferred for 28 d post travel to an at risk country

If infected with CHIKV they are deferred for donation for 6 months

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37
Q

Has there been person to person transmission of CHIKV?

A

No, and no known cases of blood/organ transmission

38
Q

What is the family and genus of hantaviruses?

A

Hantaviridae family, orthohantavirus genus

39
Q

How many hantaviruses are there - which are the important ones in humans?

A

Over 40!

New World hantaviruses - Andes and Sin Nombre

Old World hantaviruses - Souel, Hantaan, Puumala and Dobrava

40
Q

What animals are reservoir hosts for all hantaviruses?

A

Rodents, each hantavirus species is specific to a different host

41
Q

What syndromes do Old World vs New World hantaviruses cause?

A

Old World hantaviruses - Haemorrhagic fever with renal syndrome (HFRS)

New World hantaviruses - Hantavirus pulmonary syndrome (HPS)

Sometimes viruses that cause HFRS can cause HPS and vice versa

42
Q

How is hantavirus transmitted to humans?

What increases the risk of infection?

A

Infection via inhalation of infected urine, faeces and saliva

Increased human cases linked to land use changes or excess rainfall allowing rodents to breed more, or to occupational or hobby exposure

43
Q

What groups are at risk of hantavirus in the UK?

A

1) Pet rat owners

2) Occupational exposure (farmers, sewage workers, pest control, pet shop workers)

44
Q

What are the four Old World hantaviruses?

What are their hosts and distribution?

Which is most severe to least severe?

A

Seoul - SE Asia and worldwide - Rats

Puumala - Western Europe and Scandinavia - Bank Vole (disease called nephropathia epidemica)

Dobrava - Balkans - Yellow necked field mouse

Hantaan - Asia - Field mouse

Hantaan and Dobrava are most severe (15% mortality)
Seoul causes moderate disease
Puumala is mildest (<0.1% mortality)

45
Q

What is the incubation of hantaviruses?

A

Usually 2-4 weeks but can range from 2d to 8 weeks

46
Q

What are the two New World hantaviruses?

What are their hosts and distribution?

Which is most severe?

A

Sin Nombre - North America - Deer mouse

Andes - South America - Long-tail pygmy rice rat

Both highly pathogenic with 35% fatality rate

47
Q

Person to person transmission has been documented in which of the hantaviruses? What implication does this have?

A

Andes hantaviruses - this is classified as an airborne HCID

48
Q

Are vaccines available for hantaviruses?

A

Not in UK

Hantaan/Seoul virus vaccine available in China and South Korea (Hantavax)

DNA vaccines expressing proteins from the different hantavirus are in development

49
Q

What treatment is there for hantaviruses?

A

Supportive only

Ribavirin and antiserum has been used. UK guidelines specifically say not to use ribavirin or corticosteroids in Andes hantavirus infection

50
Q

What samples would you test for hantavirus?

A

RNA testing in blood and urine at RIPL

51
Q

When would you consider Andes virus infection?

A

Patients with a relevant travel history (particularly Argentina/Chile in the summer months)

Relevant exposure history - i.e. trekking, hiking

Severe acute respiratory illness within 8 weeks of exposure

52
Q

Clinical symptoms of hantavirus HFRS

A

Abrupt onset ILI

Fever
Headache
GI symptoms
Renal dysfunction
Thrombocytopaenia
Haemorrhagic manifestations in severe disease

53
Q

What are the five stages of HFRS?

A
  1. Febrile
  2. Hypotensive
  3. Oliguric
  4. Diuretic
  5. Convalescent
54
Q

Clinical symptoms of hantavirus pulmonary syndrome?

A

Abrupt onset non-specific prodrome

Cough
Tachypnoea
Thrombocytopaenia
Pulmonary oedema
Hypoxia

Capillary leakage in lungs, after onset of cardiopulmonary phase patients deteriorate rapidly

55
Q

What is the family and genus of SFTSV?

A

Phenuiviridae family, Bandavirus genus

56
Q

What other names are used for SFTSV?

A

Huaiyangshan banyangvirus or Dabie bandavirus

57
Q

What is the vector of SFTSV?

A

Haemaphysalis longicornis (Asian long horned tick)

58
Q

What are the intermediate hosts of SFTSV?

A

Sheep and goats

59
Q

Have human to human transmissions occurred in SFTSV?

What are the implications of this?

A

Yes

SFTSV is classified as a contact HCID

60
Q

What regions are most at risk of SFTSV?

A

Mostly rural areas where increased tick numbers are observed

China
Japan
Taiwan
South Korea

Possibly Pakistan and Vietnam

61
Q

What is the fatality rate of SFTSV?

A

5%

62
Q

What genus is La Crosse virus?

A

Orthobunyavirus

63
Q

Where does La Crosse virus circulate? What is the vector?

A

Rural mid-Atlantic and Mid-West USA

Aedes triseriatus (Eastern treehole mosquito)

64
Q

What are symptoms of La Crosse virus and when does it usually occur?

A

Mostly asymptomatic

Can cause meningoencephalitis, seizures, cerebral odema and respiratory compromise

Causes ‘paediatric encephalitis’ cases in the summer

65
Q

What is the family and genus of orapouche?

A

Peribunyaviridae family, orthobunyavirus

66
Q

Where does oropouche circulate? What are the reservoir hosts and what is the main vector?

A

South America

Pale throated sloths, primates and birds

Culicoides paraensis (midge)

67
Q

Where did the 2024 oropouche outbreak occur?

A

Mainly Brazil, also to Bolivia, Cuba, Columbia and Peru

Travel linked cases in Spain and Italy

68
Q

What are the symptoms of oropouche?

What is the risk in immunocompromised?

What is the risk in pregnancy?

A

Acute febrile illness, severe illness includes meningitis, rash, petechiae, GBS

Death has occurred in patients with underlying conditions

Vertical transmission has occurred and caused foetal deaths

69
Q

What is the family and genus of Toscana virus?

A

Phenuviridae family, Phlebovirus genus

70
Q

What is the main vector of Toscana virus?

A

Phlebotomus sand fly

71
Q

Where does Toscana circulate?

A

Southern Europe, Northern Africa

One of the most frequent causes of aseptic meningitis in SW Europe in summer

72
Q

What are the symptoms of Toscana virus?

A

Sudden onset fever, rash nausea, vomiting, myalgia

Neck stiffness in 90%, encephalitis in 40%

Rarely causes death

73
Q

What is the family and genus of Chandipura?

A

Rhabdovirus family, vesiculovirus genus

74
Q

Where and when does Chandipura circulate?

A

Endemic in India

Occurs sporadically, esp during monsoon season

75
Q

What is the main vector of Chandipura virus?

A

Phlebotomus papatasi (sand fly) - also spread by ticks and mosquitos

76
Q

What are the symptoms of Chandipura?

A

High grade fever, vomiting, headache

Altered sensorium, convulsions, acute encephalitis/encephalopathy

Death within 48 h

77
Q

What population is Chandipura most severe in?

What is the fatality rate?

A

Children under 15 y

50-75% mortality rate

78
Q

What is the family and genus of Ross River virus?

A

Togaviridae family, alphavirus genus

79
Q

Where does Ross River virus circulate?

A

Australia, Papua New Guinea, South Pacific Islands

80
Q

What are the symptoms of Ross River virus?

A

Outbreaks of polyarthritis and arthralgia, also causes rash

(similar to chikungunya)

81
Q

What is the vector of Ross River virus?

A

Aedes mosquitos

82
Q

What is the family and genus of LCMV?

A

Arenavirus family, mammaarenavirus genus

83
Q

What is the reservoir of LCMV? Where is it present in the world?

A

House mouse (sheds virus in saliva, urine, faeces)

Worldwide distribution

84
Q

What are symptoms of LCMV?

A

Non-specific symptoms and then CNS disease 2-3 weeks later

Aseptic meningitis or meningoencephalitis

85
Q

What are the risks of LCMV in pregnancy?

A

Congenital CNS infection
Ocular lesions
Abortion
Neonatal meningitis

Most congenitally infected neonates have severe neurological deficits, 35% die

86
Q

How would LCMV present as a transplant transmitted infection?

What treatment would be available?

A

Severe disease, mostly fatal

Reduction of immunosuppression, and ribavirin

87
Q

What is herpes B virus?

A

Alphaherpesvirus

Also known as macacine alphaherpesvirus 1 or herpesvirus simiae

88
Q

What are the reservoir hosts of herpes B?

A

Old world macaques

89
Q

What is the incubation of herpes B virus?

A

Up to 1 month

90
Q

What are the symptoms of herpes B?

A

Non-specific prodrome

Vesicular lesions at exposure site

Hiccups

CNS disease, AFP, death

91
Q

What would be given for a) PEP and b) treatment for herpes B?

A

PEP = wound cleaning and 800 mg aciclovir 5x day 14 days

Treatment = IV aciclovir 15 mg/kg TDS or 5 mg/kg ganciclovir BD

Part 2 Revision (48 decks)

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