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Viral Haemorrhagic Fevers – PST05103 Pharmaceutical Microbiology

NTA Level 5 • Semester 1 • PST05103

Viral Haemorrhagic Fevers

Pharmaceutical Microbiology • Source Session/Topic 29
Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability.

Session 29: Viral Haemorrhagic Fevers

Total Session Time: 120 minutes

Pre-requisites

• Human anatomy and physiology

Students Learning Tasks

By the end of this session students are expected to be able to:

• Describe Viral haemorrhagic fever (causative agents, transmission,

signs and symptoms)

• Describe treatment, prevention and control of Viral haemorrhagic fever

Resources Needed:

• Flip charts, marker pens, and masking tape
• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

|Step |Time |Activity/ |Content |

| | |Method | |

|1 |5 minutes |Presentation |Introduction, Learning Tasks |

|2 |25 minutes |Presentation |Introduction to Haemorrhagic |

| | | |Fevers |

|3 |30 minutes |Presentation |Ebola Haemorrhagic Fever |

|4 |15 minutes |Presentation |Marburg Haemorrhagic Fever |

|5 |10 minutes |Presentation |Rift Valley Fevers |

|6 |15 minutes |Presentation |Dengue Haemorrhagic Fever |

|7 |10 minutes |Presentation |Yellow Fever |

|8 |5 minutes |Presentation |Key Points |

|9 |5 minutes |Presentation |Evaluation |

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Introduction to Haemorrhagic Fevers (25 minutes)

• Viral haemorrhagic fevers (VHFs) are a group of illnesses caused by

several distinct families of viruses

• Common features of VHFs;

o They affect many organs

o They damage the blood vessels

o They affect the body's ability to regulate itself

o Some VHFs cause mild disease, but some, like Ebola or Marburg, cause

severe disease and death

• VHFs are caused by viruses of five distinct families; Arenaviridae,

Bunyaviridae, Filoviridae, Flaviviridae, and Paramyxoviridae

• These five families share the following features;

o They are all RNA viruses, and are all covered, or enveloped, in a

fatty (lipid) coating

o Their survival is dependent on an animal or insect host, called the

natural reservoir

o Humans are not the natural reservoir for any of these viruses

o Humans are infected when they come into contact with infected hosts

▪ However, with some viruses, after the accidental transmission from

the host, humans can transmit the virus to one another

o Human cases or outbreaks of haemorrhagic fevers caused by these

viruses occur sporadically and irregularly; occurrence of outbreaks

cannot be easily predicted

o With a few noteworthy exceptions, there is no cure or established drug

treatment for VHFs

o The viruses are geographically restricted to the areas where their

host species live

▪ Lassa fever is limited to rural areas of West Africa where rats and

mice carry the virus

STEP 3: Ebola Haemorrhagic Fever (30 minutes)

• Cause and Transmission

o Ebola is an acute viral infection caused by Ebolavirus, a filovirus

that causes haemorrhage, multiple organ failure, and high mortality

rates

o Primary transmission is from animal to human, through contact with an

infected animal or its product

o Secondary transmission is from person to person through:

▪ Broken skin, mucous membrane or exchange of bodily fluids or

ingestion, inhalation and injection of infectious material

▪ Breast feeding
▪ Sexual contact
▪ The disease can spread rapidly within the health care setting.
• Signs and Symptoms

o Incubation period is 2 to 20 days

o High grade fever

o Head ache

o Body ache

o Abdominal pain, nausea, vomiting and diarrhoea

o Photophobia, conjunctival injection, jaundice, and lymphadenopathy

o Upper respiratory symptoms (cough, chest pain, pharyngitis)

o Haemorrhagic symptoms (unexplained bleeding)

o CNS symptoms (Delirium, stupor, and coma)

o A maculopapular rash, primarily on the trunk, begins around day 5

• Treatment and Prevention

o Non-Pharmacological Treatment

▪ There is no specific treatment for Haemorrhagic Fever
▪ Supportive therapy includes
• Mechanical ventilation, renal dialysis, and anti-seizure therapy may

be required

• Management of complications symptomatically
• Maintaining Oxygen status and blood pressure

o Pharmacological Treatment

▪ Paracetamol
▪ Treat for any complicating infection and co-morbid condition • B:
▪ Oxygen and management of hypoglycaemia if present
▪ Fluid and electrolyte balance
• Sodium Lactate Compound (Ringers Lactate)
• NS intravenously if patient cannot take fluids orally

o Prevention

▪ Strictly isolation and handling of patients
▪ Wearing of completely body covering protective gears when handling

patients

▪ Special and strictly handling of the dead

STEP 4: Marburg Haemorrhagic Fever (15 minutes)

• Cause and Transmission
• Marburg is severe type of haemorrhagic fever which affects both

animals and humans

• It is caused by the Marburg virus and it is related to Ebola virus

and a parent type belongs to viral haemorrhagic fevers of Filoviridae

family

• Transmission

o Spread of the virus between humans has occurred in a setting of

close contact, often in a hospital

o Droplets of body fluids, or direct contact with persons, equipment,

or other objects contaminated with infectious blood or tissues are

all highly suspect as sources of disease

o Transmission through infected semen can occur up to seven weeks

after clinical recovery

o Transmission does not occur during the incubation period

• Signs and Symptoms

o Incubation period is between 3-9 days

o All age groups are susceptible but most case to adults

o Signs and symptoms occur in two phases:

▪ Phase One
• Sudden onset of fever, chills, headache and myalgia
▪ Phase Two
• Maculopapular rashes, Trunk rash, Nausea, Vomiting, Sore throat,

Abdominal pain, Diarrheal, Jaundice, Pancreas inflammation, Severe

weight loss Liver failure, Massive haemorrhage (all orifices), Multi-

organ dysfunction, Delirium, Shock, and Death

• Treatment and Prevention

o There is no specific treatment, cure, or vaccine for Marburg

Haemorrhagic fever

o Supportive hospital therapy:

▪ Fluid and Electrolyte balancing
▪ Oxygen
▪ Blood transfusion and clotting factors
▪ Treatment of complicating infections

o Prevention

▪ Isolation of patients
▪ Wearing protective gears when attend patients or dead bodies

STEP 5: Rift Valley Fever (10 minutes)

• This is a viral zoonosis that is primarily spread amongst animals by

the bite of infected mosquitoes, transmitting the Rift Valley virus

• Aedes mosquitoes are the main vector biting animals
• Transmission to human is mainly by direct or indirect contact with

blood or organs of infected animals through;

o Handling of animal tissue during slaughtering or butchering

o Assisting with animal births, conducting veterinary procedures

o Direct inoculation e.g. via wound from infected knife or through

contact with broken skin or through inhalation of aerosols produced

during the slaughter of an infected animal

o Bite of an infected mosquito

• Signs and Symptoms

o Acute febrile illness that does not respond to antibiotic or

antimalarial therapy

o Exhaustion, backache, muscle pains, headache (often severe)

o Photophobia

o Nausea/vomiting

o Evidence of bleeding into skin, bleeding from puncture wounds, from

mucous membranes or nose, from gastrointestinal tract and unnatural

bleeding from vagina

o Clinical jaundice

• Treatment and Prevention

o There is no any established course of treatment of this disease.

o Most of human cases are relatively mild and of short duration so will

not require any specific treatment

o Prevention

▪ Mosquito control
▪ Wearing proactive gears when handling animals or their fluids

STEP 6: Dengue Haemorrhagic Fever (15 minutes)

• Cause and Transmission

o Dengue is a mosquito-borne viral infection causing by the dengue fever

virus, whose full life cycle involves the role of mosquito as a

transmitter (or vector) and humans as the main victim and source of

infection

o Dengue does not spread directly from person to person, it is only

spread through the bite of an infected Aedes aegypti mosquito.

• Signs and Symptoms

o Dengue Febrile Illness (DF):

▪ Retro-orbital or ocular pain, headache, rash, myalgia, arthralgia
▪ Haemorrhagic manifestations (epistaxis, gum bleeding; blood in

vomitus, urine, stool; or vaginal bleeding

▪ Anorexia, nausea, abdominal pain, and persistent vomiting may also

occur

o Dengue Haemorrhagic Fever (DHF)

▪ Persistent high grade fever lasting from 2-7 days
▪ Spontaneous bleeding
▪ Retro-orbital pain
▪ Joint, muscle and abdominal pain
▪ Macular or confluent blanching rash (noted during recovery period)
▪ Thrombocytopenia (>100,000 cells per mm3)

o Dengue Shock Syndrome (DSS)

▪ Circulatory failure as evidenced by rapid and weak pulse and narrow

pulse pressure (<20mm Hg)

▪ Age-specific hypotension and cold, clammy skin and restlessness
• Treatment and Prevention

o No specific treatment is available for Dengue fever

▪ Supportive Treatment
• Paracetamol
• Fluids (Ringers lactate, NS)
• Blood transfusion and clotting factors
• Oxygen and management of hypoglycaemia if present

STEP 7: Yellow Fever (10 minutes)

• Cause and Transmission

o Yellow fever is an acute mosquito-borne flavivirus infection endemic

in tropical South America and sub-Saharan Africa

o The virus is transmitted to human through a bite of infected Aedes

mosquitoes

o The disease can be life threatening causing haemorrhagic fever and

hepatitis

• Signs and Symptoms

o Fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue

• Treatment and Prevention

o No specific anti-viral treatment

o Supportive (symptomatic) therapies are given

o Prevention and control

▪ Mosquito control
▪ Yellow Fever vaccine.
• Persons ≥ 9 months of age
• Persons planning to travel to or residence in an endemic area

STEP 8: Key Points (5 minutes)

• VHFs are caused by RNA viruses of five distinct families;

Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae, and

Paramyxoviridae

• VHFs affect many organs, damage the blood vessels and affect the

body's ability to regulate itself

• There is not specific treatment for the VHFs

STEP 9: Evaluation (5 minutes)

• What is a VHF?
• How are VHS acquired by humans?

References

Hugo and Russell (2011), Pharmaceutical Microbiology 8th Edition, Willey-

Blackwel publications

Karen C. Carroll et al (2013); Jawetz, Melnick and Adelberg’s Medical

Microbiology 26th Ed. McGraw Hill Co. Inc.

Greenwood et al (2012); Medical Microbiology, 18th edition Churchill

Livingstone

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