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Chikungunya, dengue, yellow fever, zika 2019


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Chikungunya, dengue, yellow fever, zika 2019

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Chikungunya, dengue, yellow fever, zika 2019

  1. 1. Alexandre Naime Barbosa MD, PhD Infectious Diseases Professor Winter School on Tropical Diseases Botucatu School of Medicine - UNESP 2019 - 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. CDC - 2015
  15. 15. - Dengue (DENV) - Zika virus (ZKV)
  16. 16. Family: Flaviviridae; Genus: Flavivirus Distribution: restricted to Africa & Central and South America.
  17. 17. Brazil: Endemic vs Transition vs Free Areas
  18. 18. Casos Autóctones confirmados até Jan/2018 no Brasil
  19. 19. Botucatu 2009 Epidemic
  20. 20. Transmission:
  21. 21. 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.
  22. 22. 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%
  23. 23. Pathogenesis
  24. 24. 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).
  25. 25. 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.
  26. 26. 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
  27. 27. 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
  28. 28. Brazil Epidemic 2016: 1.180.472
  29. 29. Transmission: 1 patterns (Cycle) 1. Person to person transmission by Aedes A. aegypti (America) and A. albopictus (Asia)
  30. 30. 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.
  31. 31. 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.
  32. 32. Pathogenesis
  33. 33. Diagnosis - Isolation of virus from blood - Serology: -Antibody detection IgM -Antigen detection- NS1 ag - RT-PCR
  34. 34. Treatment No antiviral therapy available Symptomatic management in majority of cases Suitable fluid replacement
  35. 35. Prevention
  36. 36. Family: Togaviridae; Genus Alphavirus Distribution:
  37. 37. Epidemia Atual 2016: 135.030 2017: 43.010
  38. 38. 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)
  39. 39. Symptoms - Fever - Severe arthritis - Chills, headache, photophobia - Nausea, abdominal pain - Rashes and petechias
  40. 40. Clinical Findings
  41. 41. Diagnosis - Isolation of virus from blood - Serology: Antibody detection IgM/IgG - RT-PCR
  42. 42. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  43. 43. Family: Flaviviridae; Genus: Flavivirus Distribution:
  44. 44. 14
  45. 45. - 1940 - 50: First evidences of human infections (Zika = Forest in Uganda)
  46. 46. - 1940 - 50: First evidencies of human infection (East Africa) - 2007: Big epidemic in Yap Island and Micronesia (80% of total population) - 2013: French Polynesia (neurologic complications, and others) - 2015: Brazil and South America (Microcephaly)
  47. 47. Beginning of 2015: - 21 cases of “Dengue-Like”: 8 RT-PCR ZKV Positives (Natal - RN)
  48. 48. First Identifield Cases: - April 2015: Camaçari (BA) - May 2015: Natal (RN) - May 2015: Sumaré (SP) Route Theory - Va’a (Canoe) World Sprint Championships (RJ, Ago/2014) - Ocean Pacific Countries: French Polynesia, New Caledonia, Cook Island, Easter Island - Zika circulation starts in 2014 - Brazil Zika virus is close to Polynesia virus
  49. 49. 2016: 170.535 2017: 7.911
  50. 50. - Família: Flaviviridae - Gênero: Flavivirus - Vírus RNA - Arbovírus - Duas linhagens - Africana - Asiática CDC - 2016
  51. 51. Importância Epidemiológica: Transmissão Vetorial - Aedes aegypti, Aedes africanus e outros Aedes - Culex???
  52. 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. 53. Outras Vias de Menor Importância Epidemiológica - Transplacentária e Perinatal - Transfusional - Sexual - Saliva e Urina (???) - Leite Materno (??????)
  54. 54. - Período de Incubação (Mosquitos): 10 dias - Reservatórios de Importância: Humanos e Pequenos Primatas - Infecção em Humanos: Células Dendríticas Linfonodos Corrente Sanguínea - Sintomas Clínicos: Leves a Moderados (Febre, Rash Cutâneo e Conjuntivite) - Associação Possível e Provável com Malformações Fetais e Sde. de Guillain-Barré - Associação Causal e Dano Neurológico Direto (e outros): em estudo e análise
  55. 55. - Microcefalia pode ocorrer, mas não se limita a esse achado (Z-TORCH) - Podem ocorrer medidas normais de PC, mas com graves malformações de SNC - Necrose tecidual => Redução massa cerebral => Microcefalia - Lisencefalia, hidrocefalia, calcificações multifocais corticais e subcorticais - Perda do tecido cortical, e presença de necrose e inflamação - Lesões oftalmológicas: mácula e peri-mácula; nervo óptico - Artrogripose: endurecimento da musculatura e as articulações - Taxa de Transmissão Transplacentária: 2-5% (???) - ZKV no feto: permanência e reativação por um longo período - Momento de maior risco na gestação (???)
  56. 56. 18/Nov/2015
  57. 57. 10/Fev/2016
  58. 58. 13/04/2016
  59. 59. Pacientes com quadro de exantema máculo-papular e DOIS dos seguintes sintomas: - febre (<38,5º C) ou - hiperemia conjuntival sem secreção ou - prurido ou - artralgia ou - edema periarticular Outros Achados: mialgia, cefaleia, edema de membros inferiores, dor retrorbital, anorexia, vômitos, diarreia ou dor abdominal. Manifestações neurológicas: - Síndrome de Guillain Barré, ADEM: 4 a 20 dias após o início dos sintomas
  60. 60. 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 are very rare.
  61. 61. Matsuda EM - 2016
  62. 62. Brasil, Ministério da Saúde - 2016
  63. 63. Treatment and Prevention No antiviral therapy available Symptomatic management in majority of cases No available vaccine
  64. 64. Não há vacina Eliminação dos criadouros dos mosquitos Evitar locais com presença do mosquito, uso de telas Repelentes - < 6 meses: sem indicação - 6 meses - 2 anos: IR3535 - 2 anos a 12 anos: DEET 10% (no máximo, aplicar 3x/dia) ou Icaridina; > 12 anos ou gestantes: DEET > 10% ou Icaridina Uso de inseticidas Uso de cobertura de áreas expostas com roupa Atualização de carteira vacinal
  65. 65. 11/03/2016
  66. 66. Obrigado pela Atenção! SAE de Infectologia HC UNESP Botucatu Faculdade de Medicina UNESP