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RIFT VALLEY FEVER

RIFT VALLEY FEVER. INFECTIOUS DISEASES. Patient no 1. 24yr farm labourer from Edenburg Presented with upper GIT bleeding to surgery on 10/3/2010

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RIFT VALLEY FEVER

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  1. RIFT VALLEY FEVER INFECTIOUS DISEASES

  2. Patient no 1 • 24yr farm labourer from Edenburg • Presented with upper GIT bleeding to surgery on 10/3/2010 • 4/7 days prior to presentation, he slaughtered and ate the meat of a dead sheep. • PCR (+), IgM (+)

  3. He was admitted to High Care and managed supportively with blood products and dialysis. • His condition deteriorated and he was admitted to Multi, where he passed away on 15/3/2010.

  4. Patient no 2 • 76 yr male from Bainsvlei • Farmed with rabbits • Presented to Trauma with racoon eyes, found to be secondary to a bleeding tendency

  5. Renal failure, deranged liver enzymes as well as thrombocytopenia • He died 2 days after admission to Multi @ Pelonomi.

  6. Patient no 3 • 55yr male, farming near Bloemfontein • Presented to Cardiology with rapid AF, cardiac failure and headache • No clear history of contact with carcasses or infected livestock

  7. Serology 1. - initial PCR weak positive for RVF - cultures positive 2. West Nile virus: titre 680 • Multi-organ failure

  8. Patient no 4 • 44yr old farmer from Koffiefontein • He handled the carcasses of sheep, with confirmed rift valley fever • Presented to Pelonomi with headache, neck stiffness and GIT bleeding

  9. PCR (+), IgM (+) • Died after massive GIT bleeding

  10. Patient no 5 • 18 yr old male from Bainsvlei • No contact with any livestock • Presented with bloody diarrhoea and heamatemesis • Serology confirmed RVF

  11. Deranged liver enzymes and thrombocytopenia • Discharged • Seen yesterday @ COE with no residual complications

  12. Patient no 6 • 46 yr old male from Soutpan • He works at the salt works • Had no contact with livestock • Elevated AST and ALT, but improved • D/C

  13. Patient no 7 • 49yr old male from Soutpan – lives in town • He had no contact with animals • ? ? He ate meat at a funeral • Presented to ENT with an uvula mass, with excessive haemorrhage post biopsy • Recovered and d/c

  14. Patient no 8 • 33yr old abattoir worker from Philipolis • Presented with bleeding haemorrhoids, with preceding headache and fever 3/52 earlier. • Serology confirmed RVF • Liver functions, clotting profile and platelets were normal • D/C

  15. Patient no 9 • 40yr hunter, culls springbok throughout the Free State • Had confirmed RVF 1/12 ago • Presented with unrelated complaints, but did have visual disturbances • Biochemically no abnormalities

  16. 9 patients: • 4 had a clear history of contact with infected meat / carcasses - 2 of whom died • 5 had no contact with meat = mosquito bites - 1 of whom died

  17. RIFT VALLEY FEVER • Family: Bunyaviridae • Genus: Phlebovirus

  18. Distribution

  19. Zoonosis Epizoonosis

  20. Excessive rainfall and flooding • Cycles of 10-15yrs • 1993 Aswan dam in Egypt • 1987 Diama dam in Mauritania

  21. VECTOR AEDES MCINTOSHI

  22. Culex, Plebotomus

  23. Culex, Plebotomus

  24. Clinical picture • Incubation period 2-5 days • Flue-like picture: Febrile-myalgic syndrome • Hepatitis / liver necrosis • Haemorrhagic (1%) --- 50% mortality • Renal failure

  25. Clinical picture • Meningo- encephalitis • Retinopathy – 3/52 - up to 10% - macular oedema - retinitis - infarctions blindness

  26. Diagnosis • History • PCR • Antibodies

  27. Diagnosis • History • PCR • Antibodies EXCLUDE Crimean Congo Fever

  28. Treatment • No specific treatment • Supportive • Isolate haemorrhagic cases until CCHF excluded • Standard infection control measures • Confirmed cases need not be isolated

  29. Prevention • Avoid high risk slaughtering practises • Avoid consumption of fresh blood, raw milk or fresh meat • Slaughtering of animals should be discouraged during outbreaks • Personal protection against mosquito bites

  30. Personal protection • DEET containing insect repellents

  31. Vaccines • Live and attenuated • Formalin inactivated vaccine – not registered in SA

  32. In short… • Preventative measures • Exclude CCHF in endemic areas • High index of suspicion for complicated cases

  33. Bibliography • Harrison’s Principles of Internal Medicine, 17th edition • Mandell, Douglas and Bennet’s Principles and Practice of Infectious Diseases, 5th edition • Uptodate • Google images • www.nicd.ac.za/outbreaks/rvf/rvf_outbreak.htm

  34. Acknowledgements Dr S. Moholo Dr P. Sonnekus Dr D. v Jaarsveld Dr R. Swart Mr G. Carter Dr Gouws Lucille Bloomberg (NICD) NHLS • Dr D. Steyn • Dr van Vuuren • Dr N. Rossouw • Dr. Elliot • Dr D. Greyling • Dr JL. Pretorius • Dr G. Harris • Dr D. Aucamp • Dr K. Behrens

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