RNA viruses- Hepeviridae, Flaviviridae, Togaviriae

Hepatitis E Virus genus and species name

Hepeviridae Orthohepevirus

Hepatitis E symptoms

fever, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, jaundice

HepE incubation length

2-9 weeks

Almost all have full recovery from HepE except _________ which is associated with a ___% mortality

pregnant people; 10-30

transmission of Hepatitis E

fecal contamination of food and water

treatment of Hepatitis E

supportive care only

no preventative measures

Hepatitis E in pregnant individuals

liver failure

fetal death in 2nd or 3rd trimester

20-25% of pregnancies in 3rd trimester result in maternal death

viral replication in placenta, umbilical cord, placental membrane

If patient presents with IgM-HEV that means they have a ______ infection

current

if a patient presents with IgG anti-HEV that means that they have a _______

current or past infection (in recovery)

HEV RNA indicates a patient has a _______

active infection

quantitative viral load assays

monitor therapies and check infection levels

Flaviviridae family includes

Genus Flavivirus

Genus Hepacivirus

Genus Flavivirus includes

yellow fever

japanese encephalitis virus

dengue virus

zika virus

powassan virus

Genus Hepacivirus includes

Hepatitis C

Yellow Fever Virus

3-6 day incubation

all asymptomatic or very mild illness

Mosquito vector

Symptoms of YFV

fever, chills, severe headache, back and joint pain, nausea and vomiting, fatigue

15% progress to jaundice, bleeding, shock, and organ failure

Japanese encephalitis virus

99% asymptomatic

5-15 day incubation

Mosquito vector

symptoms of JEV

fever, headache, vomiting, seizures, neurologic involvement in immunocompromised patients

30% mortality with encephalitis

50% mortality with symptoms have neurologic problems

West Nile Virus

80% asymptomatic

2-14 day incubation

mosquito vector

Symptoms of WNV

1 in 5 have fever, headaches, joint aches

1 in 150 have neurologic disease including encephalitis, meningitis, polio-like syndrome

>60 y.o. have high risk of severe disease

treatment for YFV

Vaccine given if traveling

no additional treatment- supportive care

treatment for JEV

vaccine given if traveling

no treatment- supportive care

treatment for WNV

no treatment- supportive care

Zika virus

first isolated from primates in 1947 in Uganda

first documented in humans in 1954 in Nigeria

14 documented cases between 1947-2007

Mosquito borne

Microencephaly

death of brain tissue when fetus is developing in utero

results in abnormally small head and brain

severity of zika influences other health problems such as

seizures

developmental delay of milestones

intellectual disability

problems with movement and balance

feeding problems

hearing loss

vision problems

diagnosis of zika virus in fetuses is by

ultrasound in pregnancy

treatment for zika

no cure

Dengue virus

4 strains

Symptoms of Dengue virus

mild primary infection

high fever

severe headache

joint, muscle, bone pain

rash

bleeding concerns

low white blood cell count

other strains of Dengue are worse if infected after

previously infected with a different strain of dengue with antibodies still circulating

Dengue Hemorrhagic Fever (DHF)

severe abdominal pain, petechial bleeding nose and gums, vomiting blood, pale/col/clammy skin, difficulty breathing

fever lasting 2-7 days followed by other symptoms

can lead to circulatory failure, shock, and death

zika virus transmission

congenital, sexual, blood transfusion

symptoms of zika virus

fever, rash, headache, joint pain, conjunctivitis, muscle pain, microencephaly development, Guillain-Barre syndrome for all

treatment for Dengue virus

no treatment

supportive care

if Dengue hemorrhagic fever develops seek medical attention immediately

vaccine available only for children 9-16 years old with evidence of prior infection

Symptoms of Hepatitis C

2-12 week incubation

fever, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, jaundice

HepC becomes a chronic infection in ____ of people

70-85

chronic infection symptoms of HepC

cancer, death resulting from liver cancer/liver dysfunction

asymptomatic

transmission of HepC

blood or body fluids

treatment for HepC

no vaccine

antivirals for chronic infection

avoid behaviors leading to infection with people who are infected

Powassan virus genus and family

Flaviviridae, Flavivirus

Powassan virus

tick borne via black legged dick

1-4 week incubation

symptoms of powassan virus

asymptomatic

fever, headache, vomiting, weakness

progression to encephalitis, altered mental status, seizures, aphasia, movement disorders, cranial nerve palsies

50% of those with encephalitis by powassan virus have a permanent sequela such as

headaches, focal paralysis, cognitive difficulties

____% mortality for those with encephalitis

10

treatment for powassan

supportive care only for neurological symptoms

pain and nausea management

monitoring of intracranial pressure

seizure management

Eastern Equine Encephalitis family and genus names

Togaviridae, Alphavirus

Eastern equine encephalitis is also

western and venezuelan equine encephalitis

Chikungunya family and genus names

Togaviridae, Alphavirus

Chikungunya virus transmission method

mosquito

Rubella (german measles) family and genus names

Togaviridae, Rubivirus

Rubella virus transmission

inhalation of aerosolized droplets

Symptoms of Eastern Equine Encephalitis

4-10 day incubation

chills, fever, malaise, arthralgia, myalgia

Lasts 1-2 weeks

people at high risk for EEE and Chikungunya

newborns, >65 y.o., predisposed- high bp, diabetes, heart disease

Chikungunya symptoms

3-7 day incubation

joint swelling/pain, rash, headache, muscle pain

will resolve in 1 week- people may have joint pain for months

Rubella symptoms in children

red rash, low grade fever, headache, mild pink eye, swollen/enlarged lymph nodes, cough/ runny nose

_______% of people with Rubella are asymptomatic

25-50

clinical forms of rubella

postnatal rubella

congenital rubella

EEE and Chikungunya are associated with

increase risk of Guillain-Barre Syndrome

Guillain-Barre Syndrome

autoimmune disease after viral infections/campylobacter infection or vaccine (rare)

includes muscle weakness, paralysis

most people fully recover, but can cause permanent nerve damage

Postnatal rubella is characterized by

malaise, fever, sore throat, lymphadenopathy, rash

lasts ~ 3 days

Congenital rubella is characterized by

infection during 1st trimester of pregnancy is most likely to result in miscarriage or multiple defects

defects associated with Congenital rubella

cardiac abnormalities, ocular lesions, deafness, mental and physical retardation

Pregnant Women are typically given a screen called _______ to tests for multiple viral and bacterial infections that could cause problems.

TORCHS

Treatment for Eastern equine encephalitis

antivirals, mosquito bite prevention, supportive care

Treatment/ Prevention for Chikungunya

supportive care, mosquito bite prevention, managing the immune response

Treatments/prevention for Rubella

supportive care, vaccination (MMR/MMRV) and Titers

Arbovirus

any virus that is transmitted by arthropod vector

examples of arthropo vectors

mosquitoes, ticks, flies, gnats, mites, llice