M2-C3-L95 --> Bunyaviridae & Filoviridae

Front 1

Old World Hantavirus:

- Discovered when?
- # of cases @ time of discovery?
- symptoms & prevalence?
- fatality?
- What was this new disease called?
- when was the virus isolated?
- what was it called?

Back 1

Korean War

3000 troops had acute febrile disease

1 in 3 exhibited hemorrhagic manifestations

5% to 10%

Hemorrhagic Fever with Renal Syndrome (HFRS)

25 yrs later

Hantaan virus

Front 2

Old World Hantavirus

- reservoir host
- vector

Back 2

Mice

Rodent-borne virus

Front 3

Do all rodents carry the same Old World Hantavirus?

Back 3

No, each carry specific ones.

Front 4

What was so surprising about the Old World Hantavirus?

Back 4

Despite being rodent-borne, it shared characteristics with other bunyaviridae which are all arboviruses.

Front 5

NEW WORLD HANTAVIRUS

The newly discovered New World Hantavirus is called what?

- is this an arbovirus?

Back 5

Sin Nombre

False, not arbovirus

Front 6

Sin Nombre virus:

- Reservoir host
- vector

- Dz caused?

Back 6

Common deer mouse

Common deer mouse

Hantavirus Pulmonary Syndrome

Front 7

HANTAVIRUS PULMONARY SYNDROME

- caused by?
- first ID'd where?
- occurs throughout?
- clusters noted where?
- how many types of viruses involved?

Back 7

- Sin Nombre
- SW US (1993)
- throughout Americas
- Four corners (CO AZ NM UT)

- caused by 10+ different hantaviruses

Front 8

SIN NOMBRE VIRUS

- causes what Dz?
- initial symptoms?

- symptom progression character?
- Progression leads to what Dz?
--> what are its symptoms? x4
--> when does this progressed Dz occur?

Back 8

- Hantavirus Pulmonary Syndrome
- "Flu-like" symptoms

- Rapid progression to......
- Severe Respiratory Disease
(BRS Death)
--> Bilateral Pulmonary infiltrates
--> Respiratory Failure
--> Shock
--> DEATH

--> 2 to 10 days post onset
(in 50 to 80% of cases)

Front 9

NEW WORLD HANTAVIRUS

T/F - Each rodent host has its own different hantavirus.

T/F - "non-pathogenic" hantaviruses exist."

Back 9

True



True

Front 10

Sin Nombre virus:

- responsible for what Dz & where
- most cases of Dz where?

- found in what reservoir host?
- reservoir host is endemic to?
- how many cases since 1993?
- Seroprevalence in endemic areas.

Back 10

- Hantavirus pulmonary syndrome (HPS)
- in N. America
- mostly in SW USA
(but seen in 30 states)

- Deer mice
- of Western/Central US
and
Canada.

300 since 1993

<1%, so human infection is RARE.

Front 11

NEW WORLD HANTAVIRUS

- There has been a cluster of cases associated with the?

- 10 fold more than usual in 1993. Why?

Back 11

- increase in deer mouse density for HPS.

- El nino effect

Front 12

HEMORRHAGIC FEVER with RENAL SYNDROME

- the FEVER syndrome you get with HANTAAN or DOBRAVA virus has what possible 3 phases in its HFRS disease?

Back 12

FHD = Fever of Hantaan or Dobrava

FHD =
(1) Febrile illness phase - LIFE
(2) Hypotension phase - STOP Dick
(3) Diuresis phase - survivors

Front 13

Hemorrhagic Fever with Renal Syndrome (HFRS) Clinicals:

- causative agent x2

- incubation period

- onset character
- first phase called?
- symptoms of first phase? x4

- followed by what phase?
- duration of this phase?
- this phase includes what? x5

- Mortality rate

- what Sx accounts for most of the deaths?

Back 13

"LIFE STOPS for Dick"
Hantaan virus
Dobrava virus

2-3 weeks

Sudden onset
Febrile illness phase
(LIFE)
- Lower Back Pain
- Increased vascular pemeability
- Flushing
- Edema

Hypotensive phase
- hours to days
(STOP Dick)
Shock
Thrombocytopenia
Oliguria (may occur)
Petechial Hemorrhage
DIC - Low grade

5 to 15%

Renal failure (50%)

Front 14

Survivors of HFRS have what additional phase?

for how long?

Back 14

phase of Diuresis

Several months

Front 15

HEMORRHAGIC FEVER with RENAL SYNDROME

- Milder forms of HFRS of Hantaan or Dobrava virus infections found where? x2

- describe mortality for both

- List what is milder? x4
(include usual symptoms of HFRS what is NOT exhibited)

Back 15

- Seoul (1 to 2% mortality)
- Puumula (less than 1% mortality)

"Get a degree in Seoul in MPH without HS education"
1. Mild renal involvement
2. Petechia, withouth Hemorrhage
3. Hypotension, without Shock

Front 16

Hentavirus Pulmonary Syndrome:

- causative agent?

- incubation period

- character of onset?

- initial phase?
- duration?
- symptoms in first phase?

Back 16

Sin Nombre

2-3 wks (same as old school)

Sudden onset

Febrile phase

Flu like symptoms



~4 days

Front 17

HANTAVIRUS PULMONARY SYNDROME

- patient usually presents after what phase?

- patient presents because of what symptoms?*** x3

- Physical Exam reveals what? x4

- It is a Pulmonary Dz, so a Chest X-ray would reveal what?

Back 17

- After Febrile Phase (~4 days)

PHD
- Pulmonary edema***
- Hypoxemia
- Dyspnea***

T-THC
- Tachycardia
- Tachypnea
- Hypotension
- Crackles/rales in lungs

Bilateral
Pulmonary Infiltrates

Front 18

HPS:

- Bilateral Pulmonary Infiltrates are caused by what damaging actions of the virus infection? x4

Back 18

MILF

- Microvascular ENDOthelial cell damage

- Increase permeability of lungs

- Lungs are fucked up

- Fluid leakage into lungs

Front 19

HPS:

- Discuss the rapid deterioration symptoms. x4

Back 19

SHiT!!!! HPS is a Dick!!!

Shock
Hypotension
(intense shit)
Thrombocytopenia

DIC

Front 20

HPS mortality if admitted to hospital?

Prognosis Recovery for those who didn't die?

Back 20

50% die in 1-3 days of admission

Remarkably rapid recovery
- lung lesions & shock resolves in 3-6 days.

Front 21

SIN NOMBRE HANTAVIRUS
EPIDEMIOLOGY

- Responsible for most of what Dz and where?

- Found in what host & vector & where? x2

- Most cases occur where?

- Since 1993, how many cases?

Back 21

- Most HPS in North America

- Deer Mice
(Western & Central US & Canada)

- SW US
(but has occured in 30 states)

- 300 cases since 1993

Front 22

SIN NOMBRE HANTAVIRUS
EPIDEMIOLOGY

- seroprevalence in endemic areas?

- cluster of cases associated with?

- in 1993, there was a 10 fold more cases. why?

Back 22

- < 1%
(rare human infection)

- Deer mouse density

- El nino effect

Front 23

HEMORRHAGIC FEVER w/ RENAL SYNDROME

- causative agent? x2

- incubation period

- onset how?

- onset with what symptom

Back 23

- Hantaan virus
- Dobrava virus

- 2 to 3 weeks

- Sudden onset

- Febrile illness

Front 24

HEMORRHAGIC FEVER w/ RENAL SYNDROME

- causative agents? x2

- onset how & with what symptom?

- additional symptoms? x4

- what pathophysiology causes these additional symptoms?

Back 24

- Hantaan virus
- Dobrava virus

- Sudden onset with febrile illness

LIFE
- Lower Back Pain
- Increased Vascular Permeability
- Flushing
- Edema


- Increased Vascular Permeability

Front 25

HEMORRHAGIC FEVER w/ RENAL SYNDROME

- after the edema, low back pain, and flushing due to increased vascular permeability, what phase follows?

- duration of this next phase?

- symptoms x5

Back 25

- HYPOtensive phase

- hours to days

O! PTSD (like soldiers get)
- Oliguria

- Petechial hemorrhage
- Thrombocytopenia
- Shock
- DIC of low grade

Front 26

HEMORRHAGIC FEVER w/ RENAL SYNDROME

- Usually fatal due to what symptoms?

- what percent die from this?

- overall mortality rate?

- Survivors have what symptoms?
(what is the duration of this?)

Back 26

- RENAL Failure

- 50%

- 5 to 15%

- Diuresis
(lasting several months)

Front 27

HEMORRHAGIC FEVER w/ RENAL SYNDROME

- milder variation of this dz found where? x2

- mortality rate for each

- symptoms involved? x3

- what is different from the more severe dz?

Back 27

- Seoul (1 to 2% mortality)
- Puumula (<1% mortality)

- HYPOtension
- Petechia
- Mild Renal involvement

- NO shock
- NO hemorrhage

Front 28

HANTAVIRUS PULMONARY SYNDROME

- causative agent
- incubation period

- onset how & symptoms
- signifies what phase?
- phase duration

- patient presents with what symptoms usually? x3

Back 28

- Sin Nombre virus
- 2 to 3 weeks

- Sudden onset of Flu-like symptoms
- Febrile phase
- 4 days

PHD
- Pulmonary Edema
- Hypoxia
- Dyspnea

Front 29

Filoviridae epidemiology:

- reservoir host
- transmission x2

- list 3 important viruses

Back 29

- Unidentified (likely zoonotic tho)

- Unknown how it is transmitted form natural reservoir to humans
(likely zoonotic tho yo)

- Direct, close person to person contact transmission
(carers, burial practices, co-workers)

- Ebola virus
- Marburg virus
- Filovirus

Front 30

EBOLA HEMORRHAGIC FEVER

- in 1989, Ebola was isolated where in US?

- isolated from whom and of where?

- virus strain that was isolated?

- severity of this strain in humans?

Back 30

- Reston, VA

- Macaques from Philipines

- Ebola-Reston strain

- NON-pathogenic strain for humans

Front 31

EBOLA HEMORRHAGIC FEVER

- Ebola-Reston causes what effects in Macaque monkeys?

- transmitted to humans how?

- danger to humans?

Back 31

- elicits Ab & causes High Mortality in monkeys

- Aerosol transmission

- Hell no!

Front 32

EBOLA HEMORRHAGIC FEVER

- since 1994, Ebola virus is active in Broad areas in and around where?

- as examples, outbreaks of the above involved what viral strain?

- the above strain occurred where? x3

- in addition, what else happened that was shit crazy?

- where did the shit crazy shit happen?

Back 32

- African Rainforest

- Ebola-Zaire strain

Donkey KonG
- DRC
- Kikwit
- Gabon

- NEW Ebola species became active

- on Ivory Coast

Front 33

How do you wane epidemics with an Ebola or Marburg virus. x3

Back 33

Quarantine infected patients

VHF isolation precaution

Barrier nursing

Front 34

Is there a relative of the Ebola virus that can transmit via aerosol droplets?

If so, name and disease associated.

Back 34

Ebola-Reston

Non-pathogenic

Front 35

Ebola virus:

- disease associated?
- severity?
- mortality?

- Confirmed EHF in humans where? x5

- what caused the above cases? x3

Back 35

- Ebola Hemorrhagic fever

- Severe & fatal to humans & primates

- 25% - 80% mortality

US DIG for Ebola
- Uganda
- Sudan
- DRC
- Ivory coast
- Gabon


SIZ-E
--> Ebola - Sudan
--> Ebola - Ivory Coast
--> Ebola - Zaire

Front 36

What virus provides the most severe form of hemorrhagic fever known?

Back 36

Filovirus

Front 37

FILOVIRUS PATHOGENESIS

- incubation period

- followed by what Sx? x4

- then, the shit hits the fan with subsequent signs and symptoms that include what involvement?

Back 37

4 to 10 days

- Fever
- chills
- malaise
- myalgia

MULTISYSTEM INVOLVEMENT

Front 38

FILOVIRUS PATHOGENESIS

- List the Multisystems that are involved in manifestations. x6

Back 38

HoVeRiNGS

- Hemorrhagic manifestations
(BLEEDING OUT!!! @#$@#!!!)

- Vascular manifestations
(Conjunctival injection, Hypotension, Edema, DIC)

- Respiratory
(CP, SOB, Cough)

- Neurologic manifestations
(HA confusion, coma)

- GI manifestations
(Abd pain, Anorexia, Vomiting, Diarrhea)

- Systemic manifestations
(prostration)