9 - Viral Hemorrhagic Fevers Flashcards
(106 cards)
1
Q
Bunyavairidae virus?
A
Crimean-congo hemorrhagic fever (CCHF)
Hanta virus
2
Q
Flavivirade viruses?
A
Dengue
Yellow fever
3
Q
Arenaviridae fever?
A
Lassa fever
4
Q
Filoviridae viruses?
A
Ebola
Marburg virus diseases
5
Q
All of the viral hemorrhagic fevers are?
A
RNA viruses
- they are enveloped in a fatty (lipid) coating
Damage the microvasculature
Dependent on host for survival
Geographically restricted
6
Q
Dengue fever is actually 4 differenet viruses, what are they?
A
DEN - 1
DEN - 2
DEN - 3
DEN - 4
7
Q
Cross protective immunity from the different DEN viruses?
A
Nope
8
Q
Where are the dengue fevers found?
A
The tropics
9
Q
What spreads dengue fever?
A
Mosquito: aedes aegypti (or albopictus)
A day bighting mosquito that prefers humans
10
Q
What is dengue fever (DF)
A
Symptom complex caused by the infection
Can be asymptomatic
Non-specific febrile illness
11
Q
Symptoms of dengue hemorrhagic fever (DHF)?
A
Bleeding complications
12
Q
What is dengue shock syndrome?
A
Good question, she just listed it
Maybe look it up later
13
Q
Dengue fever in the US?
A
Yeah, down in southern texas, hawaii and key west
14
Q
How many cases of dengue fever have been found in iraq and afghanistan?
A
None, just socom in their various missions
15
Q
S/S of dengue fever?
A
Very High fever (105.8) HA Retro-orbital pain N/V Truncal sclaratinaform rash Sever myalgias/arthralgias/malaise Hemorrhagic manifestations Abdominal pain
16
Q
Hemorrhagic manifestations of dengue fever?
A
Petechiae and bleeding at venipuncture site (MC)
Nose and gum bleeding
Melena/ hematemesis
17
Q
What is a saddleback fever?
A
Dengue fever sometimes has abates for a day then comes back
18
Q
If you see the saddle back fever what do you need to worry about?
A
This is the time that they are at risk for developing DHF or DSS
19
Q
Physical findings or dengue fever?
A
- Rash (1/2 of pts)
- petechiae/purpura
- conjunctival injection
- pharyngeal injection
- generalized lymphadenopathy
- hepatomegaly
20
Q
MC manifestation of dengue fever?
A
Petechiae and bleeding at venipuncture
21
Q
In office test for dengue fever?
A
Tourniquet test
22
Q
How is the tourniquet test conducted?
A
Inflate BP cuff on upper arm
Pump to Midwaybetween diastolic and systolic
- hold x 5 min
POS = 20 petechiae per sq inch
23
Q
Labs for dengue fever?
A
CBC Platelet count (thrombocytopenia) BMP - hyponatremia LFT - low albumen Coagulation studies
24
Q
MC metabolic change with dengue fever?
A
Haponaturemia
25
CBC findings for dengue fever?
End of febrile phase
- leukopenia
Before defervescence or shock
- lympohcytosis
Rise in HCT (> 20%)
- precedes chock
- monitor q 3-4 hrs
26
What happens with a heme concentration (HCT > 20%)
Seeping of plasma
Red cells still circulate
Blood “oozes out”
27
HCT < 10%?
Significant hemorrhage
Real bleeding - not oozing
28
Lab diagnostics findings for dengue fever?
Approx 1 week
- DENV RT-PCR
- NS1
Approx 5 days
- IGM,
- anti DENV
- ELISA
29
Tx for DF?
| Thx for dhf/Dss?
DF: Self-limited (acetaminophen)
DHF/DSS
- IV fluids
- blood transfusions
- gamma globulin
- steroids (controversial)
30
What blood product is preferred?
Fresh whole blood
31
Best method for dealing with DF?
Prevention
- 20-30% deet
32
Dont give high % deet to?
Kids
33
Dengue fever vaccine?
Degavaxia
Recommended in 2016
But its under investigation and is currently suspended
34
Complications of dengue fever?
Neurologic manifestations
- encephalitis/encephalopathy
- guillin-barre syndrome
- transverse myelitis
liver failure
- DHF/DSS
Overhydration
35
Zika
It says just FYI but its on slide 33 so maybe read it a time or 3
36
Types of yellow fever?
Epidemic/urban (ades aegypti)
Sylvatic/jungle (various mosquitos)
37
Where is yellow fever found?
Originated in africa but...
Has had many outbreaks world wide
38
Yellow fever vaccine”?
Yes, its from 1937
39
How does yellow fever spread? (Pathophysiology)
```
Female mosquito regurgitates the virus
- infects the vascular endothelia cells
- hits the reticuloendothelial system
— secondary viremia, immune system is overwhelmed
- reticuloendothelial = liver = jaundice
- mucosal and GI bleeding
- saddle back pattern
```
40
What is black water vomit?
Mucosal and GI tract bleeding that leads to black emesis
41
S/S of acute phase of yellow fever?
```
Fever
HA
Nausea
Billious vomiting
Conjunctival injection
```
*May be the only symptoms
42
How long does the acute phase of yellow fever last?
Approx 3 days
43
How long is the remission stage?
24hrs
44
S/S of toxic phase of yellow fever?
Liver specific
```
Jaundice
Oliguria
Dark urine
Stool color change
Hepatomegaly (tender)
```
45
S/S of toxic phase of yellow fever?
Skin specific
Petechiae
46
S/S of toxic phase of yellow fever?
Abdominal
```
Epistaxis
Coffee ground emesis
Hematemeis
Melena
Bright blood PR
Hematuria
```
47
S/S of toxic phase of yellow fever?
Cardiac/neural
```
Relative bradycardia
Myocardial depression
Various arrhythmias
Anascara
Mental status changes
```
48
Labs for yellow fever?
CBC - leukopenia/thrombocytopenia; HCT changes
Coagulation studies
chemestries
LFT
ECG and cardiac monitoring
Serologic studies
49
Serologic studies for yellow fever?
Acute and convalescent titers
- 4 fold increase
Specific IgM - 7-10 days post infection
50
What blood product is preferred for yellow fever?
Fresh frozen plasma
51
Tx of yellow fever?
- Supportive therapy (critical)
- get central venous access
- FFP
- isolate pt (mosquito net)
NO effective antivirals
52
Prevention of yellow fever?
Immunization and education
Avoid mosquitos
53
Complications of yellow fever?
- liver failure
- renal failure
- pulmonary edema
- myocarditis
- encephalitis
- hemorrhage
- DIC
- Shock
- Death
54
How are ebola and marburg carried?
Humans and nonhuman primates
55
Natural reservoir for ebola and marburg?
Bats
56
How are ebola and marburg spread?
Usually spread in the healthcare/lab setting
57
What stage of ebola and marburg spread human-to-human?
Human-to-human in acute stage only
58
Eboal is a filovirus
Filo =
Thread
59
Ebola rash?
A hemorrhagic rash over the entire body
60
Physical findings of ebola and marburg?
Early in disease
Early in the disease
- sever HA
- pharyngitis
- arthralgias/myalgias
- fever w/ or w/o chills
- anorexia
- asthenia
- maculopapular rash
- bilateral conjunctival injection
61
Physical findings of ebola and marburg?
Following the early symptoms?
GI symptoms
- abdominal pain
- N/V
- diarrhea
- odynophagia/dysphagia
62
Physical findings of ebola and marburg?
Late in disease
Expressionless hippocratic “ghostlike” facies
Bleeding from mucous membranes and puncture sites
Bleeding from GI tract
Tachypnea
63
Physical findings of ebola and marburg?
Terminally ill
- obtunded
- anuric
- tachypneic
- normothermic
- shock
- hiccups
- tachypnea (poor prognostic indicator)
64
Hiccups?
Have been noted in fatal cases of ebola and marburg
65
Lab findings for ebola nad marburg?
CBC
- thrombocytopenia
- leukpenia
- pronounced lymphopenia
Chem panel/liver panel
- multiple organ failure
- metabolic acidosis
- increased BUN and creatinine
IGM ELISA IgG ELISA
PCR
66
Tx of ebola and marburg?
```
No specific therapy
- supportive
- Human convalescent plasma
- ZMAPP (compassionate use)
- trial vaccine
-
```
67
The rVSU-EBOV vaccine works against which strain in trials?
Only the zaire subtype
68
Complications of ebola and marburg?
- Death ebola (80%) margurg (25%)
- ocular manifestions uveitis/scleritis
- tinnitus
- unilateral orchitis
- supportive parotitis
- asymmetric and migratory arthralgias
69
How is the recovery for ebola and marburg?
Complain of
- joint pain
- inflammation of palms/soles
- generalized pain and stiffness
- seizures
- ocular burning
- eye pain
70
Ebola and marburg virus is found?
On PCR lurking in anterior chamber 3 months post illness
Also semen for several weeks
71
How is Lassa spread?
Primary
- Rodent to human
Secondary is
- human to human
72
Lassa is particularly bad in?
Pregnancy (3rd trimester)
73
Unlike the others with lassa?
Bleeding manifestations are rare
74
To prevent lassa people were asked to?
Stop burning bushes b/c it drove the rats into their homes
75
Stats for Lassa?
20% develop multisystem disease
50% fatality rate
76
S/S of Lassa
- insidious onset
- fever
- weakness
- joint and or lumbar pain
- cough
- sever HA
- prostration
- abdominal pain’
- facial or neck edema
- dead babies
- deafness
77
How long is the onset of lassa?
Sx develope over 1-3 weeks
78
MC sequella for lassa?
Deafness (1/3 of cases)
79
What is the major cause of pediatric hospitalizations in west africa?
Lassa fever in kids and infants
80
swollen baby syndrome
Lassa fever in kids and infants
- edema
- anascara (whole body edema)
- abdominal distention
- bleeding
- poor prognosis
81
Labs for lassa?
LFT: AST >>ALT
CBC: lymphopenia, thrombocytopenia
ELISA
PCR (research only)
82
Tx for lassa?
Ribavarin : start w/in 6 days
Aggressive supportive therapy
83
Complications of lassa?
Fatality 15-20%
Maternal mortality in 3rd trimester >30%
Fetal and neonate >85%
84
Hantavirus is aka?
Hemorrhagic fever w renal failure syndrome
- HFRS
85
HFRS is not?
Hantavirus pulmonary syndrome (the US one)
86
HFRS is found?
Far east
87
Triad of HFRS?
Fever
Hemorrhage
Renal insufficency
88
Reservior species of hanta?
Rodents
89
Children under 15 w HFRS?
It is mild in kids under age 15
90
Stages of HFRs?
```
Febrile
Hypotensive
Oliguric
Diuretic
Convalescent
```
91
Febrile phase S/S
```
HA
Chills
Abdominal pain
Malaise
Flushing
Petechia
Subconjunctival hemorrhage
```
ABSOLUTE BRADYCARDIA
92
Hypotensive stage S/S
| /
```
11% of pts
Tachycardia (impending shock)
Acute abdomen (paralytic ileus)
Convulsions
Purposeless movements
```
93
Oliguric stage S/S
Oliguria
HTN
Bleeding (uremia)
Edema
Thrombocytopenia resolves
94
Dieuretic stage
Oththe symptoms resolve
| Rapid dehydration
95
Convalescent stage lasts?
3-6 months
96
Labs for HFRS?
```
UA
- hematuria
- proteinuria (lasts yrs)
CBC
- leukocytosis
- H hematocrit
- thrombocytopenia
Abnormal LFT and metabolic panel
- hyponatremia
- hyperkalemia
ELISA is diagnostic
```
97
Tx for HFRS?
Maitain fluids
Supportive
Ribavirin
98
Complications of HFRS?
Pulmonary edema
Metabolic dysfunction
- hypercalciuria
Mortality and morbidity rates vary (5-15%)
Complications are rare
99
Crimean-congo hemorrhagic fever is aka?
Central asian hemorrhagic fever
Congo fever
100
How is crimean-congo hemorrhagic fever spread?
Ticks that bite livestock
Found in africa, asia, middle ease, eastern europe
101
S/S of crimean-congo hemorrhagic fever?
- Flue like (initially)
- hemorrhage (after 3-5 days)
- massive ecchymosis
- epistaxis
- hematomegaly (50%)
- substantial mucosal and GI bleeding
- erythemia of EENT areas
102
Labs for crimean-congo hemorrhagic fever?
```
CBC
- leukopenia
- thrombocytopenia
ELISA
PCR
```
103
Tx for crimean-congo hemorrhagic fever?
Ribavirin
| Supportive care
104
Besides ticks how do you get crimean-congo hemorrhagic fever?
```
Needlesticks
Cesarean wound care
Indirect
- aerosolization from glove removal
- failure to use N95 respirator
```
105
Complications of crimean-congo hemorrhagic fever?
Encephalitis - rare
| Mortality rate 13-50%
106
what do you give a dog with a fever?
Mustard, its the best thing for a hot dog...
