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Abstract:
Human life is intricately related to it’s surrounding environment which also harbors other animals and some
deadly infectious pathogens. Any threat to the environment can thus increase the threat of new and so-called
‘emerging infectious diseases’ (EIDs) especially novel viral infections called ‘emerging viral diseases’. This
occurs partly due to changing climate as well as human interference with nature and animal life. An important
event in new disease emergence is genetic changes in the pathogen that make it possible to become established
in a new host species, productively infect new individuals in the new hosts (typically humans) and create local,
regional or worldwide health threats. The world has witnessed some emerging and deadly viral threats in
recent past with huge mortality and morbidity. Among them were severe acute respiratory syndrome (SARS),
bird flu, swine flu, Middle East respiratory syndrome (MERS), ebola virus disease. Moreover some disease has
caused great concern in certain regions including Bangladesh in terms of morbidity, like Nipah virus, Zika
virus, Dengue and Chikungunya fever. Here in this article an attempt was made to briefly describe some of
these emerging viral infections.
Key Words: Emerging virus
(BIRDEM Med J 2017; 7(3): 224-232)
225
Birdem Medical Journal Vol. 7, No. 3, September 2017
c) Chronic phase : > 3 months. 10-15% of the patient should be present: virus isolation by cell culture (only
those who present with severe Chikungunya progress research purpose), detection of viral RNA by real-time
to Sub-acute or chronic phase. reverse-transcription polymerase chain reaction (rRT-
Acute phase is characterized by the triad of Fever (92%), PCR) (within 5 days of onset of Illness), detection of
Arthralgia/arthritis (87%) and Rash. Fever is sudden antibody by enzyme linked immunosorbent assay
onset, high grade with chills and lasts for 3 to 5 days (ELISA) - Viral specific IgM antibody in single serum
(range 1 to 10 days). Fever can be biphasic.11 Joint sample collected within 5 to 28 days of onset fever or
pain occurs initially or begins 2-5 days after onset of four-fold rise of IgG antibody in samples collected at
fever. Arthralgia is bilateral, symmetrical, distal joints least three weeks apart (1st sample after 7 days).19 In
more than proximal joints. Most affected joints are CNS affected patients cerebro-spinal fluid (CSF) may
hands (50 to 76%), wrists (29 to 81%), and ankles (41 be studied.
to 68%). Involvement of the axial skeleton was noted
Treatment
in 34 to 52% of cases. Periarticular edema or swelling
has been observed in 32 to 95% of cases. Large joint Treatment of CHIKV in acute phase is mostly supportive
effusions were noted in 15% of cases.12 Skin rash has with rest, adequate electrolyte containing fluid (at least
been reported in 40 to 75% of patients which may be 2-3 L/ day) and paracetamol upto maximum 4 gm/day
macular or maculopapular, usually occurs within first for fever and joint pain. Additional tramadol or
4 days of fever, starts on the limbs and trunk, pruritic tapentadol may be used if joint pain is not relieved by
in 25 to 50% of patients. Atypical dermatologic paracetamol. There is no specific anti-viral therapy.20
manifestations include bullous skin lesions (most often There is no indication of steroid in acute phase. Non-
in children) and hyperpigmentation. 13 Cervical steroidal anti-inflammatory drugs (NSAIDs) should best
lymphadenopathy may occur in10-40% of patients, be avoided in the acute phase, but if required may be
mostly in children or young adults.14 Few patients may used once dengue is excluded, but avoid aspirin. Cold
present or develop complications like severe sepsis or compression of joints is helpful. Hospitalization is
septic shock, meningoencephalitis, Guillian-Barre required for only those with hypotension, altered
syndrome (GBS), myocarditis, decomposition of consciousness, bleeding manifestations, co-morbidity,
cardiovascular diseases, fulminant hepatitis in patients extreme age or decreased intake. In the subacute phase
with chronic liver disease (CLD), pancreatitis, the mainstay of treatment is adequate doe of NSAIDs
extensive epidermolysis, kidney failure, respiratory and physiotherapy. In some patients short course
failure. Complications occur in patients of extreme systemic steroid may be necessary. In the chronic phase
ages - > 65, children, pregnancy, co-morbidity – patient must be evaluated by a rheumatologist for the
diabetes mellitus, hypertension, ischemic heart disease initiation of disease modifying anti-rheumatic drugs
and other co-infection.15,16 In the subacute phase the (DMARDs).21
predominant features is arthritis/arthralgia and
fatigue.17 In 10-15% patients the joint symptoms Prognosis
progress beyond 3 months among whom 50 % patients Prognosis is good compared to dengue. Younger patients
evolve into rheumatoid arthritis or seronegative recover within 5 to 15 days. Recovery is delayed in the
spondyloarthitides or non-specific viral arthritis.18 elderly. In few patients joint pain can persist up to 2
years. The risk of death is around 1 in 1,000 which is
Investigations relatively low compared to dengue hemorrhagic fever
Investigations include testing blood or serum for direct (DHF).22 After a single infection it is believed most
or indirect evidences of CHIKV infection. Complete people become immune.
blood count (CBC) will reveal leukopenia with marked
lymphopenia, or sometimes pancytopenia and mild Prevention
thrombocytopenia. In all patients dengue should be Preventing mosquito bite and vector control by control
excluded by doing NS-1. For confirmation of the case of mosquito breeding places are the best way to prevent
at least one of the followings in the acute phase of illness CHIKV infection.
226
Emerging Viral Diseases Ahmed JU et al
227
Birdem Medical Journal Vol. 7, No. 3, September 2017
228
Emerging Viral Diseases Ahmed JU et al
are unusual features of seasonal influenza. Other 2003. Since then, over 700 cases have been reported,
frequent findings included chills, myalgias, and in Africa, Asia, and Europe. The highest numbers have
arthralgia. 42,43 Complications like rapidly progressive been in Indonesia, Vietnam, and Egypt. The most recent
pneumonia, respiratory failure, acute respiratory distress case of H5N1 was reported in Malaysia in March
syndrome (ARDS), and multisystem organ failure were 2017.48 It killed a number of chickens, but no human
reported in some cases during the 2009 to 2010 H1N1 cases were reported. It is not easy for humans to catch
influenza A pandemic. it, but it is fatal in 60 percent of cases. H5N1 affects
rRT-PCR is the most sensitive and specific test for the several types of birds. It has mostly been reported in
diagnosis of pandemic H1N1 influenza A virus farmed poultry, such as chickens, geese, turkeys, and
infection.44 ducks. Most people with the virus have had direct
Treatment contact with infected poultry or objects contaminated
Specific anti-viral treatment is available for swine flu. with bird feces or secretions.
During the 2009 to 2010 H1N1 influenza A pandemic, In late March and April 2013, human cases of novel
the United States Centers for Disease Control and avian influenza A H7N9 infection in China were reported
Prevention (CDC) released guidelines for the use of to the World Health Organization.49 The number of new
antivirals for patients with confirmed or suspected cases peaked in April 2013 and then declined due to
influenza virus infection, which include a neuraminidase
implementation of control strategies including closure
inhibitor (orally inhaled or intravenous zanamivir, oral
of live bird markets and increased public awareness.
oseltamivir or newly developed intravenous
peramivir).45 Prompt or early initiation of antiviral Since then, annual epidemics have occurred during
therapy was recommended for children, adolescents, or influenza season; most cases have occurred in China.50
adults with suspected or confirmed influenza infection The largest wave was the fifth wave in late 2016 and
and any of the following features-illness requiring early 2017. Since 2013, annual epidemics of avian
hospitalization, progressive, severe, or complicated influenza A H7N9 have resulted in >1300 reported cases.
illness, regardless of previous health status, children <5 Avian influenza A H7N9 virus appears to have derived
years of age, adults e”65 years of age, pregnant women from multiple reassortment events of at least 4 avian
and women up to two weeks postpartum and individuals influenza viruses. This occurred because of migration
with co-morbid conditions.46 of wild birds and growing chicken and ducks in close
proximity, thus giving the chance to genetic reassortment
Prevention
and development of a novel virus.51
Since the trivalent influenza vaccine did not give
protection against swine flu, it was necessary for a new Diagnosis
vaccine. Starting with the 2010 influenza season in the The usual incubation period has been estimated to be
southern hemisphere and the 2010 to 2011 season in the from 3 to 7 days but has been reported to be as long as
northern hemisphere, the trivalent influenza vaccine 10 days. Patients have presented with respiratory tract
included antigen from the 2009 pandemic H1N1 influenza infections, many of which have progressed to severe
A virus. Some monovalent pandemic H1N1 influenza A pneumonia. Presenting signs and symptoms may include
vaccines are also available with variable efficacy.47 The fever, cough, dyspnea, headache, myalgias, and malaise.
CDC recommended that H1N1 influenza vaccine be given Complications like fulminant pneumonia, respiratory
to all persons six months of age and older. failure, ARDS, septic shock, multiorgan failure,
rhabdomyolysis, disseminated intravascular
coagulation, and encephalopathy can develop in some
Avian Influenza/ Bird Flu patients.
Epidemiology Avian influenza A H5N1 and H7N9 can be detected by
There has been 2 different strains of avian origin rRT-PCR from nasopharyngeal and/or lower respiratory
Influenza A virus that has caused pandemics in different tract samples. On chest radiograph and computed
times. The first one is a highly pathogenic avian tomography (CT) scanning, patients with pneumonia
influenza (HPAI) virus H5N1 with a high mortality rate. have had multilobar patchy consolidations and diffuse
The first outbreak of H5N1 bird flu was in December ground-glass opacities.
229
Birdem Medical Journal Vol. 7, No. 3, September 2017
230
Emerging Viral Diseases Ahmed JU et al
7. Rahim MA, Uddin KN. Chikungunya: an emerging viral 22. Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani
infection with varied clinical presentations in Bangladesh: KV. Increased mortality rate associated with chikungunya
Reports of seven cases. BMC Res Notes 2017; 10: 410. epidemic, Ahmedabad, India. Emerg Infect Dis 2008; 14
(3):412.
8. Lenglet Y, Barau G, Robillard PY etal. Chikungunya infection
in pregnancy: Evidence for intrauterine infection in pregnant 23. de Oliveira WK, Carmo EH, Henriques CM, Coelho G,
women and vertical transmission in the parturient. Survey of Vazquez E, Cortez-Escalante J etal. Zika Virus Infection and
the Reunion Island outbreak. J Gynecol Obstet Biol Reprod Associated Neurologic Disorders in Brazil. N Engl J Med
2006; 35 (6):578-83. 2017;376(16):1591. Epub 2017 Mar 29
9. Couderc T, Gangneux N, Chrétien F etal. Chikungunya virus 24. Hayes EB. Zika virus outside Africa. Emerg Infect Dis
2009;15:1347–50.
infection of corneal grafts. J Infect Dis 2012; 206 (6):851.
25. Fauci AS, Morens DM. Zika Virus in the Americas—Yet
10. Weaver SC, Lecuit M. Chikungunya virus and the global
Another Arbovirus Threat. N Engl J Med 2016;374 (7):601.
spread of a mosquito-borne disease. N Engl J Med 2015; 372
26. Chen LH, Hamer DH. Zika Virus: Rapid Spread in the Western
(13):1231.
Hemisphere. Ann Intern Med 2016;164(9):613.
11. Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT.
27. Bogoch II, Brady OJ, Kraemer MU, German M, Creatore MI,
Chikungunya: a re-emerging virus. Lancet 2012; 379 Kulkarni MA etal. Anticipating the international spread of
(9816):662-71. Epub 2011 Nov 17. Zika virus from Brazil. Lancet 2016;387 (10016):335. Epub
12. Simon F, Parola P, Grandadam M etal. Chikungunya infection: 2016 Jan 15.
an emerging rheumatism among travelers returned from Indian 28. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K
Ocean islands. Report of 47 cases. Medicine (Baltimore) etal. Potential for Zika virus transmission through blood
2007; 86 (3):123. transfusion demonstrated during an outbreak in French
13. Lakshmi V, Neeraja M, Subbalaxmi MV, etal. Clinical features Polynesia, November 2013 to February 2014. Euro Surveill
and molecular diagnosis of Chikungunya fever from South 2014;19 (14) Epub 2014 Apr 10.
India. Clin Infect Dis 2008; 46 (9):1436. 29. Brasil P, Calvet GA, Siqueira AM, Wakimoto M, de Sequeira
14. Borgherini G, Poubeau P, Staikowsky F, etal. Outbreak of PC, Nobre A etal. Zika Virus Outbreak in Rio de Janeiro,
chikungunya on Reunion Island: early clinical and laboratory Brazil: Clinical Characterization, Epidemiological and
features in 157 adult patients. Clin Infect Dis 2007; 44 Virological Aspects. PLoS Negl Trop Dis 2016;
(11):1401. 10(4):e0004636. Epub 2016 Apr 12.
15. Gérardin P, Couderc T, Bintner M, Tournebize P, Renouil M, 30. Dos Santos T, Rodriguez A, Almiron M, Sanhueza A, Ramon
Lémant J etal. Chikungunya virus-associated encephalitis: A P, de Oliveira WK etal. Zika Virus and the Guillain-Barré
cohort study on La Réunion Island, 2005-2009. Neurology Syndrome - Case Series from Seven Countries. N Engl J Med
2016; 86 (1):94. 2016;375 (16):1598. Epub 2016 Aug 31.
16. Rollé A, Schepers K, Cassadou S, Curlier E, Madeux B, 31. Mlakar J, Korva M, Tul N, PopoviM, Poljšak-Prijatelj M,
Hermann-Storck C etal. Severe Sepsis and Septic Shock Mraz J etal.Zika Virus Associated with Microcephaly. N Engl
Associated with Chikungunya Virus Infection, Guadeloupe, J Med 2016;374 (10):951. Epub 2016 Feb 10.
2014. Emerg Infect Dis 2016; 22 (5):891-4. 32. Driggers RW, Ho CY, Korhonen EM, Kuivanen S,
17. Parola P, Simon F, Oliver M. Tenosynovitis and vascular Jääskeläinen AJ, Smura T etal. Zika Virus Infection with
disorders associated with Chikungunya virus-related Prolonged Maternal Viremia and Fetal Brain Abnormalities.
rheumatism. Clin Infect Dis 2007; 45 (6):801. N Engl J Med 2016;374(22):2142.
231
Birdem Medical Journal Vol. 7, No. 3, September 2017
33. Vouga M, Baud D. Imaging of congenital Zika virus infection: 46. United States Centers for Disease Control and Prevention.
the route to identification of prognostic factors. Prenat Diagn Updated interim recommendations for the use of antiviral
2016;36 (9):799. Epub 2016 Aug 25. medications in the treatment and prevention of influenza for
the 2009-2010 season. http://www.cdc.gov/h1n1flu/
34. Centers for Disease Control and Prevention. Emergency
recommendations.htm (Accessed on December 15, 2009).
Preparedness and Response: Recognizing, Managing, and
Reporting Zika Virus Infections in Travelers Returning from 47. Wu J, Xu F, Lu L, Lu M, Miao L, Gao T etal. Safety and
Central America, South America, the Caribbean, and Mexico. effectiveness of a 2009 H1N1 vaccine in Beijing. N Engl J
http://emergency.cdc.gov/han/han00385.asp (Accessed on Med 2010;363 (25):2416.
January 18, 2016). 48. Robert G. Webster; Elena A. Govorkova, MD. H5N1 Influenza
— Continuing Evolution and Spread. N Engl J Med 2006;
35. WHO Ebola Response Team. Ebola virus disease in West
355 (21): 2174–77.
Africa—the first 9 months of the epidemic and forward
projections. N Engl J Med 2014;371(16):1481. 49. World Health Organization. Global alert and response. H7N9
avian influenza human infections in China. http://
36. Schou S, Hansen AK. Marburg and Ebola virus infections in www.who.int/csr/don/2013_04_01/en/index.html (Accessed
laboratory non-human primates: a literature review. Comp on April 03, 2013).
Med 2000;50(2):108.
50. Gao R, Cao B, Hu Y, Feng Z, Wang D, Hu W etal. Human
37. Chertow DS, Kleine C, Edwards JK, Scaini R, Giuliani R, infection with a novel avian-origin influenza A (H7N9) virus.
Sprecher A. Ebola virus disease in West Africa—clinical N Engl J Med 2013;368 (20):1888. Epub 2013 Apr 11.
manifestations and management. N Engl J Med
51. Liu D, Shi W, Shi Y, Wang D, Xiao H, Li W etal. Origin and
2014;371(22):2054. diversity of novel avian influenza A H7N9 viruses causing
38. Feldmann H, Geisbert TW. Ebola haemorrhagic fever. Lancet human infection: phylogenetic, structural, and coalescent
2011; 377(9768):849. analyses. Lancet 2013;381 (9881):1926. Epub 2013 May 1.
39. Fowler RA, Fletcher T, Fischer WA, Lamontagne F, Jacob S, 52. Adisasmito W, Chan PK, Lee N, Oner AF, Gasimov V,
Brett-Major D etal. Caring for critically ill patients with ebola Aghayev F etal. Effectiveness of antiviral treatment in human
virus disease. Perspectives from West Africa. Am J Respir influenza A(H5N1) infections: analysis of a Global Patient
Crit Care Med 2014;190(7):733. Registry. J Infect Dis 2010;202 (8):1154.
40. Centers for Disease Control and Prevention (CDC). Outbreak 53. Writing Committee of the Second World Health Organization
Consultation on Clinical Aspects of Human Infection with
of swine-origin influenza A (H1N1) virus infection - Mexico,
Avian Influenza A (H5N1) Virus - Abdel-Ghafar AN,
March-April 2009. MMWR Morb Mortal Wkly Rep 2009;58
Chotpitayasunondh T, Gao Z, Hayden FG, Nguyen DH, de
(17): 467.
Jong MD etal. Update on avian influenza A (H5N1) virus
41. Shrestha SS, Swerdlow DL, Borse RH, Prabhu VS, Finelli L, infection in humans. N Engl J Med 2008;358 (3):261.
Atkins CY etal. Estimating the burden of 2009 pandemic 54. Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung
influenza A (H1N1) in the United States (April 2009-April M etal. A cluster of cases of severe acute respiratory syndrome
2010). Clin Infect Dis 2011;52 Suppl 1:S75. in Hong Kong. N Engl J Med 2003; 348 (20):1977.
42. Novel Swine-Origin Influenza A (H1N1) Virus Investigation 55. Peiris JS, Yuen KY, Osterhaus AD, Stöhr K. N. The severe
Team - Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom acute respiratory syndrome. N Engl J Med 2003;349
S, Garten RJ etal. Emergence of a novel swine-origin influenza (25):2431.
A (H1N1) virus in humans. N Engl J Med 2009;360 (25):2605. 56. Chinese SARS Molecular Epidemiology Consortium.
43. Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS etal. for Molecular evolution of the SARS coronavirus during the
National Influenza A Pandemic (H1N1) 2009 Clinical course of the SARS epidemic in China. Science 2004;303
Investigation Group of China. Clinical features of the initial (5664):1666. Epub 2004 Jan 29.
cases of 2009 pandemic influenza A (H1N1) virus infection 57. Centers for Disease Control and Prevention (CDC).
in China. N Engl J Med 2009;361(26):2507. Epub 2009 Dec Preliminary clinical description of severe acute respiratory
9. syndrome. MMWR Morb Mortal Wkly Rep 2003;52 (12):255.
44. Kumar S, Henrickson KJ. Update on influenza diagnostics: 58. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL
lessons from the novel H1N1 influenza A pandemic. Clin etal. for HKU/UCH SARS Study Group. Clinical progression
Microbiol Rev 2012;25(2):344. and viral load in a community outbreak of coronavirus-
associated SARS pneumonia: a prospective study. Lancet
45. Gaur AH, Bagga B, Barman S, Hayden R, Lamptey A,
2003; 361 (9371):1767.
Hoffman JM etal. Intravenous zanamivir for oseltamivir-
resistant 2009 H1N1 influenza. N Engl J Med 2010; 362 59. Stockman LJ, Bellamy R, Garner P. SARS: systematic review
(1):88. Epub 2009 Dec 23. of treatment effects. PLoS Med 2006;3(9):e343.
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