Topic - Virology
Q. A 50 year old engineer in your hospital out-patient department is found to be febrile and have to returned two days earlier from West Africa. Discuss the problem posed by this situation.
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The marked increase in traveling to far-flung and exotic locations has made the appearance of exotic infectious diseases much more frequently in the UK. Exotic viral infections in West Africa ranges from a mild arboviral illness to a life-threatening Lassa fever. The following infectious diseases should be sought for and excluded from this patient;-
1. Bacterial and parasitic diseases - malaria and typhoid fever are two common infectious diseases which occur in West Africa and should be excluded from this patient. A blood film for malaria should be taken and inactivated at the bedside of the patient and the result be available before other investigations. Other possible infections that should be considered are rickettsiae infection, leptospirosis, amoebic liver abscess etc.
2. Common ubiquitous viral diseases - one must not forget that certain ubiquitous viral diseases such as influenza is just as likely to strike a person in West Africa as in the UK and thus should be excluded as a possible diagnosis
3. Arboviruses - arboviruses of the togavirus, bunyavirus and flavivirus families are common in West Africa. The diseases caused ranges from an inapparent or mild flu-like illness to a life threatening encephalitis or haemorrhagic fever. Laboratory diagnosis of arboviral infections is difficult as there are so many different viruses which could be involved. Moreover, a few of these agents are classified as group 4 pathogens which requires specialized and expensive facilities to work with. Cases of exotic arboviral infection imported into the UK would not constitute a threat to public health or a threat to health workers as human to human transmission cannot take place in the absence of the insect vector.
4. Yellow fever and dengue - these two arboviral diseases are common in West Africa and are responsible for much morbidity and mortality. The diseases are transmitted to man via mosquito bites. In the case of yellow fever, the reservoir is in monkeys. The presence of an infected person in the UK would not constitute a public health problem since the mosquitoe vector is not that active in the UK.
5. Lassa fever - lassa fever is a prevalent infection in West Africa. Lassa fever is a zoonosis and man are infected through contact with infected urine of the multimammate rat, which is the natural host. The clinical manifestations vary from a mild undifferentiated febrile illness to a fatal disseminated multi-system disease. Typically pharyngeal signs are present and the lungs are affected. Neurological symptoms and signs may be present as well as haemorrhagic phenomena. Moreover, human to human spread is known to occur and hospital personnel had been infected in the past and thus cases of imported Lassa fever would pose a serious threat to hospital and laboratory workers. Lassa fever is classified as a group 4 pathogen. The antiviral drug ribavirin had been reported to have a possible beneficial effect on the illness.