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Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt > Viruses > Flashcards

Viruses Flashcards

1
Q

What does arbovirus mean?

A

Arthropod-borne virus
ie viruses that are transmitted by insects - Usually mosquitos or tics

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2
Q

3 main syndroms of arbovirus

A

Fever-athralgia-rash
Viral haemorrhagic fever
CNS infection

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3
Q

Key CNS arboviruses

A

Japanese encephalitis
Enterovirus 71
west nile virus

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4
Q

What does Chikungunya translate to? vector? Key way to differentiate from dengue

A

‘that which bends you over’
Aedes and culex mosquitos

Severe polyarthropathy

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5
Q

3 main syndroms of arbovirus

A

Fever-athralgia-rash
Viral haemorrhagic fever
CNS infection

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6
Q

Which is only arbovirus from anopheles mosquitos? key symptom?

A

o’nyong nyong

Conjunctivitis

ee oo
[Symmetrical O like a pair of eyes 👀]

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7
Q

Interval of how long between exposure and Sx rules out viral haemorrhagic fever

A

3 weeks

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8
Q

Lassa VHF caused by? Geography? transmission? Human-human? rx?

A

Arenavirus
West africa
Rodents / human-human
Ribavirn

[2 people riding rats with lasso in an arena]

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9
Q

Ebola / marburg VHF caused by? Geography? transmission? Human-human? rx?

A

Filovirus
Sub saharan africa
Bats / human-human
No rx

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10
Q

Hanta VHF caused by? Geography? transmission? Human-human? rx?

A

hantavirus
New and old world
rodents (NO human-human)
ribavirn

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11
Q

Crimean-congo VHF caused by? Geography? transmission? Human-human? rx?

A

Nairovirus
Europe / Asia / Africa
Hyalomma ticks / livestock / human-human
Ribavirn

[Congo by origin of river nail which travels through lots of countries. LOTS = even Europe. Only trop disease in Europe is tick borne]

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12
Q

Rift valley fever VHF caused by? Geography? transmission? Human-human? rx?

A

Phebovirus
Africa / middle east
Ades / mosquitos / livestock
Ribavirn

[Rift between You and phoebe because you went to africa and middlr east and she got bit by mosquitos and had to ride livestock ]

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13
Q

Dengue VHF caused by? Geography? transmission? Human-human? rx?

A

Flavivirus
Tropics
Ades mosquito-
no Human-human
No rx

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14
Q

Yellow fever VHF caused by? Geography? transmission? Human-human? rx?

A

Flavivirus
Africa / south america
Mosquitos / monkeys. No human
No rx

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15
Q

Key early features to make suspicious for VHF

A

Pharyngitis with ulcers (eg dysphagia / retrosternal chest pain)
Conjunctival injection - basically pronounced vessels
Petechiae
Prostration - too weak to do anything (lying face down)

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16
Q

Dx VHF ?

A

PCR
ELISA
IgM

[Need to be undertaken in biosafety level 4 labs]

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17
Q

Which VHF has sensory neural deafness as key complication long term ?

A

Lassa
[Loud crowd deafening]

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18
Q

Which VHF classically causes renal syndrome and non-cardiogenic Pulm oedema

A

Hantavirus
-requires Ribavirin

Hantavirus [in Panama like rodrick who’s got a good heart = non cardiogenic pulmonary oedema]

[note all VHF cause a degree of pulm oedema due to capillary leak]

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19
Q

Which VHF is often has a major haemorrhage? vector?

A

Crimean-congo haemorrhagic fever
ixodid ticks (hyalomma genus)

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20
Q

Generally which VHF are transmitted exclusively by arthropods?
Which by arthropods and Human-human?
which only direct eg animals and humans?

A

Arthropod only - Dengue and yellow fever

Direct transmission - Lassa, ebola / marburg

Both - crimean-congo, rift valley

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21
Q

Which is only VHF where humans can be hosts?

A

Dengue
Ades aegypti mosquito

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22
Q

Dengue Ix

A

Low neutrophils and thrombocytopenia
NS1 antigen (ELISA)
PCR
ELISA for IgM / IgG (false positives from cross-reaction with other flaviviruses)

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23
Q

w

A
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24
Q

Yellow fever clinical features?

A

Jaundice
Liver failure
GI bleeding

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25
Q

Which mosquito-borne virus is most rapidly spreading worldwide?

A

Dengue

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26
Q

Which dengue protein for entry into cell and protects against host immune response

A

Protein E

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27
Q

Post infection with dengue how long are you immune

A

Only 2-3 months

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28
Q

Dengue incubation period

A

4-7 days - Max 2 weeks

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29
Q

Characteristic rash in dengue recovery phase

A

‘White islands in a sea of red’

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30
Q

Dengue timeline of Temp vs haematocrit vs platelets

A
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31
Q

How often do you get dengue haemorrhagic fever or dengue shock syndrome

A

1% of cases
85% Asx/ Mild Sx

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32
Q

Most important risk factor for Severe dengue infection

A

Previous infection with a DIFFERENT dengue strain
-Keep in mind Infants with primary infection born to dengue-immune mothers

[Non-nutralising antibodies bind to new serotypes and get an excessive immune response…]

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33
Q

Criteria for severe Dengue

A

[Loss of Plasma, RBCs, Organs]

Severe plasma leakage leading to:
* Shock (DSS)
* Fluid accumulation with respiratory distress

Severe bleeding
-as evaluated by a clinician

Severe organ involvement
* Liver: AST or ALT ≥ 1000 U
* CNS: Impaired consciousness
* Heart and other organs

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34
Q

Who needs to be treated in hospital with denngue

A

–Any criteria of severe

– Co-existing conditions that may complicate dengue or its management: Infancy, pregnancy, old age, obesity,
diabetes mellitus, renal failure, chronic haemolytic diseases, bronchial asthma

– Live far from health facility

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35
Q

Who can be sent home with dengue

A

– Tolerate adequate volumes of oral fluids
– Pass urine at least once every 6 hours
– Do not have warning signs, especially when fever
subsides

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36
Q

Who am I

A

aedes aegypti

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37
Q

Important consideration for someone with confirmed dengue

A

Prevent them getting bitten by other aedes aegypti mosquitos

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38
Q

Who cant have dengue vaccine

A

If your dengue naive
-Otherwise risk of worse dengue if you get it again

[Only if previous infection]

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39
Q

Which viruses are we thinking about when fever
+ encephalitis
+ arthritis
+haemorrhage

A
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40
Q

Chikungunya vector? usual reservoir?

A

Aedes aegypti or Aedes albopictus (new mutation-> adapted)
Humans - also primate reservoir

41
Q

Chikungunya pattern of arthritis

A

Symmetric polyarthralgias /arthritis
Usually: hands and feet >10 joints

Assoc with swelling and tendosynovitis

42
Q

Blood tests chinkungunya vs dengue
WBC? platelets? haemoconc?

A

Chicken legs (lymphopenia)
Everything else worse in dengue

43
Q

Rx athritis chikungunya

A

Acute -NSAIDs

Chonic (45% at 10 months) - may need steroids / DMARDs

44
Q

Which alphaviruses cause arthritis - name 3

A

Chikungunya
O’nyong’nyong
Mayaro
Ross River
Sindbhi

45
Q

Zika vs Chik vs dengue
Fever? conjunctivitis? Arthritis? rash? myalgia? haemorrhage?

A
46
Q

23F Lima Peru with 4 d fever, chills, malaise, myalgias, arthralgias and HA after travel to Iquitos
[No rash, bleeding, jaundice, abdominal pain, cough, SOB, GI] Develops non-purulent conjunctivitis.

A

Zika

47
Q

name 2 Key fetal issues with zika

A

Approx 20% get infected

Fetal loss (miscarrage / still birth)
5% microcephaly - especially in 1st trimester
retinal abnormalities
Small for gestational age

48
Q

Key complication following zika

A

Guillian barre

49
Q

Where should you get sample for zika Dx?

A

Urine (95% sens)
Serum - only 56%

PCR ideal
NAAT used commonly as cheaper

50
Q

Most common infective cause of myocarditis

A

coxsackie B virus

51
Q

2 examples of Paramyxovirus

A

Measles
Mumps

52
Q

high fever, cough, runny nose and conjunctivitis is what?
(diarrhoea in 10%)
Maculopapular rash
Name 3 complications? 1 late comp?

A

Measles
-Ear infection
-Pneumonia (most common cause of death in kids)
-Encephalitis -> seizures / deafness
-Pregnancy - prematurely, or low-birth-weight baby

Late
Subacute sclerosing panencephalitis (SSPE)

[Koplik spots]

53
Q

Where does the measles rash usually start?

A

Behind ears

54
Q

Measles Rx - Low vs high income?

A

Low income - Vitamin A (may reduce mortality by 50%)

High income - immune serum
Ribavirin - in immunocompromised

55
Q

Most common precipitating factor of this progression of vit A deficiency blindness

A

Measles

56
Q

The biggest issue with the distribution of the measles vaccine worldwide

A

Cold chain essential (loses 1/2 potency after 1hr warm)

57
Q

Measles vaccine then kid comes in after a minor fall with reduced GCS - whats happened? Other complication

A

Thrombocytopenia - > bleed

[Post-infectious encephalomyelitis
- 50% permanent damage]

58
Q

Rubella complications

A

Arthritis - 70% of adult women

Pregnancy - miscarriages, fetal deaths/stillbirths
-Congenital rubella syndrome - cataracts, heart defects, and hearing impairment.

59
Q

Yellow fever geneotype west africa? East africa? South america?

A

1a - west africa
1b - south America

2 - central and east Africa

60
Q

3 types of yellow fever transmission

A

Sylvatic (jungle) from monkey reservoir - Ades

Savannah - only in Africa - Ades ssp

Urban - Ades aegypti

61
Q

Yellow fever incubation? How many go on to hemorrhagic fever

A

3-6 days
only 10% - haemorrhagic

62
Q

Name a few laboratory findings in yellow fever

A

Albuminuria
Transaminase elevation - often initially massive due to apoptosis
-Alkaline phosphatase only minimally elevated
Direct bilirubin 5-10 mg/dl
Prolonged PT

63
Q

ALT / AST >5000
DDx?

A

Councilman bodies are acidophilic inclusion bodies in the cytoplasm of hepatocytes
- Yellow fever, autoimmune hepatitis, other viral infections

64
Q

Type of vaccine is YF

A

Live attenuated virus (17D and 17DD) vaccines
- Cant give to immunocompromised

65
Q

Mpox name 2 routes of transmission? incubation period?

A

Entry via broken skin, respiratory tract,
mucous membranes
-Contact with contaminated clothing or
linens
-Direct contact with skin lesions or scabs
-Respiratory secretions

Incubation period: 7-10 days

66
Q

Mpox clinical Hx? How long are you infective

A

Invasive phase - 1-5 days
-Fever
-flu-like illness
-Lymphadenopathy

Eruptive phase - infectious while still has skin lesions

67
Q

Differentiate mpox from chicken pox

A

MPOX on palms and soles
has lymphadenopathy

68
Q

Name 3 complications of mpox

A

Secondary bacterial infections
Sepsis
Encephalitis
Pneumonia
Keratitis -> sight-threatening

69
Q

Who has very high mortality in Mpox

A

HIV infection CD4<100 mortality rate 30%

70
Q

Mpox rx

A

Mostly supportive

[Brincidofovir, Tecovirimat]

71
Q

How fast does Mox replicate?

A

Slowly (large DNA virus)
Orthopoxvirus

72
Q

2 clades of mpox? which is the 2022 outbreak

A

I higher mortality, endemic in central African countries

II lower mortality, IIb B.1 2022 outbreak strain.

73
Q

Varicella - Name 3 congenital complications

A

chorioretinitis, optic atrophy, pigmented patches of skin but may include hypoplastic limbs, club feet, cataracts, microphthalmos and early death.

74
Q

Adult T-cell leukaemia/lymphoma (ATLL) due to HTLV-1 infection is sub-divided into four categories:

A

Acute, lymphomatous, chronic, and smouldering

75
Q

All the VHFs are what type of virus

A

Enveloped RNA viruses
All zoonoses

[Filoviruses/Arenaviruses/Bunyaviridae (Hantaviruses/Nairoviruses)]

76
Q

1/52 Fever, fatigue, headache, joint pains, vomiting, nausea , diarrhoea, abdo pain
Septic shock
West Africa - which VHFs are there

A

Ebola
Lassa

77
Q

What is ebola? Incubation? Transmission? Diagnosis?

A

Filovirus
[important strains - Zaire, Sudan, Bundibugyo]

2-21 days

Fruit bat
Contact with bodily fluids from infected patient e.g tears, blood, diarrhoea, vomit, sweat, semen

RT-PCR

78
Q

Stages of ebola

A

1 Dry - flu-like
2 Wet - D&V
3 Haemorrhage / seizure etc

79
Q

Stages of ebola

A

1 Dry - flu-like
2 Wet - D&V
3 Haemorrhage/seizure etc

80
Q

Ebola Rx is mostly flluid / supportive. Could you recognise one of these Drug Rx on an MCQ?

A

mAb114
RGEN EB3

81
Q

Marburg is? Incubation? Transmission? Diagnosis?

A

Filovirus

2-21 days

Fruit bat / bush meat

RT-PCR
No approved treatment or vaccination

82
Q

Filoviruses (ebola and Marburg) presentation

A

Fever, DIARRHOEA (with or without blood) vomiting and haemorrhage

83
Q

Lassa reservoir

A

Mastomys natalensis
-rodent

84
Q

Where is lassa geography

A

West Africa
-Nigeria, sierra leone, liberia and guinnea

85
Q

Fever, sore throat, vomiting, swollen face? Other key features? Confirm diagnosis?

A

Lassa
SN hearing loss

PCR

86
Q

What order are hantavirus? Key pathopysiology? Dx?

A

Bunyavirales

  • Increased capillary permeability (causing vascular leakage)
  • thrombocytopenia.

RT-PCR

87
Q

Old world vs new world hantavirus

A

Old - haemorrhagic fever with renal syndrome
-Proteinuria, haematuria, AKI- > oliguric

New world - Cardiopulmonary syndrome
Influenza-like illnesses -> rapidly progressing pulmonary oedema caused by pulmonary capillary leak syndrome

88
Q

38 year old Afghan origin
* Involved in ritual sacrifice at wedding (Kabul)
-Shock, Fever, thrombocytopenia
=?
Transmission?
Incubation?

A

Crimean-Congo Haemorrhagic Fever (CCHF)

  • Tick bite/crushing
  • Direct contact (blood/tissues) of infected
    animals/humans

1-13 days

89
Q

2 key Bunyavirales

A

Hanta
Crimean-Congo Haemorrhagic Fever (CCHF)

Ribavarin used for both

90
Q

CCHF presentation

A

Often haemorrhagic early on compared with other VHFs

91
Q

Name 2 Key risk factors for CCHF

A

Tick bite/crushing (Hyalomma spp. main vector).

Direct contact (blood/tissues) of infected animals/humans

Living/working in close contact with Livestock (e.g., farmers, shepherds, ranchers, and abattoir workers)

92
Q

VHF from only south west india and is a biphasic illness

A

Kyasunar forest disease
Rats, bats, monkeys
[flea born]

Fever/flu-like -> recovery -> menigoencephalitis

93
Q

Dog rabies presntation

A

Paralytic ‘Dumb’ 60% - often with high pitched bark
furious 40%

94
Q

all human-to-human rabies transmission has been?

A

Organ transplant

95
Q

Rabies encephalitis 2 presentaitons in humans

A

Furious - hydrophobic spams
-Often with ++ itching around healed bite site

Paralytic ‘dumb’ - survive longer
- Ascending flaccid paralysis
- no hydrophobia or spasms

96
Q
A

Negri bodies by Seller’s stain
Rabies virus in a neurone - diagnostic

97
Q

Rabies PEP? If immunosupressed?

A

4 dose IM over 21-28 days,
or 3 or 2 dose multi-site ID over 7 days

  • RIG is recommended for severe/high risk exposures
    [Eg broken skin]

Immunosuppressed - an additional booster dose at 28/30 days and RIG even for low risk exposure

98
Q

Rabies PrEP? PEP if you’ve had PrEP

A

3 doses IM or ID over 21-28 days (boosters only for sustained high risk or check neutralising antibody titre)

2 dose IM over 3 days or multi-site ID on 1 day

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt (26 decks)

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