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88 Cards in this Set
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what are hte 4 familty of virus of the hemorrhagic fevers. what fever is in each family |
1. Flavivirus: dengue, yellow fever
2. Bunyavirdase: rifft valley, hantaan, CCHF 3. Areavirus: lassa fever 4. filocirdea: ebola, marburg **dieases range from mild to death |
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what fever is assoicated with the following groups
1. flavi 2. bunya 3. arena 4. filo |
1. flavi: denguae, yellow fever
2. bunya: RVF, hantaan, CCHF 3. LAssa 4. filo: ebola, marburg |
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as a group what can you tell me about viral hemorrhagic fever
envelope reservoir distribution transmission control |
1. enveloped RNA
2. most have animal or mosquito vector, humans are incidnetal hosts 3. disease only where animal reservoir is 4. contact with vector (mosquito ir rident) person to oerson cases are SPORADIC 5. no real cures/drugs. better to controlthe vector population |
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general sx of hemorrhagic fever
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1. fever! fatigue, dizzy, mm ache,
2. hemorrhagic manifestations- thrombocytopenia, shock, (bleed under skin, internal organ bleed, bleed from skin orrifice) 3. neurological disturbance |
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what types of sx will kill the pt w/hemorrhagic fever
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shock
renal failure nervous syst malfunction coma delirium seizure **goes from pretty non specific to things like this :/ |
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whats the general pathogenesis of VHF (viral hemorrhagic fever)
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1. infection as incidental host after exposure to vector
2. virus infects macro, dendrites adn cause cytokine release 3. cytokines stim inflammation and CLOTTING pahtway (often see a rash) 4. infected dendritic cells decrease expression of co stim molecules --> decreased immune system (decrease B7 co stim on APC) |
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the rash associated with VHF is associated with what
1. decreased perm of GI 2. lysis of macro 3. damage to endo 4. swelling of LN 5. type IV HS reaction |
damage to endo!!
**hemorrhagic complications are multifactorial! hepatic damage/consumptive coagulopathy, thrombocytopenia. can be multi organ failure. VARIES among the specific fever |
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ok so the viral hemorrhagic fevers are the flavi, bunya, arena, and filvo virsuses. the are all RNA. what is the only + sense
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flavi
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what are hte specific micro thigns of flavi virus
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denge, yellow fever (west nile, st lous encephalitis, hep C)
all were RNA, this isthe only + sence envelope (ALL VHF have envelope) AB facillitate viral uptake cytoplasmic recation |
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where is dengue fever
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flavivirus, not in us
more in mexico, africa,and S america adn india **Aedes aegypti is the vector |
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aedes agypti
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dengue fever
**there are 4 serotypes of dengue and NONE offer cross immunity (AB help viral uptake) infects kids more than adults |
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are kids or adults more infected with dnege fever
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kids, they have less immune response
**NO cross immunity btwn the 4 serotypes |
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denge hemorrhagic fever mortalitiy
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3% die treated
50% die if untreated **virtually NO deaths for just denge fever, w/no hemorrhage |
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what is the urban host, jungle host and vector for dengue fever
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Urban: human
Jungle: primates (monkey) Vector: aedes aegypti mosquito |
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whats a unique sx of denge fever
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its the normal fever, HA, maliase, fatigue
but there is a rash that fades then you get another secondary rash that is maculopapular on the limbs and face that desqumates*** resolves in 2 weeks |
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how does denge fever resolve
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immune clearance
**recall there are 4 types that offer NO immunity **recall in DHF non neutralizing AB promote viral uptake into macro. |
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what causes the initial rash adn then the secondary maculopapular rash in DHF
1. anaphylaxis 2. AB mediated 3. AB:AG mediated 4. memory |
AB:AG mediated
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pathogensis of denge
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virus taken up by macro, and endothelial cells. virus replicates and starts off the inflammatory process
secondary viremia spreads virus throughout the body |
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whats the deal with IgM AB in denge
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IgM detected in like a week and IgG later. these help prevent spread of virus (secondary viremia) BUT can make AB:AG HS III reactions
**NO cross immunity among 4 denge strains |
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what are the strains of yellow fever and how is it transmitted
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dakar and 17D (D is in the vaccien)
**vector is mosquito *flavi virus |
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who gets yellow fever
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all ages-kids have mild infection (recall denge was Kids>adult)
M>F common in s america and central aftica |
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yellow fever
jungle host (sylvatic) Urban host Vector |
Jungle: monkey
UrbanL human transmission: aedes, haemagogus **teh same as Denge except yellows transmission vectors are the aedes and haemagogous |
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what is the clinical of yellow fever
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BIPHASIC
acute: fever, HA, mm pain, back ache, LOA, red tongue, flushed, red eyes. sx go away! TOXIC Phase: 15% of pts progress to this. fever returns pt gets jaundice and has a GI hemorrhage (BLACK VOMIT) can then disseminate to kidney, heart, vasculature, widespread hemorrhage |
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what is the VHF that is biphasic and in the toxic phase has BLACK vomit
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yellow fever
**its acute phase is pretty general (HA, fever, backache, then you get red tongue, red eyes) in 15% of pts it then progresses to TOXIC adn they get jaundice, fever, and GI hemorrhage disseminates to kideny, heart/vasculature, and causes widespread hemorrhage. 50% mortality- die from lactic acidosis and hyperkalemia |
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whats the pathogenesis of yellow fever
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simliar to denge fever BUT it attacks kupffer cells adn hepatocytes more
COUNCILMAN BODIES** |
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T or F
a pathologist ID councilman bodies in the liver and notes extensive damage to hepatocytes and kupfur cells. is this dx of yellow fever |
nope, its def seen in YF but also in others
**YF is like denge but there is more damage to kupfer and hepatocytes |
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we know with YF you can get GI hemorrhage and then widespread hemorrhage. but what is the mech of death (50% mortality)
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lactic acidosis
hyperkalemia |
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tell me about the immunity and prevention of yellow fever
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AB are specific to YF (simliar to denge)
LIVE ATTENUATED VACCINE!!!! good for 10 years :) |
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tell me the micro of bunya virus
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RVF, Hantaan, CCHF
Envelope (-) sense has G1, G2 glycoprotein in envelope **like denge, replicate in cytoplasm and then bud off |
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tell me about rift valey fever virus
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its in the phlebovirus group of bunya virus
passes to humans by several kinds of mosquito E and S africa, resevoire is livestock |
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what HFV is in a livestock resevoir and transmitted to humans by several mostuito species. its common in E nad S africa
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Rift valley fever
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whats the mortality rate of RVF (rift valleyfever)
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1% but 10% if you get the hemorrhagic part
if infected livestock are preggo they will abort |
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is RVF transmitted exclusively by the mosquitoes: Aedes, Cluex, adn Erethmapodites
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nope, also through contact with secretions of infected livestock
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whats the clinical for RVF
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often asx (1% mortality, 10% if hemorrhagic)
mild: fever, liver problems, flu like sx. can then progress to the hemorrhagic fever and progress to shock, ocular disease and hepatic necrosis in livestock its a MAJOR problem |
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tell me about the 1 and 2 viremia associated with RVF
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1: flu like sx, replication in reticuloendothelial system
2. virus infects SPECIFIC things like the CNS, endothelium and other viscera BLINDNES |
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what is the unique sx reported in some pts w/rift valley HEMORRHAGIC fever
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blindness
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what is the immunity/protection for rift valley fever
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if you have it and recover you have LASTING IMMUNITY
**there is a vaccine for livestock bc its such a problem *human vaccine not yet approved |
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what is the ROBO virus
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hantaan virus,
it means rodent born (in the buyna virus family) infected when you contact infected secretions or tissue inthe striped field mouse |
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where is hantaan varus common
what is the transmiaation |
asia, europe
resevoir is rodent- striped field mouse. human are infected when contact w/infected tissue or secreation |
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which virus causes a hemorrhagic fever with renal syndrome
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hantaan (the one passes throgh the striped field mouse)
**clinical: fever, HA, comit, petechial hemorrhage, shoch. RENAL failure, thrombocytopenia |
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which compliment protein is key for regulating leukocyte recruitment
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c5a
*potent chemoattractant, mast cell degranulation |
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ok so RVF can cause blinness in some pts, what virus is associated with retinal damage
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hantaan virus is retinal. can lead to vision loss
*retinal inflammation is hantan |
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tell me about the pathogenesis of Hantaan virus
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like RFV
Hantaan- transmission through rodent excrement (RFV is tick-hyalomma marginatum tik) primary viremia- infecting cells, Secondary viremia- HF sx (renal syndrome also) |
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tell me about CCHF (crimean congo hemorrhagic fever)
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part of the nairovirus in the bunya family
*passed through mosquito *occurs in SE europe, asia, africa M>F bioterrorism threat |
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waht is the virus that is passed by mosquitoes infected M>F nad is seen in SE europe, asia and africa. it is a bioterrorism threat
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CCHF
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what does the hyalomma marginatum tick spread
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CCHF
**humans infected through tick bite or associated with infected animals |
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what are the clinical features of CCHF
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ABRUPT onset of fever, HA, back/abd pain
bleed --> pulm edema, shock *hrmorrhagic state: nose bleed, pee bleed, and melena **often see hepatitis sx, liver/kidney failure |
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what is the pathogenesis of CCHF
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simliar to denge
((replication at the tick bite site, later viremia spreads to distant organs |
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tell me about the micro of arena virus
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envelope, - sense
segmented genoma has G1/G2 envelope protein (like bunyavirus) replicate in cyto and then bud from PM |
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what virus is in the arena virus family
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LCMV-
LASSA multimammate rat **both are rodent born |
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where is lassa virus seen
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W africa
from the multimammate rat |
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how is lassa transmitted
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multimammate rat, ingested food/water contamated with animal urine or direct contact w/the rat or PERSON TO PERSON
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what can be transmitted person to person
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lassa
also the multimammate rat urine/contact |
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what is teh hemorrhagic fever that has an insidious onset? whats hte clinical
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lassa- get a fever, HA, FRY COUGH, pharyngitis, dirrhea
**sometimes facial edema and a maculopapular rash *photophobia, deafness, necrosis |
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photophobia, facial edema, maculopapular rash and insidous onset describes what fever
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lassa
also deafness |
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what are some of the end stage sx of lassa virus
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its initially an insidious onset (fever, HA, dry cough, facial edema, rash, photophobia)
progress to multiorgan necrosis, GI hemorrhage, vascular collapse, shock hypotension etc **some get deafness |
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how is the lassa virus acquired
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inoculation, inhalation, ingestion (from the multimammate rat)
**virus infects macro and release inflammatory mediaors --> cell/vascular damage, also a T cell response |
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what cells are infected when you inhale multimammate rat poo
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macrophages --> inflamm release
T cell damage (vascular damage) |
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tell me about the micro of arena virus
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envelope, - sense
segmented genoma has G1/G2 envelope protein (like bunyavirus) replicate in cyto and then bud from PM |
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what virus is in the arena virus family
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LCMV-
LASSA multimammate rat **both are rodent born |
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where is lassa virus seen
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W africa
from the multimammate rat |
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how is lassa transmitted
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multimammate rat, ingested food/water contamated with animal urine or direct contact w/the rat or PERSON TO PERSON
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what can be transmitted person to person
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lassa
also the multimammate rat urine/contact |
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what is teh hemorrhagic fever that has an insidious onset? whats hte clinical
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lassa- get a fever, HA, FRY COUGH, pharyngitis, dirrhea
**sometimes facial edema and a maculopapular rash *photophobia, deafness, necrosis |
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photophobia, facial edema, maculopapular rash and insidous onset describes what fever
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lassa
also deafness |
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what are some of the end stage sx of lassa virus
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its initially an insidious onset (fever, HA, dry cough, facial edema, rash, photophobia)
progress to multiorgan necrosis, GI hemorrhage, vascular collapse, shock hypotension etc **some get deafness |
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how is the lassa virus acquired
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inoculation, inhalation, ingestion (from the multimammate rat)
**virus infects macro and release inflammatory mediaors --> cell/vascular damage, also a T cell response |
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what cells are infected when you inhale multimammate rat poo
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macrophages --> inflamm release
T cell damage (vascular damage) |
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what virus are in the filoviridae family
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ebola
maarburg SEVERE fatal, esp ebola sx are similar to both |
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whats the mortality of the filoviridae
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BAD!!! its ebola (super deadly) and manburg
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whats the micro of the flivo virus (ebola and manburg)
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filamentous, pleomorphic, gram - ssRNA
enveloped, glycoprotein for attachment, internalized from endocytosis. replication in the cytoplasm and virions bud from PM |
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where is manburg virus common
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africa NO cases in US
**passed by fruit bats |
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what is associated with fruit bats
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manburg virus- deadly
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where is ebola virus common
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africa
5 subtypes, also passes by fruit bats like manburg |
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ok so the sx of ebola nad manburg are the same, what are they
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severe to fatal hemorrhagic fever
**initial- fever, HA, mylagia, sore throat, diarrhea Then you get rash, lymphadenopathy and photophobia |
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the hemorrhage associated with ebola and manburg are associated with what
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SEVERE thrombocytopenia
**these ones are severe/fatal hemorrhages ((shock, dic, **in these viruses there is rapid replication and extensive tissue necrosis, VIREMIA persists |
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what is the pathogensis of ebola and manburg
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virus enters blood and replcates FAST causes extensive tissue necrosis
viremia persistis **macros release mediators that mimic septic shock, causes widespread hemorrhage and DIC DEATH IS FAST!! |
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how is the dx of VHF made
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epidemiology
vector serology PCR/Viral isolation leukopenia, thrombocytopenia, increased HCT increased liver enzymes, hypoalbuminemia, proteinuria, elevated BUN, elestrolyte imbalance |
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whats the tx of VHF
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supportive
ribavirin- decrease mortality for lassa, lantaan, and RVF Prevention: control the vector, isolate infected, Vaccine: only for yellow, denge- development RVF- animals only |
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what VHF have vaccines available
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1. yellow
2. denge- being developed 3. RVF- only for animals (livestock) |
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whats ribavirin used for
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decrease morbidity associated with
lassa hantaan RVF |
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what 2 virus are in primates (monkey) and passed to us by mosquitoes, how can they be told apart
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denge- seen world wide get hemorrhagic if infected with 2nd strain,
yellow- seen in africa, central/south america. see jaundice, black vomit, councilman bodies. HIGH mortality |
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what virus causes blindness has low mortalite and is associated with livestock
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RVF- E/S africa
mosquitoes are vector |
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what virus causes inflammatino of the retina and is passed to us by the striped field mice
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hantaan
seen in asia and europe |
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what virus is passed through ticks and can be a bioterrorism threat
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CCHF
passed through tick and also contact with animals/inhalation of animal poo |
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what virus is passed through rodent urine nad causes hearing loss in some
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lassa
multimmate rat transmission |
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multimammate rat
striped field mouse |
lassa
hantaan |
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what is associated with fruit bats and extensive tissue necrosis
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marburg
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