This document provides an overview of a winter school on tropical diseases organized by Dr. Alexandre Naime Barbosa. The objectives of the school are education and training students and health professionals, community outreach to share scientific information with the public, and encouraging scientific discussion. The document outlines 5 topics that will be covered: arboviruses (overview), yellow fever, dengue, chikungunya, and Zika. Presentations will include descriptions of the viruses, their transmission cycles, geographical distribution, symptoms, pathogenesis, diagnosis, treatment and prevention.

1. Alexandre Naime Barbosa MD, PhD
Infectious Diseases Professor
Winter School on Tropical Diseases
Botucatu School of Medicine - UNESP
2015 - Botucatu - SP - Brazil

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. 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. 1. Arbovirus: Overview
2. Yellow Fever
3. Dengue
4. Chikungunya
5. Zika
6. Conclusions

6. So what is the world's deadliest animal?

7. Maybe a smaller animal…

8. 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.

9. Cycle Type 1: Man-Arthropod-Man

10. Cycle Type 2: Animal-Arthropod-Man

11. 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

12. 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

13. 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)

14. 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.

16. Family: Flaviviridae; Genus: Flavivirus
Distribution: restricted to Africa & Central and South America.

17. Family: Flaviviridae; Genus: Flavivirus
Distribution: restricted to Africa & Central and South America.

18. Brazil: Endemic vs Transition vs Free Areas

19. Brazil: Endemic vs Transition vs Free Areas

20. São Paulo State: Endemic vs Transition vs Free Areas

21. Botucatu 2009 Epidemic

22. Brazil: YF in 2012-13

23. Transmission:

24. 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.

25. 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%

26. Pathogenesis

27. 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).

28. 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.

29. 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

31. 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

32. Brazil: 2014 - 2015 Epidemic

33. Brazil: 2014 - 2015 Epidemic

34. Transmission: 1 patterns (Cycle)
1. Person to person transmission by Aedes
A. aegypti (America) and A. albopictus (Asia)

35. 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.

36. 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.

37. Pathogenesis

38. Diagnosis
- Isolation of virus from blood
- Serology:
-Antibody detection IgM
-Antigen detection- NS1 ag
- RT-PCR

39. Treatment
No antiviral therapy available
Symptomatic management in majority of cases
Suitable fluid replacement

40. Prevention

42. Family: Togaviridae; Genus Alphavirus
Distribution:

43. Brazil: 2014 Epidemic

44. Brazil: 2014 Epidemic

45. 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)

46. Symptoms
- Fever
- Severe arthritis
- Chills, headache, photophobia
- Nausea, abdominal pain
- Rashes and petechias

47. Clinical Findings

48. Diagnosis
- Isolation of virus from blood
- Serology: Antibody detection IgM/IgG
- RT-PCR

49. Treatment and Prevention
No antiviral therapy available
Symptomatic management in majority of cases
No available vaccine

51. Family: Flaviviridae; Genus: Flavivirus
Distribution:

52. 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

53. 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.

54. Diagnosis
- Isolation of virus from blood
- Serology: Antibody detection IgM/IgG
- RT-PCR

55. Treatment and Prevention
No antiviral therapy available
Symptomatic management in majority of cases
No available vaccine

57. Comparison of Symptoms (Chikungunya, Dengue anda Zika)

61. Obrigado pela Atenção!