Dengue

-Man is the only vertebrate maintenance host

-arbovirus infection
-urban areas
-high population density
-rapid development activities
Aedes aegypti
Aedes albopictus
Aedes polynesiensis
Aedes scutellaris
-affected by seasonal changes involving
-rainfall and daily temperatures
Transmission
blood transfusions
infected mother to her foetus
-Has 4 serotypes and each has several genotype
-Small, spherical, enveloped ssRNA virus
-Flaviviridae family
-Infection with one dengue serotype confers
lifelong homotypic immunity, and
very brief period of partial heterotypic immunity
-DHF or DSS develops on 3rd - 7th day of illness and it takes longer
to recover compared to dengue
Classical dengue(Primary dengue or backbone fever)
-Asymptomatic
-Mild in children
-ADULTS
Severe pain over backbone
Maculopapular rash
-Petechiae on dorsum of hands
- fever
Secondary dengue
-local residents
-Show symptoms similar to primary dengue and will recover easily
-If severe has hemorrhagic symptoms like epistaxis, petechiae,
melaena
-Neurological involvement
-Purpura, epistaxis

Dengue without warning sign

-Fever and two of the following:

Nausea, vomiting
Rash
Leukopenia
Positive tourniquet test (petechial rash)
Dengue with warning signs
-Abdominal pain or tenderness
- Persistent vomiting
- Clinical fluid accumulation
Severe Dengue
-Severe plasma leakage leading to:
Shock (DSS)
Fluid accumulation with respiratory distress
-Severe bleeding
-Severe organ involvement:
Pathogenesis of DHF
-Virus multiply in monocytes and vascular endothelium
-plasma leakage
increased capillary permeability
pleural effusion & ascites
- Bleeding
capillary fragility and thrombocytopenia
petechial skin hemorrhages
gastrointestinal bleeding
-DHF may occur when antibody dependent immune enhancement
and increase virulence
-Immune enhancement
Following exposure to another serotype within 6 months of
first infection, antibody from first infection will attach to the
dengue virus but neutralisation does not occur

Fc complex region attaches to the surface receptors of

monocytes and promotes viral entry and replication
The antibody thus acts as enhancing antibody
produce specific cytokines and activates complement causing
endothelial damage
-Increased virulence
due to subsequent exposure to same viral serotype
a more virulent second strain,
resulting in ineffective neutralisation.
Primary
IgM
appear 5 days after onset of syptoms
detectable for up to 6 months
IgG

detectable 14 days later


Remain positive for life
Secondary
IgM
lower titre
IgG
detected 2 days after symptoms appear
higher titre
Treatment
-symptomatic
panadol, blood transfusion
Control
-Dengue Control Programme
Chikungunya
-Mosquito vectors
Aedes aegypti

Aedes africanus
-Cause of febrile disease with rash
-Man is an accidental vertebrate host
C/F
-Resembles classical dengue
-Begin with
sudden fever
severe joint pains
headache
maculopapular rash
-Haemorhagic complications
Laboratory diagnosis
-ELISA, IF
Treatment
-Symptomatic
Control
-Mosquito control
Yellow fever
-Urban type
reservoir humans
vector - Aedes aegypti
-Sylvatic type
reservoir - tree-dwelling monkeys
vectors Haemagogus or Aedes mosquitoes

C/F

asymptomatic
jaundice, liver damage

Complications
haemorrhage
toxic nephrosis with proteinuria
Diagnosis
Virus isolation: mosquito larvae, Vero cells
ELISA, HAI
Treatment
Supportive care
Control
Effective mosquito control measures & reduce exposure
Vaccination
Live attenuated 17D virus strain
Subcutaneously, 10 days before arriving endemic area
Crimean-congo haemorrhagic fever
Tick-borne Bunyavirus disease
Animal hosts : hares, ticks and birds
contact with infected blood or body fluid to medical staff
high mortality
haemorrhage, circulatory collapse
Rift Valley fever
Large epizootics in sheep and cattle
contact with infected animals or tissues,
mosquito bite (several mosquito species)
mild fever, headache
haemorrhage, encephalitis
Complication
retinitis
Onyong-nyong
Febrile illness with joint pains
Ross River Virus
Febrile illness with rash
Polyarthritis
Non-arthropod borne haemorrhagic fever

-Haemorrhagic fever & renal syndrome (HFRS)

Hantaan virus
-Marburg & Ebola viruses
-Lassa fever
-South American haemorrhagic fevers
Haemorrhagic fever & renal syndrome (HFRS)
-caused by hantaviruses from the family Bunyaviridae
-HFRS includes diseases such as
Korean hemorrhagic fever,
epidemic hemorrhagic fever, and
nephropathis epidemica.
-Hantaan and Seoul are virus cause HFRS
-Hantaviruses by rodents.
-Infected via broken skin or mucous membrane
aerosolized urine
saliva

after exposure to dust from their nests

-Mice-to-mice
Korean hemorrhagic fever
Apodemus agrarius field mouse
antibody in Rattus mice
C/F

fever
hemorrhagic
hypovolemic shock

Complications
renal failure
hepatitis
Diagnosis
ELISA
IF
Treatment
Symptomatic
IV Ribavirin used in early
Control
Rodent control

Filovirus
-Pleomorphic shapes
-Viral filaments enveloped in a lipid (fatty) membrane.
-One ss, (-)sense RNA genome
-Filoviridae
-Genera:
Cuevavirus
Marburgvirus
Ebolavirus
Ebolavirus
Fruit bats of Pteropodidae family
Direct contact with infected blood or fluid (man or animals),
Consumption of infected meat
Sexual contact with convalescent patient
C/F
Fever
Muscle pain
Stomach pain
-The disease can only spread to others after the symptoms begin
-multi-organ failure thn deadth
Laboratory Diagnosis
Vero cell
ELISA
Indirect IF
Treatment
Symptomatic (transfusions). No antivirals
Hyperimmunoglobulin
Control
Isolate patient
Lasssa fever
-Mastomys natalensis mice
-Human-to-human transmission
direct contact
direct contact with patients blood
aerosol
C/F

asymptomatic
fever and sore throat
weakness and malaise

Mouth and pharynx ulcers, cervical lymphadenopathy

Facial oedema
haemorrhage & shock

complication
Deafness
Laboratory Diagnosis
Vero cells
IF, ELISA
Treatment
supportive
Immunotherapy : Specific immunoglobulin
IV ribavirin
Control
Rat control
South American Haemorrhagic fever
rats or mouse-like rodents
Clinical
haemorrhagic, renal, neurological symptoms
Treatment
supportive
Immunotherapy : Specific immunoglobulin
Antivirus agent : IV ribavirin
Control
Rat control