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Nagasaki Flashcard Extravaganza > Arboviruses > Flashcards

Arboviruses Flashcards

1
Q

How do flavirus infect cells (5 stages)?

A
  1. Receptors: facilitate entry
  2. Decapsulation in cytoplasm (Nucleocapsid release)
  3. Genome replication in the ER Novel nucleocapsid formation Viral particle formation
  4. Matures in Golgi vesicles
  5. Released from plasma membrane
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2
Q

What are the characteristics of Culex?

A

Brown body. Nocturnal. Inside. Likes countryside.

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3
Q

What are the characteristics of Aedes?

A

Black and white body. Likes clean water. Ambush type. Outside. Diurnal

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4
Q

What is the vector for JE?

A

Culex

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5
Q

What are the hosts for JE?

A

Birds, cattle, pigs

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6
Q

Where is JE found?

A

24 countries in Southeast Asia and the Western Pacific are endemic for JEV, with over 3 billion people at risk of infection.

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7
Q

How is JE tested for?

A

IgM in serum or CSF

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8
Q

How many JE cases p/a?

A

68K

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9
Q

What are the risk factors for infection for JE?

A

Children, immunocompromised

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10
Q

What is the fatality rate of JE?

A

20-30%

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11
Q

What is the clinical syndrome of JE?

A

Japanese encephalitis typically presents with an initial non-specific febrile illness, with subsequent neurological involvement. This usually comes on after 3-4 days and manifests as reduced level of consciousness, headache, vomiting, and seizures. Extra-pyramidal features such as blank, mask-like facies and tremors, and other movement disorders, are common. In endemic areas, JE is a disease of childhood.

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12
Q

What % of JE cases have Neuropsych sequelae?

A

50-60%

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13
Q

What is the treatment for JE?

A

None specific

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14
Q

Describe the vaccine for Japanese Encephalitis

A

Inactivated or killed. Recommended in endemic areas. Effective

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15
Q

What is the vector for West Nile virus?

A

Culex

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16
Q

What is the host for WNV?

A

Birds

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17
Q

Where is WNV found

A

Africa, Middle East, Southeast Asia, Australia, Southern Europe, North America.
Major routes of bird migration

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18
Q

Who is at particular risk for JE?

A

Old, immunosuppressed

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19
Q

What is the asymptomatic rate of WNV?

A

80%

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20
Q

What is the fatality rate of WNV Encephalitis?

A

14-16%

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21
Q

What is the rate of Neuropsych sequalase of WNVE?

A

50-65%

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22
Q

What is the treatment for WNVE?

A

None specific

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23
Q

Is there a vaccine for WNV?

A

Yes for horses, not for humans

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24
Q

What is the vector for Dengue?

A

Aedes

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25
Q

What is the host for dengue?

A

Primates/humans

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26
Q

Where is dengue found?

A

Same as Zika areas
Half world’s population
Africa, Asia, Australia, Americas, Southern Europer

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27
Q

Can you be reinfected with Dengue?

A

Yes
For example, if a person is exposed to type 1, he or she is immune to type 1 for life, but cross protective immunity
to other serotypes disappears after a few months, after which the person can be infected with other types.
30-50% of those infected are asymptomatic

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28
Q

what is the treatment for dengue

A

Nil specific - supportive

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29
Q

What is the issue with Dengue vaccine?

A

Possible ADE in antibody-negative cases

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30
Q

Who is the CYD-TDV recommended for?

A

WHO recommends CDY-TDV if abx -45 in endemic areas

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31
Q

When does dengue become febrile?

A

2-7 days

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32
Q

What are probable dengue signs?

A

Severe headache
Pain behind eyes
Myalgia
N&V
LNs

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33
Q

What is severe dengue?

A

Plasma leakage
Breathing difficulties
Severe Haemorrhage
Organ Damage

Symptoms: abdo pain, vomiting ++, high RR, DIC, bleeding, hepatomegaly

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34
Q

what is the vector of Zika?

A

Aedes

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35
Q

What is the host of Zika?

A

Primates/humans

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36
Q

Where is Zika found?

A

North and South America, Africa, Asia

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37
Q

When was Zika isolate?

A

1947

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38
Q

When was the link with Zika and microcephaly discovered?

A

2015, in Brazil

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39
Q

How is Zika transmitted?

A

Perinatally (placentally), sex, transfusion, transplant

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40
Q

What % of Zika cases are asymptomatic?

A

80%

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41
Q

What are the symptoms of Zika?

A

Fever
Rash
Joint pain
Conjunctivitis
Myalgia

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42
Q

What is the treatment for zika?

A

Supportive

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43
Q

Is there a vaccine for Zika?

A

No

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44
Q

What is the vector for Yellow Fever Virus?

A

Aedes

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45
Q

What is the host for YFV?

A

Primates/Humans

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46
Q

Where is Yellow Fever found?

A

Africa
South America

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47
Q

How many severe YFV cases annually?

A

Approx 130K

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48
Q

What are the symptoms of mild YFV?

A

Fever, chills, headache, N&V, fatigues

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49
Q

What is the triad for severe yellow fever?

A

12% Jaundice, haemorrhage, proteinuria.

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50
Q

What is mortality rate of severe YF?

A

20%

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51
Q

What is the treatment for YF?

A

None specific

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52
Q

What is the vector for TBEV?

A

Ticks

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53
Q

Is there a vaccine for YF?

A

Yes, very effective

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54
Q

What is the host for TBEV?

A

Rodents

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55
Q

Where is TBEV found?

A

Europe, Far East

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56
Q

What are the subtypes of TBEV?

A

Far Eastern , Siberian, European

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57
Q

What is the rate of symptomatic TBEV?

A

2-30%

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58
Q

What is the vector for Chikungunya?

A

Aedes

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59
Q

What are the hosts for Chikungunya?

A

Rodents, small mammals

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60
Q

Where is Chikungunya found?

A

Africa, S America, SE Asia, Europe

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61
Q

What are the symptoms of Chikungunya?

A

Fever, distal symmetrical arthritis, rash

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62
Q

What is the important Ddx of chikungunya?

A

Dengue

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63
Q

What is the treatment of Chikungunya?

A

Nil specific

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64
Q

Is there a Chikungunya vaccine?

A

Yes, new live attentuated vaccine for adults

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65
Q

What is the vector for Rift Valley Fever Virus?

A

Culex and Aedes

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66
Q

What are the hosts of Rift Valley Fever Virus?

A

Sheep, cattle, goats etc

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67
Q

Where is RVFV found?

A

Sub-saharan africa

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68
Q

How is RVFV transmitted?

A

Contact with blood of infected animals - eg meatpackers, vets

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69
Q

What is incubation periods of RVFV?

A

2-6 days

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70
Q

What are signs of severe RVFV?

A

Eye disease, meningoencephalitis, VHF

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71
Q

What is the treatment for RVFV?

A

None specific

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72
Q

Is there a vaccine for RVFV?

A

Yes for animals, no for humans

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73
Q

What is the vector for CCHFV?

A

Ticks

74
Q

What is the host for CCHFV?

A

Sheep, goat, cattle

75
Q

Where is CCFV found?

A

Africa, Middle East, eastern europe

76
Q

Is there a vaccine for Crimean Congo?

A

No

77
Q

What is the vector for Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

TICKS

78
Q

What are the hosts for Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV) ?

A

Cats, dogs, deer, boars, raccoons (imagine a Ghibli forest full of cute animals)

79
Q

Where is Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV) found?

A

East Asia

80
Q

What is the incubation period of Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

6-14 days

81
Q

What are the symptoms of Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

Fever, N&V, bleeding, CNS infection

82
Q

What is the fatality rate of Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

6-30%

83
Q

What is the treatment for Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

None specific

84
Q

Is there a vaccine for Severe Fever with Thrombocytopenia
syndrome Virus (SFTSV)?

A

No

85
Q

What is the definition of an arbovirus?

A

(ArBo = ARthropod BOrne) arthropod vectors -> most have reservoirs in mammals/birds
high proportion of asymptomatic cases
tend to agglutinate red blood cells

86
Q

What clinical syndromes do arboviruses cause?

A

FAR - fever, arthralgia, rash

VHF - viral heamorrhagic fever

CNS - central nervous system syndrome (encephalitis)

87
Q

What are the phases of dengue?

A

Febrile phase (2-7 days): fever, rash
Critical phase
Recovery phase

88
Q

What is the tourniquet test?

A

A BP cuff inflated to half way between systolic and diastolic pressure for 5 min - positive if there are 20+
petechiae in a 2.5cm square on the forearm

89
Q

What are the lab signs of dengue

A

Leukopenia and thrombocytopenia
AST/ALT raised if severe

90
Q

How many cases of dengue and severe dengue p/a?

A

Up to 50m infections
2m severe
20000 deaths

91
Q

What is the virology of dengue?

A

Flaviviridae
Single-stranded enveloped RNAvirus, 30nm in diameter.
The dengue virus genome encodes 3 structural proteins;Capsid(C) Precursor membrane (prM) and Envelope (E), and 7 Non-structural
proteins:

92
Q

Who gets severe dengue?

A

Secondary infection with a heterologous subtype

93
Q

what is used for biocontrol of dengue?

A

Wolbachia

94
Q

what are the transmission cycles of Yellow Fever?

A

Sylvatic (Jungle) - mosquito->primate->human
Urban - human->human
Intermediate (Savannah) - > Mosquito ->human/primate->human

95
Q

What are signs of severe dengue?

A

Severe plasma leakage
Severe haemorrhage
Severe organ impairment / shock

96
Q

What are the warning signs of dengue

A

Severe abdominal pain
Persistent vomiting
Rapid breathing
Bleeding gums and nose
Fatigue
Restlessness
Hepatomegaly
GI bleeding

97
Q

Dengue warning signs:
LOVMAPH …

A

Lethargy
Oedema (clinical fluid accumulation)
Vomiting (persistent)
Mucosal bleed
Abdo pain / tenderness
Platelets low / Hct high
Hepatomegaly >2cm

98
Q

Probably dengue:
Fever and 2+: LARVAT
…

A

Leukopenia
Aches (myalgia)
Rash
Vomiting / nausea
Any warning sign
Tourniquet test pos

99
Q

What is the host of Nipah?

A

Bats! Pigs can amplify
Might get from fruit, date palms

100
Q

What is the clinical syndrome of Nipah?

A

Encephalitis
ARDS

101
Q

What type of virus is Nipah?

A

ssRNA, henipavirus, like Hendra

102
Q

Where does Nipah occur?

A

South India, Bangladesh
Malaysia

103
Q

What is the management of Nipah?

A

Supportive

104
Q

How is Nipah diagnosed?

A

Early - PCR
Later - serology

105
Q

What is the IPC of Nipah?

A

No vaccine
Pig and bat control
Safe consumption of fruit/fruit juice

106
Q

How fatal is Nipah?

A

CFR of 40% to 75%

107
Q

What kind of virus is Lassa?

A

ssRNA arenavirus
VHF

108
Q

Where does Lassa happen?

A

West Africa

109
Q

What is the clinical syndrome of Lassa?

A

Fever, non-spec, pharyngitis
May go deaf

110
Q

What is the diagnosis of Lassa?

A

RT-PCR

111
Q

What is the management of Lassa?

A

Ribavarin (one book suggested should be within 6 days)

112
Q

What is the animal reservoir for Lassa?

A

RATS
Can be human to human

113
Q

What is the incubation of Lassa?

A

7-21 days

114
Q

Who is at particular risk with Lassa?

A

Mortality 1-15%
80% in women in 3rd trimester

115
Q

What type of virus is Hanta?

A

ssRNA

116
Q

What is the clinical syndrome of Hanta?

A

Like Lassa or lepto
High proportion of complications
Haemorrhagic fever renal syndrome (HFRS)
Hantavirus pulmonary syndrome (HPS)

117
Q

What kind of virus is dengue?

A

Flavivirus
ssRNA
4 serotypes
3 main structural proteins

“Arbovirus” group

118
Q

Dengue vector

A

Aedes

Day biter
Breeds in small pools of water
Urban dweller

119
Q

Incidence of dengue, severe dengue, and deaths

A

Incidence = 500 million

Severe = 2 million

Deaths = 20 thousand

120
Q

What is dengue clinical syndrome?

A

Fever + retro-orbital pain + erythematous macular rash

Low platelets, low WCC (if either high –> not dengue)
Anorexia, nausea, aches and pains, lymphadenopathy

121
Q

What are dengue warning signs?

A

L - lethargy
O - overload of fluid
V - vomiting persistently
M - mucosal bleeding
A - abdominal pain
L - low platelets (plus high HCT)
L - liver enlargement

122
Q

What are signs of severe dengue?

A

S - shock
I - impaired consciousness
R - respiratory distress
P - plasma leakage
L - liver failure
E - end organ damage
B - bleeding (severe)

123
Q

Name some risk factors for severe dengue

A

Young age

Female sex

Previous dengue infection (ADE), especially if heterologous serotype

Dengue serotype 2

124
Q

In whom does antibody dependent enhancement occur in dengue?

A

Those with previous dengue infection

Those vaccinated against dengue who have never had dengue before

Children born to mothers with dengue antibodies

125
Q

How is dengue managed?

A

Supportive only
Admit if warning signs

Fluid resuscitation
Monitor HCT closely for signs of third spacing
Colloids in refractory shock

126
Q

What type of vaccine is dengue vaccine? Give one positive and two negatives

A

Live attenuated (yellow fever backbone)

NEGATIVES:
Cannot be given to dengue naive patients –> risk of ADE and severe dengue
Not very effective against dengue serotype II (the most severe one)

POSITIVES:
Helps prevent severe dengue in those with history of dengue infection

127
Q

How can dengue be prevented? (7 ways)

A
  1. Vaccination

AEDES VECTOR CONTROL
2. Indoor residual spraying
3. Destroying / covering breeding sites which are small water pools
4. Larvicial in drinking water tanks
5. Wolbachia

BITE CONTROL
6. Day biting - repellent and long clothing
7. Screens / nets

128
Q

Which serotype of dengue is most associated with severe disease?

A

2 (oh poo I’ve got dengue type two)

129
Q

How is dengue diagnosed?

A

PCR for viral DNA

For acute dengue diagnosis, clinicians should order NS1 and IgM tests or NAAT and IgM tests.

  • Primary infections: early steep rise in IgM
    (> day 5); later, more gradual rise in IgG
  • (> day 14)
    Secondary infections: slow or absent rise in IgM; early rise in IgG (> day 2)
130
Q

What kind of virus is Zika?

A

Flavivirus
ssRNA
Capsid, membrane proteins, envelope

Arbovirus group

131
Q

What is the vector of Zika virus?

A

Aedes, mostly egypti but depends on location

Day biter, breeds in small pools of water

132
Q

What are the 4 main ways of zika virus transmission?

A
  1. Vector borne: infected female aedes mosquito bites
  2. Vertically
  3. Sexually
  4. Infected blood products / organs
133
Q

What is zika virus distribution?

A

Endemic throughout tropics

134
Q

What is incubation period of zika virus?

A

3-14 days

135
Q

What is zika virus clinical syndrome?

A

Asymptomatic
Mild disease

Fever + rash + conjunctivitis
Arthralgia, headache, malaise also seen

136
Q

What are some complications of zika virus?

A

Congenital infection
Guillain Barre
Myelitis
Neuropathy

137
Q

What are the features of congenital zika virus infection?

A

Microcephaly, miscarriage and IUD

Eye: retinal pigmentation, cataracts

Brain: cerebral calcification, ventriculomegaly, brain atrophy, brain stem abnormalities

Other: limb contractures, spasticity

138
Q

Who should be tested for zika virus infection?

A

Symptomatic (all)

Asymptomatic pregnant women with history of exposure

139
Q

How is zika virus diagnosed?

A

<7 days of onset: blood / urine PCR for viral DNA

> 7 days of onset: serology (NB lots of other flavivirus cross reactivity)

Amniotic fluid PCR and USS for foetal abnormalities

140
Q

How is zika managed?

A

Supportive only

Serial USS for congenital abnormalities

141
Q

How can congenital zika be prevented?

A

Women: avoid conception for 2/12 after infection / travel to endemic area

Men: avoid conception for 3/12 after infection / travel to endemic area

142
Q

How can zika infection be prevented?

A

BITE PREVENTION
Aedes = day biter. Long clothes, repellant

VECTOR CONTROL
Aedes = small water pool breeding. Drain / cover. Larvicide in water tanks. Indoor residual spraying

SEXUAL TRANSMISSION
Barrier methods for 2/12 in women / 3/12 in men

No vaccine

143
Q

What kind of virus is chikungunya?

A

Alphavirus –> togaviridae

144
Q

Vector for chikungunya

A

Aedes mosquito (egypti, albopictus)
Day biter

145
Q

What is the incubation period and clinical syndrome of chikungunya?

A

Incubation = 3-10 days

Clinical syndrome = fever, polyarthralgia, rash

Iritis, pedal oedema, headache also seen

146
Q

What are the typical bloods of a patient with chikungunya?

A

Low Plt
Low WCC
High Creatinine
High LFT

147
Q

Name 4 complications of chikungunya

A
  1. Persistent polyarthralgia
  2. Myocarditis
  3. Hepatitis
  4. Meningoencephalitis
148
Q

How is chikungunya diagnosed?

A

<5 days: blood for viral PCR

> 5 days: serology (IgM)

149
Q

How is chikungunya managed?

A

Supportive only

NSAIDs for polyarthralgia if dengue ruled out

150
Q

How can chikungunya be prevented?

A

Vaccination (live attenuated)

Bite protection: day biter, long sleeved clothes and repellent

Vector control: destroy breeding pools (small water collections), IRS, larvicide in drinking water tanks

151
Q

What kind of virus is japanese encephalitis?

A

Flavivirus
ssRNA
enveloped

152
Q

What is vector for JEV?

A

Culex (tritaeniorhynchus)

153
Q

How many cases and deaths / year in JEV?

A

Cases = 70k
Deaths = 15k

154
Q

What season sees most JEV transmission?

A

Transmission occurs year round but most common in rainy season

155
Q

What is the clinical syndrome of severe JEV?

A

Incubation period = 5-15 days

Rapid onset fever + headache + neck stiffness + coma + seizures + spastic paralysis

Classically in a child, <10 years old

156
Q

What is the clinical syndrome of mild JEV?

A

Vast majority (>300:1) are asymptomatic

Mild = fever, headache.

Abdominal pain and vomiting may suggest onset of severe disease in children

157
Q

What are the outcomes of severe JEV?

A

Death in 30%

Permanent neurological sequelae in 50%

158
Q

What is the incubation period for JEV?

A

5-15 days

159
Q

How is JEV diagnosed?

A

CSF / Serum ELISA for JEV specific IgM

False +ve in prev infection / immunised (lower false +ve in serum samples). x reactivity with other flavivirus esp dengue

IgM present from ~ day 3 of illness

Use neutralising antibody to increase diagnostic accuracy

160
Q

What is reservoir of JEV?

A

Wading birds, particularly those that live in rice paddiesW

161
Q

What is amplifier host of JEV?

A

Piggies

162
Q

What is accidental host of JEV?

A

Humans

163
Q

What type of vaccine is JEV and who should receive it?

A

Inactivated

Only those spending prolonged time in endemic areas doing high risk activities

164
Q

How can JEV be prevented?

A

Vaccination (live attenuated)

Bite prevention (culex night biter) bed nets, repellent

Vector control: destroy pools of water in which they breed, IRS

165
Q

What kind of virus is yellow fever?

A

Flavivirus
ssRNA
Enveloped

166
Q

Vector for Yellow Fever

A

Aedes mosquito ( –> egypti)

167
Q

What is the distribtion of Yellow Fever?

A

South America, Africa

168
Q

What is the reservoir of Yellow Fever?

A

Jungle Monkeys

169
Q

What is the clinical syndrome of yellow fever?

A

Incubation period: short 3-6 days
Mostly asymptomatic

Biphasic illness: acute phase –> toxic phase

Acute phase illness:
Fever + conjunctival injection + backache + faget’s sign

Toxic phase (within 24h of acute phase resolution): jaundice + bleeding + renal failure

170
Q

What is the mortality rate of severe yellow fever?

A

50%
Death usually occurs within 2/52

171
Q

What do routine bloods demonstrate in Yellow Fever?

A

LOW: WCC, Plt
HIGH: LFT
Deranged clotting

172
Q

How can Yellow Fever be diagnosed?

A

PCR for virus in blood
Serology for IgM (ELISA)
Liver biopsy –> Councilman bodies

173
Q

How can yellow fever be prevented?

A

Vaccination (Live attenuated, very effective) –> associated with viscerotrophic disease in the elderly

Vector control: IRS, cover pools of water

Bite prevention: nets at night (night biter), DEET

Vector = aedes

174
Q

What kind of virus is West Nile?

A

Flavivirus (2 lineages)

175
Q

What is the vector for West Nile?

A

Culex pipiens

176
Q

What is the reservior for West Nile?

A

Wading birds

177
Q

How is West Nile Transmitted?

A

Bite of culex
Vertically
Infected blood products

178
Q

What is the distribution of West Nile virus?

A

Europe, Middle East, Africa, Australia, Americas

179
Q

What is the clinical syndrome of West Nile Virus?

A

Incubation = 3-14 days
80% asymptomatic
Mild flu like illness

Severe = neurological sequelae (myelitis, meningitis, encephalitis)

Severe more likely to be seen in >50s and immunocompromised. Mortality is 10%

180
Q

How is West Nile Virus diagnosed?

A

Serum / CSF / tissue –> PCR

> 8 days since onset –> IgM (cross reactivity with other flavivirus)

181
Q

How can West Nile Virus be prevented?

A

Culex = night biter
Breeds in ground water
No vaccine

182
Q
A

Nagasaki Flashcard Extravaganza (34 decks)

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