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Chikungunya, Dengue, Yellow Fever, Zika 2015

Chikungunya, Dengue, Yellow Fever (Febre Amarela), Zika 2015

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Chikungunya, Dengue, Yellow Fever, Zika 2015

  1. 1. Alexandre Naime Barbosa MD, PhD Infectious Diseases Professor Winter School on Tropical Diseases Botucatu School of Medicine - UNESP 2015 - Botucatu - SP - Brazil
  2. 2. O material que se segue faz parte do projeto didático do Prof. Dr. Alexandre Naime Barbosa Objetivos 1. Ensino: Treinamento de Estudantes e Profissionais da Área de Saúde; 2. Extensão: Facilitar o Contato da População em Geral com Conceitos Científicos; 3. Científico: Fomentar a Discussão Científica e Compartilhar Material Didático. Autoria e Cessão 1. Conteúdo: Os dados contidos estão referenciados, em respeito ao autor original; 2. Uso: Está permitido o uso do material, desde que citada a fonte; 3. Contato: fale com o autor e conheça o seu projeto didático em:
  3. 3. The following material is part of the educational project produced by Prof. Dr. Alexandre Naime Barbosa Objectives 1. Education: Training for Students & Health Professionals 2. Community: Provide and Translate Scientific Information to the Population; 3. Scientific: Encourage the Scientific Discussion and Share Teaching Materials. Authorship and Assignment 1. Content: The following data are referenced in respect to the original author; 2. Use: It is allowed to use the material, if the source is mentioned; 3. Contact: Talk to Dr. Barbosa and keep in touch with his project in:
  4. 4. 1. Arbovirus: Overview 2. Yellow Fever 3. Dengue 4. Chikungunya 5. Zika 6. Conclusions
  5. 5. So what is the world's deadliest animal?
  6. 6. Maybe a smaller animal…
  7. 7. Arbovirus: Arthropod Borne viruses WHO definition: viruses that are maintained in nature principally, or to an important extent, through biological transmission between susceptible vertebrate host by hematophagous arthropods; viruses multiply in tissues of arthropods, and are passed on to new vertebrates by bites of arthropods after a period of extrinsic incubation period.
  8. 8. Cycle Type 1: Man-Arthropod-Man
  9. 9. Cycle Type 2: Animal-Arthropod-Man
  10. 10. Family Members Bunyaviridae La Crosse, Oropouche, Rift Valley, Sandfly, Crimean-Congo Flaviviridae Yellow Fever, Dengue, Zika, Japanese Encephalitis, Saint Louis Encephalitis, West Nile, Kyasanur Forest, Omsk Togaviridae Chikungunya, O’nyong-nyong, Ross River, Equine Encephalitis (East, West, Venezuelan), Sindbis
  11. 11. Encephalitis Syndrome Virus Genus Vector Distribution EEE Alphavirus Mosq. USA, Canada WEE Alphavirus Mosq. USA, W. Indies J.E Flavivirus Mosq. Orient St. L.E Flavivirus Mosq. USA, C. America La Crosse Bunyavirus Mosq. USA
  12. 12. Fever, with or without rash and arthralgia Virus Genus Vector Distribution Chickungunya Alphavirus Mosq. Africa, Asia, C&S Amer. O’nyong-nyong Alphavirus Mosq. Africa Sindbis Alphavirus Mosq. Africa, Asia, India Dengue Flavivirus Mosq. Entire tropics, India West Nile Flavivirus Mosq. Africa, India Sandfly Phlebovirus Sandfly Med, Asia, India Oropouche Bunyavirus Mosq. W.I, South America (N)
  13. 13. Hemorrhagic Fever Virus Genus Vector Distribution Chickungunya Alphavirus Mosq. Africa, Asia, C&S Amer. Dengue Flavivirus Mosq. Entre tropics Yellow Fever Flavivirus Mosq. Africa, S. America Kyasanur Forest Disease Flavivirus Tick India(Karnataka) Omsk HF Flavivirus Tick Russia Crimean-Congo HF Nairovirus Tick Africa, Asia, E.U.
  14. 14. Family: Flaviviridae; Genus: Flavivirus Distribution: restricted to Africa & Central and South America.
  15. 15. Family: Flaviviridae; Genus: Flavivirus Distribution: restricted to Africa & Central and South America.
  16. 16. Brazil: Endemic vs Transition vs Free Areas
  17. 17. Brazil: Endemic vs Transition vs Free Areas
  18. 18. São Paulo State: Endemic vs Transition vs Free Areas
  19. 19. Botucatu 2009 Epidemic
  20. 20. Brazil: YF in 2012-13
  21. 21. Transmission:
  22. 22. Symptoms The majority of persons infected with yellow fever virus have no illness or only mild illness. In persons who develop symptoms, the incubation period (time from infection until illness) is typically 3–6 days. The initial symptoms include sudden onset of fever, chills, severe headache, back pain, general body aches, nausea, and vomiting, fatigue, and weakness. Most persons improve after the initial presentation.
  23. 23. Symptoms After a brief remission of hours to a day, roughly 15% of cases progress to develop a more severe form of the disease. The severe form is characterized by high fever, jaundice, bleeding, and eventually shock and failure of multiple organs. Rate of Death: 50%
  24. 24. Pathogenesis
  25. 25. Diagnosis Virus isolation – From the blood or post-mortem liver tissue Rapid diagnostic test: – Detection viral genome by PCR in blood o tissues – Not widely available Detection IgM antibodies (ELISA) – Simple sample provides a presumptive diagnosis. Confirmation is made by a rise between paired acute and convalescent samples or a fall between early and late convalescent samples. – Cross-reactions with other flaviviruses complicate the diagnosis particularity in Africa (multiple flaviviruses cocirculate).
  26. 26. Treatment No specific treatments have been found to benefit patients with yellow fever. Whenever possible, yellow fever patients should be hospitalized for supportive care and close observation. Treatment is symptomatic. Rest, fluids, and use of pain relievers and medication to reduce fever may relieve symptoms of aching and fever.
  27. 27. Prevention Vaccine: - Types: Inactivated mouse brain or Live attenuated - Mandatory for people that live at endemic area and travelers Others - Use insect repellent - Wear proper clothing to reduce mosquito bites - Be aware of peak mosquito hours
  28. 28. Family: Flaviviridae; Genus: Flavivirus, 4 Serotypes (1,2,3,4) Distribution: all tropical and some subtropical areas - WHO: 2.5 billion people, two fifths of the world's population, at risk from dengue and estimates that there may be 50 million cases of dengue infection worldwide every year. The disease is endemic in more than 100 countries
  29. 29. Brazil: 2014 - 2015 Epidemic
  30. 30. Brazil: 2014 - 2015 Epidemic
  31. 31. Transmission: 1 patterns (Cycle) 1. Person to person transmission by Aedes A. aegypti (America) and A. albopictus (Asia)
  32. 32. Classic Dengue (Break bone Fever) - Incubation: 3-10 days; - Chills, high fever, intense headache, myalgia, arthralgia, retro-orbital pain, colic pain and abdominal tenderness. Fever biphasic (saddle type). - Maculopapular rashes develop on chest, trunk.
  33. 33. Dengue Hemorrhagic Fever (DHF) & Dengue Shock Syndrome (DSS) C/F-High fever, hemorrhagic phenomena including bleeding from the eyes, nose, mouth, ear, into the gut, and oozing of blood from skin pores, thrombocytopenia, and hemoconcentration Vascular leak syndrome - blood leaks through the skin and into spaces around the lungs and abdomen. This fluid loss and severe bleeding can cause blood pressure to fall; then Dengue Shock Syndrome (DSS) sets in, which has a high mortality rate.
  34. 34. Pathogenesis
  35. 35. Diagnosis - Isolation of virus from blood - Serology: -Antibody detection IgM -Antigen detection- NS1 ag - RT-PCR
  36. 36. Treatment No antiviral therapy available Symptomatic management in majority of cases Suitable fluid replacement
  37. 37. Prevention
  38. 38. Family: Togaviridae; Genus Alphavirus Distribution:
  39. 39. Brazil: 2014 Epidemic
  40. 40. Brazil: 2014 Epidemic
  41. 41. Transmission: 2 patterns (Cycles) 1. Person to person transmission by Aedes sp. 2. Monkey-monkey by arboreal mosq. A. aegypti (America) and A. albopictus (Asia)
  42. 42. Symptoms - Fever - Severe arthritis - Chills, headache, photophobia - Nausea, abdominal pain - Rashes and petechias
  43. 43. Clinical Findings
  44. 44. Diagnosis - Isolation of virus from blood - Serology: Antibody detection IgM/IgG - RT-PCR
  45. 45. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  46. 46. Family: Flaviviridae; Genus: Flavivirus Distribution:
  47. 47. Transmission: 2 patterns (Cycles) 1. Person to person transmission by Aedes sp. 2. Monkey-monkey by arboreal mosq. Aedes aegypti Aedes africanus, Aedes apicoargenteus Aedes furcifer Aedes luteocephalus Aedes vitattus
  48. 48. Symptoms About 1 in 5 people infected with Zika virus become ill. The most common symptoms of Zika are fever, rash, joint pain, or red eyes. Other symptoms include muscle pain, headache, pain behind the eyes, and vomiting. The illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon. Deaths due to Zika have not been reported.
  49. 49. Diagnosis - Isolation of virus from blood - Serology: Antibody detection IgM/IgG - RT-PCR
  50. 50. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  51. 51. Comparison of Symptoms (Chikungunya, Dengue anda Zika)
  52. 52. Obrigado pela Atenção!

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