CLINICAL SYMPTOMS AND PATHOGENICITY IN HUMANS H. Zeller, MC Georges, I. Schuffenecker, I. Marendat, S. Murri National Reference Centre for Arboviruses and Viral Haemorrhagic Fevers, WHO Collaborating Centre, Institut Pasteur, Lyon, France Luxemburg 20-21 January 2003
48
Embed
Arboviral infections: clinical syndromes and pathogenicity ...ec.europa.eu/health/ph_threats/com/west_nile/ev_20030120_co02_en.pdf · CLINICAL SYMPTOMS AND PATHOGENICITY IN HUMANS
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
CLINICAL SYMPTOMS AND PATHOGENICITY IN HUMANS
H. Zeller, MC Georges, I. Schuffenecker,I. Marendat, S. Murri
National Reference Centre for Arboviruses and ViralHaemorrhagic Fevers, WHO Collaborating Centre,
Institut Pasteur, Lyon, France
Luxemburg 20-21 January 2003
CLINICAL SYMPTOMS AND PATHOGENICITY IN HUMANS
Main Arboviruses affecting humans known to circulate in Europe
Intrauterine West Nile Virus Infection New York Sept 2002
• Index case: woman delevring a live infant 5 weeks after a WN meningoencephalitis.
• Baby with a bilateral chorioretinitis, severe cerebral abnormalities, including severe bilateral white-matter loss in the temporal and occipital lobes and cystic change in one temporal lobe consistent with focal cerebral destruction.
Female:17 years-old bitten by a Hyalomma tick on May 2000 in Pristina Kosovo (3)
Drostein et al, J Clin Microbiol 2002, 40 1122
Kosovska Mitrovica 2000
43 year old female with high fever, headache, nausea, generalized myalgia, disoriented . On day 2 deterioration bleeding from the gastrointestinal tractus
Transferred to Belgrade death a few hours later
The physician who intubated the patient :sick high fever asthenia petechiae, exanthema, pneumonia symptoms, leukopenia, thrombocytopenia
2 nosocomial infectionsone physician, one lab-technician
7 deaths Source: T. Avšič-Županc
CCHF Kosovo
Clinical Features of CCHF (1)Clinical Features of CCHF (1)incubation period: 3 -12 days
1-3 days for tick bite5-6 days for nosocomial or blood exposure
(1-2 days in last Kosovo outbreak 2001)
Sudden onset of fever, malaise, weakness, irritability, anorexia, headache, severe pain in limbs and back, conjunctival injection, hemorrhagic enanthem of soft palate, uvula and pharynx, and a fine petechial rash
Day 3-5 haemorrhage, day 5-14 hepato-renal failure, coma, death
Source: WHO CSR
Clinical Features of CCHF (2)Clinical Features of CCHF (2)
There may be large purpuric areas, bleeding from gums, nose, lungs, uterus and intestine, but in large amounts only in serious or fatal cases, often associated with severe liver damage
Fever persists 5 -12 days (may be biphasic)
Case fatality rate 2% - 50%, convalescence is prolonged
Source: WHO CSR
Clinical Features of CCHF (3)Clinical Features of CCHF (3)
Haemorrhagic phasecutaneous and mucous membrane petechiaespreading cutaneous ecchymosisbleeding from puncture sitesgastrointestinal*, urinary, uterine haemorrhages* sometimes massive haemorrhages
Typically last 5-7 daysAssociated with tachycardia, toxicity, hypotensive and CNS manifestations
Source: WHO CSR
Clinical Features of CCHF (4)Clinical Features of CCHF (4)
EVOLUTIONrecovery:prolonged convalescence with
persistent fatigue and dizziness
DEATHS: Occurred between days 5-14 of illnessHepatorenal failure, severe anemia, shock with pulmonary and cardiac insufficiency
Source: WHO CSR
CCHF : laboratory dataCCHF : laboratory data
LEUCOPENIA, particularly neutropeniaThrombocytopeniaHematocrit increases early then falls downASL, AST levels increasesProteinuria and hematuriaMild azotemia, bilirubine increase
VIREMIA long lasting through the disease
Source: WHO CSR
Treatment of CCHFTreatment of CCHF
Supportive treatmentfluid and electrolytic balancestransfusion, platelets, coagulation factors
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.