Chikungunya, una enfermedad vírica emergente. Propuesta de un algoritmo de manejo clínico / Chikungunya, an emerging viral disease. Proposal of an algorithm for its clinical management

La fiebre de Chikungunya (CHIK) es una enfermedad vírica emergente. Está causada por un virus ARN del género alfavirus y la familia Togaviridae: el virus de Chikungunya. Se transmite a los humanos por la picadura de mosquitos infectados, principalmente Aedes aegypti y Aedes albopictus. Dichos mosquitos están implicados en la transmisión de otras enfermedades (dengue, malaria, otros alfavirus, etc.). Actualmente la CHIK es endémica en algunas regiones de África y del Sudeste Asiático. Se han descrito casos en Latinoamérica, Caribe y Europa (Francia, Italia y España). En España existen reservorios de los mosquitos vectores en áreas mediterráneas (Cataluña, Alicante, Murcia y las Islas Baleares). Clínicamente, la CHIK se caracteriza por fiebre elevada de inicio súbito y artromialgias simétricas graves o incluso invalidantes. Suele mejorar en días o semanas, existiendo formas graves y crónicas. No existen tratamiento ni profilaxis específicos para la CHIK. Proponemos un algoritmo de manejo basado en las últimas guías (AU)

Chikungunya fever (CHIK) is an emerging viral disease. It is caused by the Chikungunya virus, analphavirus from the Togaviridae family. It is transmitted to humans by the bite of infected mosquitoes, mainly Aedes aegypti and Aedes albopictus. They are also involved in the transmission of dengue, malaria, etc. CHIK is now endemic in any region of Africa and Southeast-Asia. Cases of CHIK have been reported in America, the Caribbean, and Europe (France, Italy and Spain). There are reservoirs of these mosquitoes in some regions of Spain (Catalonia, Alicante, Murcia and Balearic islands). CHIK is characterized by a sudden high and debilitating fever, and severe or disabling symmetrical arthralgia. It tends to improve in days or weeks. There are severe and chronic forms of CHIK. There is no specific treatment or prophylaxis for CHIK. An algorithm is proposed for the clinical management of CHIK based in the latest guidelines (AU)

Human arboviral encephalitis.

Worldwide, arboviral illnesses constitute the most important international infectious threat to human neurological health and welfare. Before the availability of effective immunizations, approximately 50,000 cases of Japanese encephalitis occurred in the world each year, one-fifth of which cases proved lethal and a much larger number were left with severe neurological handicaps. With global climate change and perhaps other factors, the prevalences of some arboviral illnesses appear to be increasing. Arboviral illnesses, including Japanese encephalitis, tick-borne encephalitis, Yellow fever, and others, are emerging as possible global health care threats because of biological warfare. This chapter will review ecology, pathophysiology, diagnosis, management, and outcome of the forms of arboviral encephalitis that are of greatest importance in North America, together with some of the most important arboviral encephalitides prevalent in other parts of the world.

Kunjin flaviviral encephalomyelitis in an Arabian gelding in New South Wales, Australia.

Flaviviruses, including Kunjin virus, are arboviruses that cause encephalomyelitis in humans and horses. This case report describes an Arabian gelding exhibiting neurological signs of flavivirus encephalomyelitis, the diagnostic investigation and confirmation of an unreported case of Kunjin virus equine encephalomyelitis in Australia.

Efficacy and safety of an inactivated vaccine against Salmonid alphavirus (family Togaviridae).

Pancreas disease (PD) in salmonid fish is caused by an infection with Salmonid alphavirus (SAV) and remains as one of the major health problems in the European fish farming industry. Sequence studies have revealed a genetic diversity among viral strains. A subtype of SAV (SAV3) is causing an epizootic in farmed salmonids in Norway. Here we evaluate efficacy and safety of an inactivated virus vaccine based on ALV405, a strain of SAV3 that was isolated from Norwegian salmon. The vaccine provided an average relative percent survival (RPS) of 98.5 in an intraperitoneal challenge model, and induced nearly total protection against PD in a cohabitant challenge model. It provided significant protection against SAV-induced mortality also in a field trial under industrial conditions. Local reactions seen as melanization and adhesions in the visceral cavity were less severe than those induced by two commercial vaccines. Finally, we demonstrated that the protection is not impaired when the ALV405 antigen is combined with other viral or bacterial antigens in a polyvalent vaccine. The results confirm that efficient and safe protection against SAV infection and development of PD is possible using an inactivated virus vaccine, both alone and as a component in a polyvalent vaccine.

[Insect-borne diseases and insect bites in Finland]. / Hyönteisten levittämät taudit ja puremat Suomessa.

Clinically significant endemic, arthropod-borne infectious diseases in Finland include Lyme disease, tick-borne encephalitis, tularemia and Karelian fever. The diagnosis of early borreliosis or tularemia is clinical and the treatment is initiated already before the results of eventual blood tests. The diagnosis of late stage borreliosis, tick-borne encephalitis or Karelian fever is confirmed mainly with serologic tests. The clinical significance of endemic anaplasmosis, Rickettsia helvetica, Inkoo and Uukuniemi viruses as well as anthropod-borne bunyaviruses and bartonelloses is either minor or remains open.

Field evaluation of clinical features during chikungunya outbreak in Mayotte, 2005-2006.

BACKGROUND: To record and assess the clinical features of chikungunya fever (CHIKF), with a view to enable diagnosis based on clinical criteria rather than costly laboratory procedures in field conditions. METHODS: As part of a cross-sectional serologic survey conducted in Mayotte after a massive chikungunya outbreak in 2006, we collected data on clinical features of chikungunya infection and assessed the performance and accuracy of clinical case definition criteria combining different symptoms. RESULTS: Of 1154 participants included, 440 (38.1%) had chikungunya-specific IgM or IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Of symptomatic participants, 318 (72.3%) had confirmed chikungunya, the dominant symptoms reported were incapacitating polyarthralgia (98.7%), myalgia (93.1%), backache (86%), fever of abrupt onset (85%) and headache (81.4%). There was a strong linear association between symptomatic infection and age (chi(2) for trend = 9.85, P < 0.001). Only 52% of persons with presumptive chikungunya sought medical advice, principally at public primary health care facilities. The association of fever and polyarthralgia had a sensitivity of 84% (95% CI: 79-87) and a specificity of 89% (95% CI: 86-91). This association allowed to classify correctly 87% (95% CI: 85-89) of individuals with serologically confirmed chikungunya. CONCLUSIONS: Our results suggest that the pair fever and incapacitating polyarthralgia is an accurate and reliable tool for identifying presumptive CHIKF cases in the field. These criteria provide a useful evidence base to support operational syndromic surveillance in laboratory-confirmed chikungunya epidemic settings.

Mayaro fever virus, Brazilian Amazon.

In February 2008, a Mayaro fever virus (MAYV) outbreak occurred in a settlement in Santa Barbara municipality, northern Brazil. Patients had rash, fever, and severe arthralgia lasting up to 7 days. Immunoglobulin M against MAYV was detected by ELISA in 36 persons; 3 MAYV isolates sequenced were characterized as genotype D.

Infection by UNA virus (Alphavirus; Togaviridae) and risk factor analysis in black howler monkeys (Alouatta caraya) from Paraguay and Argentina.

A neutralizing antibody (NTAb) survey on UNA and Mayaro viruses in black howler monkeys (Aloutta caraya) from subtropical regions of Argentina and Paraguay was carried out. Risk factors for infection in monkeys were analyzed. No positive sera for Mayaro virus were detected. A prevalence of 73% (61/84) of NTAb against UNAV was detected with titers ranging from 20 to 1280. According to the statistical analysis performed, the monkey's age was a significant risk factor, but not the origin or sex. This is the first report of Alouatta caraya infection by UNAV and the first record of its activity in Paraguay.

Seroprevalence and distribution of Flaviviridae, Togaviridae, and Bunyaviridae arboviral infections in rural Cameroonian adults.

Arboviruses from the families Flaviviridae, Togaviridae, and Bunyaviridae are suspected to cause widespread morbidity in sub-Saharan African populations, but little research been done to document the burden and distribution of these pathogens. We tested serum samples from 256 Cameroonian adults from nine rural villages for the presence of Dengue-2 (DEN-2), West Nile (WN), Yellow fever (YF), Chikungunya (CHIK), O'nyong-nyong (ONN), Sindbis (SIN), and Tahyna (TAH) infection using standard plaque-reduction neutralization tests (PRNT). Of these samples, 12.5% were DEN-2 positive, 6.6% were WN positive, 26.9% were YF positive, 46.5% were CHIK seropositive, 47.7% were ONN positive, 7.8% were SIN positive, and 36.3% were TAH positive. DEN-2, YF, and CHIK seroprevalence rates were lower among individuals living in dwellings with grass or thatched roofs versus corrugated tin and in villages isolated from urban centers. Seroprevalence rates of YF and CHIK increased with age. These results suggest that inter-epidemic arboviral infection is common in central African populations.

UNA virus: first report of human infection in Argentina.

Una virus (UNAV), Togaviridae family, is widely distributed in South America, where infections have been detected in mosquitoes and vertebrate hosts (humans, birds and horses). We analyzed human sera from Córdoba inhabitants aged 44 to 89 years and using a neutralization test, we found a prevalence of UNAV antibodies of 3.8% (3/79). The low titers detected suggest past infections probably acquired in rural areas of the Province of Córdoba (central Argentina). None sera were found positive for MAYV neutralizing antibodies. This is the first report of human infections by UNAV in Argentina.

A dual infection of infectious salmon anaemia (ISA) virus and a togavirus-like virus in ISA of Atlantic salmon Salmo salar in New Brunswick, Canada.

Two viruses, infectious salmon anaemia (ISA) virus and a novel togavirus-like virus, were isolated from ISA disease outbreaks that were first reported as a new syndrome, haemorrhagic kidney syndrome (HKS) affecting farmed Atlantic salmon Salmo salar L. on the East coast of Canada. Laboratory confirmation of ISA diagnosis was initially complicated by isolation of only the togavirus-like agent using the CHSE-214 cell line. Here we demonstrate that a clinical sample from a disease outbreak of ISA contained a mixture of ISA virus and togavirus-like virus. Reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed the presence of both viruses during serial passage of cultures in SHK-1 and CHSE-214 cells. Virus harvested at passage level 3 in both cell lines caused high mortalities and severe gross pathology consistent with ISA virus infection in experimentally inoculated Atlantic salmon parr (approximately 35 g) in freshwater, beginning 12 d post inoculation. ISA virus was detected by virus isolation from kidney and liver tissues of all dead or moribund fish tested. A comparison of virus isolation, 1-step procedure RT-PCR and RNA dot-blot hybridization for detection of ISA virus (ISAV) in fish tissues showed virus isolation to have 100% sensitivity, followed by RT-PCR (66 and 28% sensitivity in kidney and liver, respectively), with RNA dot-blot hybridization as the least sensitive method (20 and 10% sensitivity in kidney and liver, respectively). No togavirus-like virus was detected in these samples by virus isolation. Moreover, another togavirus-like virus isolate grown in CHSE-214 cells in the absence of any other detectable pathogen was non-pathogenic in experimentally inoculated fish. This study confirms that the original ISA outbreaks in New Brunswick, Canada, were caused solely by ISAV.

Epidemic O'Nyong-Nyong fever in southcentral Uganda, 1996-1997: entomologic studies in Bbaale village, Rakai District.

Entomologic studies were conducted between January 27 and February 2, 1997, in Bbaale village in southcentral Uganda during an o'nyong-nyong (ONN) virus epidemic, which began in mid 1996 and continued into 1997. The objectives were to confirm the role of anophelines in ONN virus transmission and to examine other mosquito species as epidemic vectors of ONN virus. Of 10,050 mosquitoes collected using light traps and pyrethrum knockdown sprays, Anopheles (Cellia) funestus Giles was presumed to be the principal vector because it was the most abundant mosquito species from which a strain of ONN virus was isolated. This virus was isolated for the first time from a culicine species, Mansonia (Mansonioides) uniformis Theobald. Bwamba virus and Nyando virus were also isolated from An. funestus.

Aspects of the epizootiology of pancreas disease in farmed Atlantic salmon Salmo salar in Ireland.

A computerised database containing information on over 17.8 million salmon contained within 49 separate marine populations was used to study the epidemiology of pancreas disease (PD) in Ireland. Of the 43 recorded PD outbreaks, 57% occurred in the 3 mo period August to October inclusive (17 to 32 wk post-transfer). Analysis of variance of mortality rates during PD outbreaks occurring on 6 marine sites over a 5 yr period showed that mortality rates vary significantly between sites (p < 0.001) but not between years over this time period. The mortality rate during PD outbreaks ranged from 0.1 to 63%. Mortality rates were significantly higher when PD outbreaks occurred earlier in the year (y = -1.28x + 59, SE of b 0.33). The mean length of a PD outbreak was 112 d (SE = 7.7, n = 37). There was no correlation between PD mortality rate and smolt input weight, initial stocking density and transfer mortality.

Historical, epidemiological and ecological aspects of arboviruses in Argentina: Togaviridae, Alphavirus

This is a review of the arboviruses in Argentina belonging to families Flaviridae, Bunyaviridae and Rhabdoviridae. Of the many viruses belonging to these families, the flavivirus St. Louis encephalitis (SLE), has been most intensively studied. SLE virus strains have been recovered from three sources: 2 strains from humans with an undifferentiated, febrile disease; 6 from mosquitoes; and 2 from rodents. The viruses recovered from rodents are attenuated and those from mosquitoes are virulent based on a neuroinvasiveness test in mice; the degree of virulence of the mosquito strains remain to be analyzed. Serological surveys indicate a wide distribution and endemicity of SLE virus in the temperate and subtropical areas (central and northern Argentina), but no data are available from the andean region or from the South. The virulent SLE virus strains appear to be transmitted between Culex (Cx.)spp. from which they were isolated, and wild birds, based on antobody prevalence. A urban cycle may involve Cx. quinquefasciatus (source of a viral isolate and a competent experimental vector) and abundant birds (house sparrows, doves, and/or chickens), chickens are experimentally competent host species. Despite similarities in the ecology of SLE between Argentina and North America, urban outbreaks of SLE have not been recognized. Possible explanations for this discrepancy include virus strain differences in virulenc, ecologic factors determining the rate of virus transmission, and the lack of disease recognition and specific laboratory diagnosis of human meningoencephalitis. The transmission cycle of attenuated SLE virus strains isolated from rodentshas not been studied. Ilheus virus has isolated only once from a human being. The available serological data are difficult to interpret due to cross-reactivity with other flaviviruses, and the ecologyand medical importance of this agent remain uncertain. Dengue has not been recognized in Argentina since 1916, although is vector, Aedes aegypti, was not erradicated until 1963. Dengue was previously present in coastal localities of Chaco. Corrientes and Misiones Provinces. Within the last few years, Argentina was reinfested by Ae. aegypti. Although no human cases have vet been reported, outbreaks of dengue in bordering countries (Brazil, Paraguay, Bolivia) since 1986, cleary signal that the country in once againat risk of importantion ans spread of the virus

[Epidemiological analysis of cases of TBE in 1993 in Bialystok district]. / Analiza epidemiologiczna kleszczowego zapalenia opon mózgowo-rdzeniowych i mózgu (KZM) w 1993 roku na terenie województwa bialostockiego.

111 cases of TBE was 20 times increased morbidity in comparison to 1992 in Bialystok district in 1993. Among hospitalized dominated male patients (52.35%). First cases was reported in may and last in November with a peak in July. The age of patients was from 6 to 78 years old, 63.06%, in age group from 31 to 59 years old. We established that 78.87% patients were citizens of Bialystok, spending there recreation time in forest. Despite occurrence increased cases of TBE in 1993 we conclude that among people from risk group vaccination is indicated.

Arbovirus infections of humans in high-risk areas of south-eastern Australia: a continuing study.

OBJECTIVES: To determine the current immune status of high-risk populations of New South Wales and Victoria to the arboviral pathogens, Murray Valley encephalitis (MVE) and Kunjin (KUN) viruses, which are associated with Australian encephalitis (AE), and Ross River (RR) and Kokobera (KOK) viruses which are associated with polyarthritis. Further, to estimate seroconversion rates to these viruses in high-risk populations over the 10-year period 1981-1991. DESIGN AND STUDY POPULATION: Blood was taken from 2873 permanent residents, children and adults from previously identified high-risk areas in western NSW and northern Victoria. Samples were tested by the haemagglutination-inhibition (HI) test for antibodies to the four viruses. All sera were also tested for MVE and KUN antibodies by the more specific neutralisation test (NT). Ninety-five of the subjects had been seronegative when sampled 10 years previously. RESULTS: Age standardised prevalence rates for flavivirus HI antibodies (MVE, KUN, KOK) ranged from 66% (Bourke) to 15% (Forbes), and were similar to those observed 10 years previously. However, specific NT antibodies to MVE and KUN were uncommon in all districts except Bourke, indicating a very high level of susceptibility to Australian encephalitis, should a fresh epidemic occur. Whereas KUN virus seems enzootic in NSW and Victoria, MVE did not appear to have been present since the last outbreak in 1974, even in Bourke. Flavivirus antibody rates (as detected by the broadly reactive HI test) greatly exceeded those specifically attributable to MVE and KUN (NT test) or KOK, leading to the speculation that unidentified flaviviruses are responsible for most human infections. Ross River virus antibody prevalence rates exceeded those of flaviviruses in all districts, ranging from 72% (Bourke) to 25% (Cohuna), and were uniformly higher than those observed in 1981. Ten-year seroconversion rates in seronegative panels were 8.5% for flaviviruses and 24.2% for RR virus, and are broadly consistent with the cross-sectional study. CONCLUSIONS: Although flavivirus and alphavirus infections have occurred at a "steady rate"in western NSW and northern Victoria, there is a general lack of immunity to the agents of Australian encephalitis in all centres except Bourke. This needs to be considered in public health policy in these areas.

[Development and use of an immunoenzyme technique for the routine diagnosis of the porcine reproductive and respiratory syndrome]. / Développement et utilisation d'une épreuve immuno-enzymatique pour le diagnostic courant du syndrome dysgénésique et respiratoire du porc.

An indirect enzyme-linked immunosorbent assay was developed for rapid detection of serum antibodies against the virus responsible for the porcine reproductive and respiratory syndrome (PRRS). This test is more sensitive than the reference technique (immunoperoxidase test applied to cultures of alveolar macrophages), particularly for detecting animals at the stage of seroconversion. It is also very specific for PRRS virus, because all specific hyperimmune sera against other porcine viruses, and all serum samples taken from herds before the disease appeared in western France were negative. The test has been used for routine diagnosis of PRRS. The results obtained during nine months from over 21,000 samples have confirmed the value of the test for diagnosis and epidemiological surveillance of the disease.

Australian encephalitis in Western Australia, 1978-1991.

OBJECTIVE: To review the various clinical manifestations of Murray Valley encephalitis (MVE) or Kunjin virus encephalitis in patients in Western Australia. DESIGN: Review of clinical records, 1978 to 1991. PATIENTS: Of 26 reported cases of Australian encephalitis, four were excluded from study because the patient's symptoms were not definitely associated with MVE virus or Kunjin virus infection. Two further cases of MVE were not reviewed as case records were not available. Of the remaining 20 patients, 18 had MVE and two had Kunjin virus encephalitis. RESULTS: Sixteen cases were in the Kimberley, a tropical region where the viruses are endemic. Four were in the subtropical Pilbara and Gascoyne regions. Thirteen of the 20 cases were in Aborigines, of whom 11 were children. The seven non-Aboriginal patients were adults. Seventeen of 20 cases were in males. The range of neurological disease and outcome was similar to that in previously reported cases, with convulsions, brainstem disease or respiratory failure in severe and fatal cases, and involvement of the spinal cord, cranial nerve or cerebellum in the moderate cases. One mild cases without neurological involvement was caused by Kunjin virus. CONCLUSIONS: The poor outcome in young Aboriginal children indicated that disease resulting from exposure early in life was more likely to be severe. The disease in adults, irrespective of facial background, was similar to that in cases reported previously from south-eastern Australia, but generally milder.

An outbreak of epidemic polyarthritis (Ross River virus disease) in the Northern Territory during the 1990-1991 wet season.

OBJECTIVE: To describe the epidemiology of a large outbreak of epidemic polyarthritis in the Northern Territory during the wet season of 1990-1991. DESIGN, SETTING AND PARTICIPANTS: Arbovirus cases notified to the Northern Territory Department of Health and Community Services by general practitioners and local laboratories between 1 July 1990 and 30 June 1991. MAIN OUTCOME MEASURES: Date and place of infection, age, sex and symptoms. RESULTS: Doctors in the Northern Territory notified 368 cases; another 14 were infected interstate. The epidemic started in September, peaked in January and tailed off in April. The highest attack rates occurred in the rural areas of Jabiru, Litchfield Shire and Katherine. Those most affected were 30-34 year olds. Children, the elderly and Aboriginal people were under-represented. CONCLUSIONS: Epidemic polyarthritis is a wet season problem in the Northern Territory, affecting the rural towns and districts more than the cities. Pre-planned mosquito control measures (effective water drainage and larval control) limited the extent of the 1990-1991 epidemic in Darwin City and Palmerston. The low attack rate in children reflects asymptomatic and less clinically severe infections. The under-representation of Aboriginal people may be the result of infection occurring earlier in life. A related cross-sectional seroprevalence survey has shown that rural Aboriginal people across all age groups have a significantly higher seropositive rate than urban non-Aboriginal residents.