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38 Cards in this Set

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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?
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
Old World Hantavirus

- reservoir host
- vector
Mice

Rodent-borne virus
Do all rodents carry the same Old World Hantavirus?
No, each carry specific ones.
What was so surprising about the Old World Hantavirus?
Despite being rodent-borne, it shared characteristics with other bunyaviridae which are all arboviruses.
NEW WORLD HANTAVIRUS

The newly discovered New World Hantavirus is called what?

- is this an arbovirus?
Sin Nombre

False, not arbovirus
Sin Nombre virus:

- Reservoir host
- vector

- Dz caused?
Common deer mouse

Common deer mouse

Hantavirus Pulmonary Syndrome
HANTAVIRUS PULMONARY SYNDROME

- caused by?
- first ID'd where?
- occurs throughout?
- clusters noted where?
- how many types of viruses involved?
- Sin Nombre
- SW US (1993)
- throughout Americas
- Four corners (CO AZ NM UT)

- caused by 10+ different hantaviruses
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?
- 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)
NEW WORLD HANTAVIRUS

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

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



True
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.
- 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.
NEW WORLD HANTAVIRUS

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

- 10 fold more than usual in 1993. Why?
- increase in deer mouse density for HPS.

- El nino effect
HEMORRHAGIC FEVER with RENAL SYNDROME

- the FEVER syndrome you get with HANTAAN or DOBRAVA virus has what possible 3 phases in its HFRS disease?
FHD = Fever of Hantaan or Dobrava

FHD =
(1) Febrile illness phase - LIFE
(2) Hypotension phase - STOP Dick
(3) Diuresis phase - survivors
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?
"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%)
Survivors of HFRS have what additional phase?

for how long?
phase of Diuresis

Several months
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)
- 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
Hentavirus Pulmonary Syndrome:

- causative agent?

- incubation period

- character of onset?

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

2-3 wks (same as old school)

Sudden onset

Febrile phase

Flu like symptoms



~4 days
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?
- After Febrile Phase (~4 days)

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

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

Bilateral
Pulmonary Infiltrates
HPS:

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

- Microvascular ENDOthelial cell damage

- Increase permeability of lungs

- Lungs are fucked up

- Fluid leakage into lungs
HPS:

- Discuss the rapid deterioration symptoms. x4
SHiT!!!! HPS is a Dick!!!

Shock
Hypotension
(intense shit)
Thrombocytopenia

DIC
HPS mortality if admitted to hospital?

Prognosis Recovery for those who didn't die?
50% die in 1-3 days of admission

Remarkably rapid recovery
- lung lesions & shock resolves in 3-6 days.
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?
- Most HPS in North America

- Deer Mice
(Western & Central US & Canada)

- SW US
(but has occured in 30 states)

- 300 cases since 1993
SIN NOMBRE HANTAVIRUS
EPIDEMIOLOGY

- seroprevalence in endemic areas?

- cluster of cases associated with?

- in 1993, there was a 10 fold more cases. why?
- < 1%
(rare human infection)

- Deer mouse density

- El nino effect
HEMORRHAGIC FEVER w/ RENAL SYNDROME

- causative agent? x2

- incubation period

- onset how?

- onset with what symptom
- Hantaan virus
- Dobrava virus

- 2 to 3 weeks

- Sudden onset

- Febrile illness
HEMORRHAGIC FEVER w/ RENAL SYNDROME

- causative agents? x2

- onset how & with what symptom?

- additional symptoms? x4

- what pathophysiology causes these additional symptoms?
- Hantaan virus
- Dobrava virus

- Sudden onset with febrile illness

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


- Increased Vascular Permeability
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
- HYPOtensive phase

- hours to days

O! PTSD (like soldiers get)
- Oliguria

- Petechial hemorrhage
- Thrombocytopenia
- Shock
- DIC of low grade
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?)
- RENAL Failure

- 50%

- 5 to 15%

- Diuresis
(lasting several months)
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?
- Seoul (1 to 2% mortality)
- Puumula (<1% mortality)

- HYPOtension
- Petechia
- Mild Renal involvement

- NO shock
- NO hemorrhage
HANTAVIRUS PULMONARY SYNDROME

- causative agent
- incubation period

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

- patient presents with what symptoms usually? x3
- Sin Nombre virus
- 2 to 3 weeks

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

PHD
- Pulmonary Edema
- Hypoxia
- Dyspnea
Filoviridae epidemiology:

- reservoir host
- transmission x2

- list 3 important viruses
- 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
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?
- Reston, VA

- Macaques from Philipines

- Ebola-Reston strain

- NON-pathogenic strain for humans
EBOLA HEMORRHAGIC FEVER

- Ebola-Reston causes what effects in Macaque monkeys?

- transmitted to humans how?

- danger to humans?
- elicits Ab & causes High Mortality in monkeys

- Aerosol transmission

- Hell no!
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?
- African Rainforest

- Ebola-Zaire strain

Donkey KonG
- DRC
- Kikwit
- Gabon

- NEW Ebola species became active

- on Ivory Coast
How do you wane epidemics with an Ebola or Marburg virus. x3
Quarantine infected patients

VHF isolation precaution

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

If so, name and disease associated.
Ebola-Reston

Non-pathogenic
Ebola virus:

- disease associated?
- severity?
- mortality?

- Confirmed EHF in humans where? x5

- what caused the above cases? x3
- 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
What virus provides the most severe form of hemorrhagic fever known?
Filovirus
FILOVIRUS PATHOGENESIS

- incubation period

- followed by what Sx? x4

- then, the shit hits the fan with subsequent signs and symptoms that include what involvement?
4 to 10 days

- Fever
- chills
- malaise
- myalgia

MULTISYSTEM INVOLVEMENT
FILOVIRUS PATHOGENESIS

- List the Multisystems that are involved in manifestations. x6
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)