Arbo viruses

Dr Faseeha Noordeen Department of Microbiology University of Peradeniya May 2013

Learning outcomes
Modes of transmission and the pathogenesis of ARBO viral infections / diseases in humans Clinical features of ARBO viral infections / diseases Principles of diagnosis, management and prevention ARBO viral infections / diseases

Introduction
Transmission: Haematogenous arthropods and mammalian hosts Viraemic mammals Arthropods Mammals

Important arboviral infections in SL

Japanese encephalitis (JE) Dengue fever (DF) Dengue haemorrhagic fever (DHF) Chikungunya fever (CHIK fever)

Other arboviral infections of global importance

California encephalitis, Sand fly fever, yellow fever, Colorado tick fever, Carimean-Congo haemorrhaigic fever

Japanese encephalitis (JE)

Aetiology:

JE virus Flaviviridae, Mosquito borne RNA virus

Transmission: Mosquitoes
Culex tritaeniorhynchus Culex gelidus

Distribution:

South and Southeast Asia

Epidemiology of JE

Migrant birds & pigs are infected with virus Infection seen in pigs 2-3 weeks prior to human infection Changing patterns of JE with climatic conditions Epidemics mosquito density is high JEV replicates in salivary gland of mosquitoes

Epidemiology of JE

Humans

Pathogenesis of JE in humans
Inoculation of virus through mosquito bite

Viraemia Early non-specific symptoms

Blood

Brain

Neurological symptoms

Clinical manifestations JE in humans

1 in 50-1000 results in typical encephalitis IP is 6-16 days Disease begins with a non-specific prodrome, abrupt onset of high fever chills, severe headache, nausea, vomiting, abdominal pain, dizziness and Progress to neurological signs hyper excitability, stupor, disorientation, coma, tremors, paralysis (generalised) and loss of co-ordination

Children with JE

Epidemiology of JE in Sri Lanka

Endemic: North central & western provinces

Pig farming is popular in these areas Pigs act as the amplifier host Migrant birds are infected with the virus Large areas of wetland habitats mosquitoes Epidemics: Vector density is high

Diagnosis
1. History + clinical symptoms 2. Epidemiological data 3. Laboratory:
a. JEV antigen or RNA detection in CSF b. Antibody detection in serum (IgM) c. Detection of 4-fold rise in antibody titre in acute: convalescent sera d. CSF picture for viral infection (lymphocytosis)

Treatment

No specific treatment Supportive therapy until recovery Outcome

Case fatality is 20 - 50% 70 % survivors - mental retardation, psychiatric complains + paralysis

Prevention
1. Vaccination in humans killed and live attenuated JE vaccines 2. Vaccination in pigs 3. Vector management - intermittent drying of paddy fields to kill mosquito larvae 4. Minimizing vector density - chemicals 5. Monitoring infection rates using sentinel pigs

DF/DHF

Aetiology:

Dengue virus (4serotypes) Flaviviridae, Mosquito borne RNA virus

Transmission: Mosquitoes
Aedes aegypti Aedes albopictus

Distribution: South and Southeast Asia including SL

Clinical manifestations
of DF/DHF
Inoculation of virus through mosquito bite

Viraemia Early non-specific symptoms

Clinical manifestations of DF
Viraemia Early non-specific symptoms
Sudden onset of fever Headache, myelgia and arthralgia Rash may appear: 3-5th day URT symptoms in children Symptoms may last for 10 days

Clinical manifestations of DHF

Viraemia Early non-specific symptoms Purpuric rash, bleeding from the mucosae (vomitous + faeces) Drop in platelets Extravasation of fluid from the vascular compartment Hypovoleaemia, hypotension, tachycardia, apathy and shock

Pathogenesis of DF/DHF
Dengue viral infections are asymptomatic in many DF primarily occurs in non-immune adults and children Symptoms begin after 5-10-days of incubation period DHF/DSS usually occurs during a second dengue virus infection in persons with pre-existing immunity to a heterologous dengue virus serotype Illness begins abruptly within 2-4 days of infection and rapid deterioration Increased vascular permeability and bleeding may be mediated by circulating dengue antigen-antibody complexes, activation of complement and release of vaso-active cytokines

Epidemiology of DF/DHF in SL
Endemic: Many parts of the Island

First DHF: 1965 in SL No non-human hosts Man

Mosquitoes Man

Clean water habitats/households mosquitoes Epidemics: Vector density is high

Diagnosis
1. History + clinical symptoms + Epidemiology 2. Laboratory: Detection of dengue virus RNA during the acute phase Detection of serum antibodies from the 5th day Analysis acute and convalescent sera Confirmatory Monitoring the PCV + Platelets

Treatment

No specific treatment Supportive therapy until recovery Early recognition of DHF is important

Control
1. Vector management Removal of Aedes mosquito breeding sites 2. Minimising vector density chemicals 3. Prevention of mosquito bites (nets and repellents)

Chikungunya fever
Spread by the bite of infected mosquitoes Resembles DF and is characterized by severe, sometimes persistent, joint pain (arthritis), as well as fever and rash It is non-life-threatening, widespread occurrence of diseases causes morbidity and economic loss

Chikungunya fever in India

In October 2006, 151 districts of India have been affected by chikungunya fever with >1.25 million cases Attack rates have reached up to 45% SL experienced an outbreak in 2006/07

Diagnosis
1. History + clinical symptoms + Epidemiology 2. Laboratory: Detection of CHIK virus RNA during the acute phase Detection of CHIK antibodies in acute and convalescent sera Detection of CHIK virus specific IgM in the acute phase serum

Treatment
Symptomatic treatment for pain and fever using anti-inflammatory drugs Recovery from CHIK is the expected outcome, convalescence can be prolonged for years Persistent arthralgia may require analgesic and long-term anti-inflammatory therapy

Prevention/control
No vaccine is available Prevention is entirely dependent on taking steps to avoid mosquito bites and elimination of mosquito breeding sites

A significant number of patients belonging to a wider range of age group (10 -60 years old) were presented to a regional hospital in Ampara district soon after the last rainy season with mild to severe fever and body aches and pains; some also had symptoms of upper respiratory tract infection. Daytime mosquitoes bites are common in the area especially in those actively engage in study or work related activities. When blood samples were examined for a complete blood evaluation, most of the patients had reduction in platelet counts with or without lymphocytosis. 1.Name 2 virus infections that can be responsible for the above clinical scenario? 1.How can you confirm or refute these 2 virus infections using different laboratory criteria, considering the course of the disease with virological and immunological events that occur in patients infected with these 2 virus infections? 2. Discuss strategies for management and prevention of these virus infections/diseases.