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Viral hgeic fever
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- 2. • Zoonoses causedby different viruses • Ebola, Marburg, Lassa, Dengue, CCHF
- 3. Clinical features • Startswith non-specific fever, malaise, body pains, sore throat, headache • Conjunctivitis, throat congestion, rash, hemorrhage, lymphadenopathy • Capillary leak due to endothelial damage by virus. • Bleeding due to endothelial and platelet dysfunction • ARDS, shock, organ failure • Travel history, contact history
- 4. Investigations • CBC- leucopenia,thrombocytopenia • Urine DR- proteinuria • LFT • Blood, urine, throat swab, pleural fluid for serology and PCR for viral nucleic acid
- 5. Management • Specialized highsecurity infectious disease unit • Supportive management • Ribavirin
- 6. • Flavi virus •Aedes aegypti—breeds in standing water • Incubation period 2—7 days DENGUE FEVER
- 7. • PRODROME • ACUTE: fever continuous / saddle back, high grade, 7-8 days – Backache, arthralgias, headache, pain on eye movement – Anorexia, nausea, vomiting – Prostration – Rash macular, maculopapular, scarlet, centrifugal spread Clinical features
- 8. Rash maculopapular indengue
- 11. • DENGUE HAEMORRHAGICFEVER: petichiae, ecchymosis, epistaxis, GI bleeding, DIC • DENGUE SHOCK SYNDROME: After 3-4 days of fever—hypotension, circulatory failure • Hepatitis, myocarditis, encephalitis, rhabdomyolysis, cranial nerve palsies Complications
- 13. • Tourniquet test •CBC • LFT • RFT • SEROLOGY – Dengue NS-1 antigen – Dengue serology • Imaging Investigations
- 14. MANAGEMENT • Symptomatic • Treatmentof complications
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- 16. Historical Background CCHF likesymptoms were described initially by physicians in 12th century from the region currently known as Tazhikistan. In 1944-1945 when 200 Soviet military personnel were infected during war in Crimea. In 1967 peoples from Congo and Uganda were infected by similar disease thus the name Crimean Congo hemorrhagic fever. In 1967, Chumakov in Moscow first used newborn white mice for the isolation of CCHF virus. This resulted in a Drosdov strain which became the prototype strain for experimental work. 16
- 17. Problem statement 52 countries Morethan 6,000 cases Nearly 140 outbreaks 17
- 18. 3 March 2020Dr. Sunil Panjwani, 9825331039 18
- 19. Geographical distribution • Geographicallythis tick borne viral infection has been reported from different countries in Southeast Europe Asia Middle East Africa 19
- 20. • Crimean-Congo haemorrhagicfever (CCHF) is a viral haemorrhagic fever caused by Nairovirus. • Primarily an animal disease, sporadic cases and outbreaks of CCHF affecting humans do occur. • CCHF outbreaks constitute a threat to public health because of its Epidemic potential. High case fatality. Potential for nosocomial outbreaks. Difficulties in treatment and prevention. 20
- 21. Mode of transmission •Bite of an infective adult tick, particularly Hyalomma marginatum or Hyalomma anatolicum. • Skin lesions when crushing an infected tick. • Nosocomial outbreaks due to exposure to infected blood and secretions. • Slaughtering of infected animals via small-particle aerosol from infected rodent excreta. • From contaminated needle sticks or infected fomites. 3 March 2020 22Dr. Sunil Panjwani, 9825331039
- 22. 3 March 202023Dr. Sunil Panjwani, 9825331039
- 23. 3 March 2020Dr. Sunil Panjwani, 9825331039 24
- 24. 3 March 2020Dr. Sunil Panjwani, 9825331039 25
- 25. At-risk population • Animalhandlers, livestock workers, and slaughter houses in endemic areas are at risk of CCHF. • Healthcare workers in endemic areas are at risk of infection through unprotected contact with infectious blood and body fluids. • Individuals and international travelers with contact to livestock in endemic regions may also be exposed. • Age – all ages. • Sex – 3 times more in males than females. • Immunity – Life time immunity for that genome. 26
- 26. Incubation period • Thisdepends on the route of exposure to virulence and viral dose. • The incubation period after tick bite is usually 1 to 3 days, with a maximum of 9 days. • The incubation period following contact with infected blood or tissues is usually 5 to 6 days, with a documented maximum of 13 days. 3 March 2020 28
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- 29. Clinical Features • Courseof this disease follows four distinct phases in humans –Incubation phase –Pre-hemorrhagic phase- fever, body ache –Hemorrhagic phase-skin, mucous membrane, organ failure, ARDS –Convalescence phase 3 March 2020 34
- 30. Laboratory Findings • CBC-anemia, leucopenia, thrombocytopenia • Urine DR- proteinuria, hematuria • LFT • RFT • LDH • PT, APTT, INR • CPK 35
- 31. Diagnosis • There areno rapid diagnostic tests. • ELISA-for IgG and IgM from 6th day of illness. IgM - upto four months IgG - upto five years. • The virus may be isolated from blood or tissue specimens in the first five days of illness, and grown in cell culture. • PCR and RT PCR-for detecting the viral genome 36
- 32. Differential Diagnosis • Thereare a number of tropical infections which presents similar clinical features and hence they should be suspected and ruled out while making a diagnosis of CCHF. The differentials include – Dengue Hemorrhagic Fever – Falciparum malaria – Leptospirosis – Typhoid Fever – Septicemic Plague – Rickettsial Infections – Meningococcemia – Viral Hepatitis – Other viral hemorrhagic fevers. 37
- 33. Treatment • The mainstayof treatment in CCHF is supportive in nature Maintenance of fluid and electrolyte balance. Maintenance of circulatory volume, and blood pressure. Platelet transfusion, PCV transfusion. Management of DIC, sepsis, shock and MOF • Possible benefits with immunoglobulin . 38
- 34. • Antivirus drugRibavirin, the dosage recommended by the WHO within 24 hours of hospital admission for better results are 2 gm loading dose 4 gm/day in 4 divided doses for 4 days. 2 gm/day in 4 divided doses for 6 days. 39
- 35. Prophylaxis Protocol Indirect contactwith case body fluids should be monitored for 14 days from the date of last contact with the patient or other source of infection by taking the temperature twice daily. OR If the patient develops a temperature of 38.5° C or greater, headache and muscle pains, he/she would be considered a probable case and should be admitted to hospital and started on ribavirin treatment. 40 Treatment Protocol for CCHF disease High-dose oral Ribavirin therapy : 2 gm loading dose 4 gm/day in 4 divided doses (6 hourly) for 4 days. 2 gm/day in 4 divided doses for 6 days.
- 36. LASSA FEVER • Rodentassociated. • Arenavirus • Virus is in rat excreta, spread by direct contact or aerosolized particles. • Clinical features--- • Diagnosis serological , PCR • Treatment : ribavirin. • Post exposure prophylaxis.
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- 38. CHIKUNGUNYA • Alpha virus •Fever, rash and arthropathy • Aedes aegypti • Incubation period 2-12 days • Fever, followed by afebrile phase, recrudescence of fever • Children most commonly develop rash • Adults develop arthritis with pain and swelling • Joint pain becomes chronic in individuals positive for HLA-B27
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