Arbo Virus by Dr. Rakesh Prasad Sah

Dr. Rakesh Prasad Sah
Dr. Rakesh Prasad SahAssociate Professor in Microbiology em Saraswati Medical College, Unnao, Lucknow
By Dr. Rakesh Prasad Sah
Assistant Professor
Microbiology
ARBOVIRUSES
ARTHROPOD BORNE VIRUS
ARBOVIRUSES
2
 Arthropod borne viruses – virus of vertebrates.
 Transmitted by insects vectors.
 Cause infections in animals & birds.
 Transmitted to man by bite of infected mosquitoes, ticks & sand flies.
 Worldwide, more in tropical areas than temperate.
Transmission Cycles
 Man – Arthropod – Man
 Animal – Arthropod - Man
Man-Arthropod-Man Cycle
 Reservoir may be in either man or arthropod vector.
 E.g. dengue, urban yellow fever.
 In the latter transovarial transmission may take place.
3
Animal-Arthropod-Man Cycle
 The reservoir is in an animal.
 The virus is maintained in nature in a transmission cycle involving the
arthropod vector and animal. Man becomes infected incidentally.
 e.g. Japanese encephalitis, EEE, WEE, yellow fever.
Both cycles may be seen with some arboviruses such as yellow fever.
4
Urban CycleSylvatic Cycle
Animal Reservoirs
In many cases, the actual reservoir is not known. The following animals
are implicated as reservoirs.
Birds -
Pigs -
Monkeys -
Rodents -
Japanese encephalitis, St Louis encephalitis, EEE, WEE
Japanese encephalitis
Yellow Fever
VEE, Russian Spring-Summer encephalitis
5
 About 500 viruses in this group.
 About 100 causes infection in man.
 About 10 in India.
 Sub groups: Alpha virus ( Toga viruses)
Flavi virus
Bunya virus
Rhabdo virus
Reo virus6
Examples of
Arthropod Vectors
Aedes Aegypti Ticks
Culex Mosquito Phlebotmine Sandfly
Morphology
 Size : 60-150nm
 Symmetry: Spherical .cubical, helical
 Genome: ss RNA (Reoviridae -ds RNA)
 Distribution: Worldwide. Many diseases given names according to location.
Eg: Venzulean Equine Encephalitis, Japanese B encephalitis. St. Louis enc.
Virus, Russian spring summer Enc., California enc. etc
7
General Properties:
 Causes fatal encephalitis in suckling mice after intracerebral inoculation.
 Possess haemagglutinin and agglutinate erythrocytes of goose or day old chicks.
 Mosquito borne arboviruses multiply in aedes and culex, while tick borne multiply in
Ixodid ticks.
 They can be grown in cell like chick embryo fibroblasts or continuous cell lines like vero
or HeLa, & in cultures of appropriate insect tissues.
 May also be isolated in the yolk sack or CAM of chick embryo.
 They are readily inactivated at room temperature and by bile salts, ether and other lipid
solvents.8
Antigenic Structure:
9
 Three antigens are important in serological studies namely:
a. Haemagglutinins
b. Complement fixing antigen
c. Neutralizing antigen
 Cross reactions occur among arboviruses.
Pathogenesis
 Virus enters the body through bite of the vector.
 Virus multiplies in reticuloendothelial system and leads to viraemia.
 Virus transported to target organs such as CNS – encephalitis;
Capillary endothelium – haemorrhagic fevers & Liver – Yellowfever.
Diseases Caused
 Febrile illness - This is usually a non-specific illness resembling a number of
other viral illnesses such as influenza, rubella, and enterovirus infections. The
patients may go on to develop encephalitis or haemorrhagic fever.
E.g. Chikungunya, Dengue.
 Encephalitis – Inflammation of brain.
E.g. EEE, WEE, St Louis encephalitis, Japanese encephalitis.
 Hemorrhagic fever – Bleeding disorder with high fever.
E.g. yellow fever, dengue hemorrhagic fever.10
Family & Genus Encephalitis
Arbovirus infections
Febrile illness Haemorrhagic fever
I. Togaviridae
Alphavirus
(Mosquito – borne)
•WEE
•EEE
•VEE
•Chikungunya
•O’nyong-nyong
•Semliki Forest
•Sindbis
•Ross river virus
•Chikungunya
II. Flaviviridae
Flavivirus
a. Mosquito- borne
b. Tick-borne
•St. Louis Encep.
•Ilheus
•West Nile
•Murray Valley Enc.
•Japanese B Enc.
•Russian spring summer
enceph.
•Powassan
•Dengue, types 1-4 •Dengue
•Yellow fever
•Kyasanur forest
disease
•Omsk Haemorrhagic
fever
11
Family & Genus Encephalitis Febrile illness Haemorrhagic fever
III. Bunyaviridae
a) Bunya virus
(Mosquito-borne)
b) Phlebovirus
(Phlembotomus or
mosquito-borne)
c) Nairovirus (tick-
borne)
•California encephalitis
•La Crossie
•Chittor virus
•Sandfly fever
•Rift-valley fever
•Nairobi sheep
disease
•Ganjam virus
----
IV. Reoviridae
Orbivirus
(Tick-borne)
-------- •Colorado tick borne
virus ----
V.Rhabdoviridae
Vesiculovirus
(Mosquito-borne,
sandfly-borne)
--------
•Vesicular stomatitis
virus
•Chandipura virus
----
12
TOGAVIRIDAE
 Toga = Mantle
(cloak, a Roman dress)
 Spherical, enveloped, 60-70 nm in diameter with
icosahedral capsid surrounded by lipoprotein envelop and
contains single stranded RNA.
 Contains 2 genera: Alphavirus & Rubivirus
 Alphavirus- 32 members, 13 cause human infection.
 Rubivirus contains Rubella virus, is not arthropod borne.13
Encephalitis viruses:
 EEE (Eastern Canada, USA & the Caribbean)
 WEE (America)
 VEE (Central & SouthAmerica)
 Causes encephalitis in horses & humans.
 Influenza like illness with encephalitis in less cases.
 Culex & Anopheles mosquitoes (vectors).
 Formalin inactivated mouse brain vaccines (for EEE & WEE), Live
attenuated vaccines (VEE).
14
Viruses causing Febrile illness:
1. Chikungunya virus:
15
 First isolated from human patients and Aedes aegypti
mosquitoes in Tanzania in 1952.
 Transmitted by Aedes aegypti.
 Appeared in India in 1963.
FEATURES:
•Fever, crippling joint pains, conjunctivitis, lymphadenopathy & rash.
•Patients lies doubled up (severe joint pains) hence the name.
•Hemorrhagic manifestations may occur.
•Biphasic fever with period of remission after 1-6 days.
•No animal reservoir & No vaccines available so far.
2. O’nyong-nyong virus:
 Isolated in Uganda. Confined toAfrica.
 Closely related to Chikungunya virus antigenitically.
 Transmitted by Anopheles species.
3. Semliki Forest virus:
 First isolated in 1942 in Uganda from Aedes mosquitoes.
4. Sindbis Virus:
 Isolated from Culex mosquitoes in Sindbis district of Egypt in 1952.
 Recovered from Africa, India, Australia &Phillippines.
16
FLAVIVIRIDAE:
17
 Flavus = Yellow (refers to yellow fever)
 Originally named as group B arboviruses.
 Contains over 70 viruses, 13 causes human infection.
 Mosquito and Tick borne.
 Non-arthropod-borne viruses of this family belong to 2 genera: Pestivirus
(veterinary pathogens) and Hepatitis C virus.
Morphology:
 Spherical 40 – 50 nm in diameter.
 Single stranded RNA.
 Inner viral core is surrounded by a lipid envelope which is covered with
glycoprotein and matrix or membrane protein.
Japanese
encephalitis:
 Korea, Japan, S/E Asia, India.
 Recognized in Japan since 1871.
 Virus first isolated in Japan in 1935.
 Named JE- B to differentiate it from JE-A (von Economosdisease).
 JE is a serious disease. Signs of encephalitis seen after 1 - 6 days.
 S/S of encephalitis- Neck rigidity, convulsion, coma. CSF pressure increased,
lymphocytes- increased, sugar-Normal, proteins-increased, Chlorides-Normal.
18Mortality- up to 50%. Residual neurological damage.
 Japanese Encephalitis appeared in India in 1955.
 Pigs act as amplifier hosts.
 Hosts: Herons & ergrets ( birds), ducks, pigeons, sparrows, cattle.
 Transmitted by- Culex mosquito.
 Preventive measures:
 Relocate piggeries away from dwellings.
 Mosquito control.
 There is no satisfactory vaccine.
 Treatment: No specific treatment.
19
FLAVIVIRIDAE
 Flavus = Yellow (refers to yellow fever)
 Originally named as group B arboviruses.
 Contains over 70 viruses, 13 causes human infection.
 Mosquito and Tick borne.
 Non-arthropod-borne viruses of this family belong to 2 genera: Pestivirus
(veterinary pathogens) and Hepatitis C virus.
•Morphology:
 Spherical 40 – 50 nm in diameter.
 Single stranded RNA with a capsid protein, enveloped virus
 Envelop lipid bilayer glycoprotein and a matrix protein.
Yellow Fever
 Confined to Africa, and SouthAmerica.
 Still not reported in India
 Immunization necessary for Air travel to these countries.
 Yellow fever does not indicate Jaundice, but the Yellow quarantine flag used
by the ships during 17th century to warn the presence of infection onboard.
 MOT  bite of infeceted Ades mosquito
 I.P.  3-6 days
20
Pathogenesis
By bite of Ades mosquito
During blood meal,  deposits the saliva contaning
virus into a bite wound.
Virus replicates locally and regional lymph nodes
Virus spreads from blood  B.M., liver, myocardium,
spleen  further replication of virus occurs
Pathogenesis
Condition  hemorrhagic manifestations occurrs  due to DIC
DIC  due to Bleeding from the GIT mucosa, abdominal &
pleural serous layers.
reduction in the synthesis of coagulation factor & altered
platelet function.
The condition progresses to shock and finally death due to
multiple organ failure involving Liver, Kidney, Brain and Heart.
Clinical Features
• Characterized by Jaundice and
Fever.
• Acute onset of fever followed by
jaundice within 2 weeks of onset
of symptoms.
• Fever
• Chills
• Malaise
• Prostration
• Headache
• Giddiness
• Myalgia
• Anorexia
• Nausea
• Vomiting
• Bleeding  nose, gums,
GIT or skin within few
weeks of illness
• Hemorrhagic diathesis
DIC most impt
complications of ds
• Multiple organ failure
death of patient
Lab Diagnosis
• Isolation of yellow fever virus from the clinical specimens
• Demonstration of IgM-specific antibodies in the serum or
demonstration of fourfold or more rise in serum IgG
• Ag in tissues by immunohistochemistry
• Detection of viral genomes by PCR and
• Elevated transaminase and bilirubin levels, which are demonstrated
during the toxic stage of illness.
Vaccines
• The 17 D strain of yellow fever virus is a widely used attenuated
live virus vaccine.
• 17 D strain vaccine was recovered during serial passage of a
pantropic strain of yellow fever virus through tissue culture.
• A single dose of vaccine is highly effective which produces 99% of
vaccinated people by 30 days
• Provides immunity mainly for 30-35 yrs and probably for whole life
after single dose.
Distinctive features
 Recognised in 17th century
 Originated in Africa » » » Europe,America
 Transmitted by Aedes aegypti mosquitoes
 Incubation period is 3-6 days.
 Fever, headache, vomiting, chills,
jaundice, albuminuria, hemorrhages.
 Liver/kidney failure
 Liver- fatty degeneration and necrosis.
Councilman bodies. Eosinophilic inclusion bodies
in nucleus.
Fatty degeneration of Liver
. Eosinophilic inclusion bodies
Counsilman bodies
Dengue
 Name derived from the Swahili, Ki denga pepo,
meaning a sudden seizure by a demon.
 Widely distributed.
 Affects 2.5 billion people in 200 countries.
 4 serotypes: DEN1, DEN2, DEN3 & DEN4.
 Transmitted by Aedes aegypti mosquitoes.
 Antigenitically related to yellow fever, but no significant cross immunity.
 Break bone fever coined by Rauss in 1780
22
Morphology
• Small, spherical and enveloped virus.
• Is a flavivirus having cubic symmetry
• 40-50nm in diameter
• Single stranded RNA virus of 11 kb size
• An icosahedral nucleocapsid and is covered by a lipid enevelop.
• Inactivated by diethyl ether and bile salts eg. Sod deoxycholate
Pathogenesis and immunity
• By the bite of infected Ades mosquito
• Leakage of plasma  sed capillary permeability  Dengue hemorrhagic
fever  Dengue shock syndrome
• Bleeding in DHF capillary fragility & thrombocytopenia  petechial skin
hemorrhages life threatening GIT bleeding
Clinical Syndromes
• Classic Dengue Fever
• Dengue hemorrhagic fever
• Dengue shock syndrome
Classic Dengue Fever
• I.P.  2 to 7 days
• Fever, malaise, cough and headache
• High fever on 3rd day and lasts for 5-7 days
• Mculopapular rash  3rd or 4th day last for 1 to 5 days
• Severe pain in Muscles, deep bone pain and joint pain (Break bone fever)
• Enlarged lymphnode, Retrobulbar pain
• Leukopenia
• Rarely fatal
• May last for 2 weeks.
Dengue hemorrhagic fever
• Severe manifestation
• Calssic phase of dengue fever  worsens with shock &
hemorrhage (skin & GIT)
• Hemorrhagic manifestation  bleeding from nose, gums,
malena, hematemesis
• Fatality rate 10%
Dengue shock syndrome
• Most severe form of ds
• Commonly seen in untreated cases of dengue hemorrhagic fever
• Abdominal pain, vomiting and restlessness
• Die of circulatory failure & shock
• Mortality rate  Treated 5%,
if left untreated 50%
Clinical Features:
 Affects usually older children and adults.
 Incubation period is 3 -14 days.
 Sudden onset, fever, headache, muscle pain
retrobulbar pain, pain in back and limb (break bone
fever) on 3rd or 4th day.
 Lymphnode enlargement, and maculo -papulary
rash.
 Febrile illness lasts for about 10 days, after which
recovery is generally complete.
 Rarely fatal.
23
Complications
 Due to multiple dengue virus.
 Hemorrhages in skin, mucosa, internal organs
(Dengue Hemorrhagic Fever)
 Pulmonary edema.
 Low BP.
 Liver cirrhosis.
 Shock – Dengue Shock Syndrome.
 Mortality - 5 to 10%
24
25
 Elimination of mosquitoes and mosquito breeding places.
 No specific treatment.
 No effective vaccines available.
 Live attenuated vaccine containing all 4 dengue serotypes is under clinicaltrials.
Prophylaxis
:
Kyasanur Forest disease
26
 Disease first recognized in Kyasanur forest in Karnataka in 1957.
 Severe prostrating illness.
 Reservoirs - Birds & animals. Tick may act as the reservoir.
 Transmission – by bite of Tick.
Clinical features:
 Incubation period: 3 – 7days
 Patient develops fever of sudden onset.
 Headache, vomiting, conjunctivitis, myalgia and sever prostration.
 Massive hemorrhages in alimentary canal, chest cavity and epistaxis may
occur.
 Case fatality – 5%.  Vaccination – killed KFD vaccine.
BUNYAVIRIDAE
 Contains more than 300 members.
 First isolated from
Bunyamwera in Uganda.
 About 100 nm diameter.
 Has complex structure, with
a triple segmented genome of ss RNA.
 Contains 4 medically important genera-
Bunyavirus, Phlebovirus, Nairovirus & Hantavirus.
27
1. Bunyavirus: Mosquito-borne. It includes California encephalitis virus,
La Crossie virus & Chittor virus. Clinical features similar in all three except that
Chittor virus causes only mild fever.
2. Phlebovirus: Phlebotomus or mosquito borne. Causes Sandfly fever & Rift
valley fever. 20 antigenic types, only 5 causes human infection. No vertebrate
hosts other than humans.
3. Nairovirus: Tick borne. Mainly the disease of sheep. Infects humans
occasionally causing mild febrile illness.
4. Hantavirus: Non-arthropod-borne. Transmitted to humans by rodents hosts.
Causes haemorrhagic fever and nephropathy. Also named HFRS(Haemorrhagic
fever with renal syndrome). Clinical picture resembles Leptospirosis & typhoid.
28
Lab diagnosis of Arbovirus diseases
 Specimen: Blood, CSF, Brain may be used for virus isolation.
 Virus isolation:
1. Intra cerebral inoculation in suckling mice. Most
sensitive. Develops fetal encephalitis.
2. Yolk sac of chick embryo
3. Tissue culture
4. Xenodiagnosis (a method of animal inoculation using
laboratory-breed bugs and animals)
29
Serology:
 ELISA – Used for detection of serotype specific IgM antibody.
 Complement fixation test.
 Haemagglutination or neutralisation test.
Treatment
: Antibiotics are not effective for treatment and no effective antiviral drugs have
yet been discovered.
 Treatment is supportive, attempting to deal with problems & other treatable
complications.
VACCINES:
 The only effective vaccine available is for Yellow fever .
 It is a live attenuated vaccine known as 17 – D strain .
 The vaccine is administered subcutaneously in one dose , with a booster dose
every 10 years .
 Recommended to travelers to endemic areas.
 Should not be given to children less than 9-months.
30
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Arbo Virus by Dr. Rakesh Prasad Sah

  • 1. By Dr. Rakesh Prasad Sah Assistant Professor Microbiology
  • 3. ARBOVIRUSES 2  Arthropod borne viruses – virus of vertebrates.  Transmitted by insects vectors.  Cause infections in animals & birds.  Transmitted to man by bite of infected mosquitoes, ticks & sand flies.  Worldwide, more in tropical areas than temperate. Transmission Cycles  Man – Arthropod – Man  Animal – Arthropod - Man
  • 4. Man-Arthropod-Man Cycle  Reservoir may be in either man or arthropod vector.  E.g. dengue, urban yellow fever.  In the latter transovarial transmission may take place. 3
  • 5. Animal-Arthropod-Man Cycle  The reservoir is in an animal.  The virus is maintained in nature in a transmission cycle involving the arthropod vector and animal. Man becomes infected incidentally.  e.g. Japanese encephalitis, EEE, WEE, yellow fever. Both cycles may be seen with some arboviruses such as yellow fever. 4
  • 7. Animal Reservoirs In many cases, the actual reservoir is not known. The following animals are implicated as reservoirs. Birds - Pigs - Monkeys - Rodents - Japanese encephalitis, St Louis encephalitis, EEE, WEE Japanese encephalitis Yellow Fever VEE, Russian Spring-Summer encephalitis 5
  • 8.  About 500 viruses in this group.  About 100 causes infection in man.  About 10 in India.  Sub groups: Alpha virus ( Toga viruses) Flavi virus Bunya virus Rhabdo virus Reo virus6 Examples of Arthropod Vectors Aedes Aegypti Ticks Culex Mosquito Phlebotmine Sandfly
  • 9. Morphology  Size : 60-150nm  Symmetry: Spherical .cubical, helical  Genome: ss RNA (Reoviridae -ds RNA)  Distribution: Worldwide. Many diseases given names according to location. Eg: Venzulean Equine Encephalitis, Japanese B encephalitis. St. Louis enc. Virus, Russian spring summer Enc., California enc. etc 7
  • 10. General Properties:  Causes fatal encephalitis in suckling mice after intracerebral inoculation.  Possess haemagglutinin and agglutinate erythrocytes of goose or day old chicks.  Mosquito borne arboviruses multiply in aedes and culex, while tick borne multiply in Ixodid ticks.  They can be grown in cell like chick embryo fibroblasts or continuous cell lines like vero or HeLa, & in cultures of appropriate insect tissues.  May also be isolated in the yolk sack or CAM of chick embryo.  They are readily inactivated at room temperature and by bile salts, ether and other lipid solvents.8
  • 11. Antigenic Structure: 9  Three antigens are important in serological studies namely: a. Haemagglutinins b. Complement fixing antigen c. Neutralizing antigen  Cross reactions occur among arboviruses. Pathogenesis  Virus enters the body through bite of the vector.  Virus multiplies in reticuloendothelial system and leads to viraemia.  Virus transported to target organs such as CNS – encephalitis; Capillary endothelium – haemorrhagic fevers & Liver – Yellowfever.
  • 12. Diseases Caused  Febrile illness - This is usually a non-specific illness resembling a number of other viral illnesses such as influenza, rubella, and enterovirus infections. The patients may go on to develop encephalitis or haemorrhagic fever. E.g. Chikungunya, Dengue.  Encephalitis – Inflammation of brain. E.g. EEE, WEE, St Louis encephalitis, Japanese encephalitis.  Hemorrhagic fever – Bleeding disorder with high fever. E.g. yellow fever, dengue hemorrhagic fever.10
  • 13. Family & Genus Encephalitis Arbovirus infections Febrile illness Haemorrhagic fever I. Togaviridae Alphavirus (Mosquito – borne) •WEE •EEE •VEE •Chikungunya •O’nyong-nyong •Semliki Forest •Sindbis •Ross river virus •Chikungunya II. Flaviviridae Flavivirus a. Mosquito- borne b. Tick-borne •St. Louis Encep. •Ilheus •West Nile •Murray Valley Enc. •Japanese B Enc. •Russian spring summer enceph. •Powassan •Dengue, types 1-4 •Dengue •Yellow fever •Kyasanur forest disease •Omsk Haemorrhagic fever 11
  • 14. Family & Genus Encephalitis Febrile illness Haemorrhagic fever III. Bunyaviridae a) Bunya virus (Mosquito-borne) b) Phlebovirus (Phlembotomus or mosquito-borne) c) Nairovirus (tick- borne) •California encephalitis •La Crossie •Chittor virus •Sandfly fever •Rift-valley fever •Nairobi sheep disease •Ganjam virus ---- IV. Reoviridae Orbivirus (Tick-borne) -------- •Colorado tick borne virus ---- V.Rhabdoviridae Vesiculovirus (Mosquito-borne, sandfly-borne) -------- •Vesicular stomatitis virus •Chandipura virus ---- 12
  • 15. TOGAVIRIDAE  Toga = Mantle (cloak, a Roman dress)  Spherical, enveloped, 60-70 nm in diameter with icosahedral capsid surrounded by lipoprotein envelop and contains single stranded RNA.  Contains 2 genera: Alphavirus & Rubivirus  Alphavirus- 32 members, 13 cause human infection.  Rubivirus contains Rubella virus, is not arthropod borne.13
  • 16. Encephalitis viruses:  EEE (Eastern Canada, USA & the Caribbean)  WEE (America)  VEE (Central & SouthAmerica)  Causes encephalitis in horses & humans.  Influenza like illness with encephalitis in less cases.  Culex & Anopheles mosquitoes (vectors).  Formalin inactivated mouse brain vaccines (for EEE & WEE), Live attenuated vaccines (VEE). 14
  • 17. Viruses causing Febrile illness: 1. Chikungunya virus: 15  First isolated from human patients and Aedes aegypti mosquitoes in Tanzania in 1952.  Transmitted by Aedes aegypti.  Appeared in India in 1963. FEATURES: •Fever, crippling joint pains, conjunctivitis, lymphadenopathy & rash. •Patients lies doubled up (severe joint pains) hence the name. •Hemorrhagic manifestations may occur. •Biphasic fever with period of remission after 1-6 days. •No animal reservoir & No vaccines available so far.
  • 18. 2. O’nyong-nyong virus:  Isolated in Uganda. Confined toAfrica.  Closely related to Chikungunya virus antigenitically.  Transmitted by Anopheles species. 3. Semliki Forest virus:  First isolated in 1942 in Uganda from Aedes mosquitoes. 4. Sindbis Virus:  Isolated from Culex mosquitoes in Sindbis district of Egypt in 1952.  Recovered from Africa, India, Australia &Phillippines. 16
  • 19. FLAVIVIRIDAE: 17  Flavus = Yellow (refers to yellow fever)  Originally named as group B arboviruses.  Contains over 70 viruses, 13 causes human infection.  Mosquito and Tick borne.  Non-arthropod-borne viruses of this family belong to 2 genera: Pestivirus (veterinary pathogens) and Hepatitis C virus. Morphology:  Spherical 40 – 50 nm in diameter.  Single stranded RNA.  Inner viral core is surrounded by a lipid envelope which is covered with glycoprotein and matrix or membrane protein.
  • 20. Japanese encephalitis:  Korea, Japan, S/E Asia, India.  Recognized in Japan since 1871.  Virus first isolated in Japan in 1935.  Named JE- B to differentiate it from JE-A (von Economosdisease).  JE is a serious disease. Signs of encephalitis seen after 1 - 6 days.  S/S of encephalitis- Neck rigidity, convulsion, coma. CSF pressure increased, lymphocytes- increased, sugar-Normal, proteins-increased, Chlorides-Normal. 18Mortality- up to 50%. Residual neurological damage.
  • 21.  Japanese Encephalitis appeared in India in 1955.  Pigs act as amplifier hosts.  Hosts: Herons & ergrets ( birds), ducks, pigeons, sparrows, cattle.  Transmitted by- Culex mosquito.  Preventive measures:  Relocate piggeries away from dwellings.  Mosquito control.  There is no satisfactory vaccine.  Treatment: No specific treatment. 19
  • 22. FLAVIVIRIDAE  Flavus = Yellow (refers to yellow fever)  Originally named as group B arboviruses.  Contains over 70 viruses, 13 causes human infection.  Mosquito and Tick borne.  Non-arthropod-borne viruses of this family belong to 2 genera: Pestivirus (veterinary pathogens) and Hepatitis C virus. •Morphology:  Spherical 40 – 50 nm in diameter.  Single stranded RNA with a capsid protein, enveloped virus  Envelop lipid bilayer glycoprotein and a matrix protein.
  • 23. Yellow Fever  Confined to Africa, and SouthAmerica.  Still not reported in India  Immunization necessary for Air travel to these countries.  Yellow fever does not indicate Jaundice, but the Yellow quarantine flag used by the ships during 17th century to warn the presence of infection onboard.  MOT  bite of infeceted Ades mosquito  I.P.  3-6 days 20
  • 24. Pathogenesis By bite of Ades mosquito During blood meal,  deposits the saliva contaning virus into a bite wound. Virus replicates locally and regional lymph nodes Virus spreads from blood  B.M., liver, myocardium, spleen  further replication of virus occurs
  • 25. Pathogenesis Condition  hemorrhagic manifestations occurrs  due to DIC DIC  due to Bleeding from the GIT mucosa, abdominal & pleural serous layers. reduction in the synthesis of coagulation factor & altered platelet function. The condition progresses to shock and finally death due to multiple organ failure involving Liver, Kidney, Brain and Heart.
  • 26. Clinical Features • Characterized by Jaundice and Fever. • Acute onset of fever followed by jaundice within 2 weeks of onset of symptoms. • Fever • Chills • Malaise • Prostration • Headache • Giddiness • Myalgia • Anorexia • Nausea • Vomiting • Bleeding  nose, gums, GIT or skin within few weeks of illness • Hemorrhagic diathesis DIC most impt complications of ds • Multiple organ failure death of patient
  • 27. Lab Diagnosis • Isolation of yellow fever virus from the clinical specimens • Demonstration of IgM-specific antibodies in the serum or demonstration of fourfold or more rise in serum IgG • Ag in tissues by immunohistochemistry • Detection of viral genomes by PCR and • Elevated transaminase and bilirubin levels, which are demonstrated during the toxic stage of illness.
  • 28. Vaccines • The 17 D strain of yellow fever virus is a widely used attenuated live virus vaccine. • 17 D strain vaccine was recovered during serial passage of a pantropic strain of yellow fever virus through tissue culture. • A single dose of vaccine is highly effective which produces 99% of vaccinated people by 30 days • Provides immunity mainly for 30-35 yrs and probably for whole life after single dose.
  • 29. Distinctive features  Recognised in 17th century  Originated in Africa » » » Europe,America  Transmitted by Aedes aegypti mosquitoes  Incubation period is 3-6 days.  Fever, headache, vomiting, chills, jaundice, albuminuria, hemorrhages.  Liver/kidney failure  Liver- fatty degeneration and necrosis. Councilman bodies. Eosinophilic inclusion bodies in nucleus. Fatty degeneration of Liver . Eosinophilic inclusion bodies Counsilman bodies
  • 30. Dengue  Name derived from the Swahili, Ki denga pepo, meaning a sudden seizure by a demon.  Widely distributed.  Affects 2.5 billion people in 200 countries.  4 serotypes: DEN1, DEN2, DEN3 & DEN4.  Transmitted by Aedes aegypti mosquitoes.  Antigenitically related to yellow fever, but no significant cross immunity.  Break bone fever coined by Rauss in 1780 22
  • 31. Morphology • Small, spherical and enveloped virus. • Is a flavivirus having cubic symmetry • 40-50nm in diameter • Single stranded RNA virus of 11 kb size • An icosahedral nucleocapsid and is covered by a lipid enevelop. • Inactivated by diethyl ether and bile salts eg. Sod deoxycholate
  • 32. Pathogenesis and immunity • By the bite of infected Ades mosquito • Leakage of plasma  sed capillary permeability  Dengue hemorrhagic fever  Dengue shock syndrome • Bleeding in DHF capillary fragility & thrombocytopenia  petechial skin hemorrhages life threatening GIT bleeding
  • 33. Clinical Syndromes • Classic Dengue Fever • Dengue hemorrhagic fever • Dengue shock syndrome
  • 34. Classic Dengue Fever • I.P.  2 to 7 days • Fever, malaise, cough and headache • High fever on 3rd day and lasts for 5-7 days • Mculopapular rash  3rd or 4th day last for 1 to 5 days • Severe pain in Muscles, deep bone pain and joint pain (Break bone fever) • Enlarged lymphnode, Retrobulbar pain • Leukopenia • Rarely fatal • May last for 2 weeks.
  • 35. Dengue hemorrhagic fever • Severe manifestation • Calssic phase of dengue fever  worsens with shock & hemorrhage (skin & GIT) • Hemorrhagic manifestation  bleeding from nose, gums, malena, hematemesis • Fatality rate 10%
  • 36. Dengue shock syndrome • Most severe form of ds • Commonly seen in untreated cases of dengue hemorrhagic fever • Abdominal pain, vomiting and restlessness • Die of circulatory failure & shock • Mortality rate  Treated 5%, if left untreated 50%
  • 37. Clinical Features:  Affects usually older children and adults.  Incubation period is 3 -14 days.  Sudden onset, fever, headache, muscle pain retrobulbar pain, pain in back and limb (break bone fever) on 3rd or 4th day.  Lymphnode enlargement, and maculo -papulary rash.  Febrile illness lasts for about 10 days, after which recovery is generally complete.  Rarely fatal. 23
  • 38. Complications  Due to multiple dengue virus.  Hemorrhages in skin, mucosa, internal organs (Dengue Hemorrhagic Fever)  Pulmonary edema.  Low BP.  Liver cirrhosis.  Shock – Dengue Shock Syndrome.  Mortality - 5 to 10% 24
  • 39. 25  Elimination of mosquitoes and mosquito breeding places.  No specific treatment.  No effective vaccines available.  Live attenuated vaccine containing all 4 dengue serotypes is under clinicaltrials. Prophylaxis :
  • 40. Kyasanur Forest disease 26  Disease first recognized in Kyasanur forest in Karnataka in 1957.  Severe prostrating illness.  Reservoirs - Birds & animals. Tick may act as the reservoir.  Transmission – by bite of Tick. Clinical features:  Incubation period: 3 – 7days  Patient develops fever of sudden onset.  Headache, vomiting, conjunctivitis, myalgia and sever prostration.  Massive hemorrhages in alimentary canal, chest cavity and epistaxis may occur.  Case fatality – 5%.  Vaccination – killed KFD vaccine.
  • 41. BUNYAVIRIDAE  Contains more than 300 members.  First isolated from Bunyamwera in Uganda.  About 100 nm diameter.  Has complex structure, with a triple segmented genome of ss RNA.  Contains 4 medically important genera- Bunyavirus, Phlebovirus, Nairovirus & Hantavirus. 27
  • 42. 1. Bunyavirus: Mosquito-borne. It includes California encephalitis virus, La Crossie virus & Chittor virus. Clinical features similar in all three except that Chittor virus causes only mild fever. 2. Phlebovirus: Phlebotomus or mosquito borne. Causes Sandfly fever & Rift valley fever. 20 antigenic types, only 5 causes human infection. No vertebrate hosts other than humans. 3. Nairovirus: Tick borne. Mainly the disease of sheep. Infects humans occasionally causing mild febrile illness. 4. Hantavirus: Non-arthropod-borne. Transmitted to humans by rodents hosts. Causes haemorrhagic fever and nephropathy. Also named HFRS(Haemorrhagic fever with renal syndrome). Clinical picture resembles Leptospirosis & typhoid. 28
  • 43. Lab diagnosis of Arbovirus diseases  Specimen: Blood, CSF, Brain may be used for virus isolation.  Virus isolation: 1. Intra cerebral inoculation in suckling mice. Most sensitive. Develops fetal encephalitis. 2. Yolk sac of chick embryo 3. Tissue culture 4. Xenodiagnosis (a method of animal inoculation using laboratory-breed bugs and animals) 29 Serology:  ELISA – Used for detection of serotype specific IgM antibody.  Complement fixation test.  Haemagglutination or neutralisation test.
  • 44. Treatment : Antibiotics are not effective for treatment and no effective antiviral drugs have yet been discovered.  Treatment is supportive, attempting to deal with problems & other treatable complications. VACCINES:  The only effective vaccine available is for Yellow fever .  It is a live attenuated vaccine known as 17 – D strain .  The vaccine is administered subcutaneously in one dose , with a booster dose every 10 years .  Recommended to travelers to endemic areas.  Should not be given to children less than 9-months. 30