CC Sept 2015 Chikungunya

echoecho's version from 2016-04-28 01:50


Question Answer
Describe what Chikungunya virus (CHIKV) is?1) arthropod-borne 2) single-stranded RNA Arbovirus
The name Chikungunya is derived from where?1) a local language in Tanzania 2) refers to the bent, stopped, contorted walk seen in patients with severe arthralgias characteristic of the disease
As of February 2015, local transmission of CHIKV has occurred in 100 counties and territories in what areas of the world?1) Asia 2) Africa 3) Oceania / Pacific Islands 4) Europe 5) Americas
As of January 2015, there have been ________ suspected cases in the Caribbean Islands, Latin American and the United States?1,135,000
There were 2,492 cases reported in the US in 2014, eleven transmitted cases from what state (with all others in travelers returning from affected areas)?Florida
Between Jan 1 and March 24, 2015, there were _____ cases reported over 19 states, all involving travelers returning from endemic areas?68
Is CHIKV a nationally notifiable conditions in the US, reported to the CDC by state and local health departments?yes
List the 3 forms of transmission?1) vector 2) nosocomial 3) vertical
Vector transmission is sustained by _____ transmission to susceptible humans?mosquito
List the 2 primary mosquito vectors?1) Aedes aegypti 2) Aedes albopictus
These 2 mosquito vectors also transmit what virus (like CHIKV) is increasing in geographic range and rate of transmission?Dengue virus
Where is Aedes aegypti confined to what parts of the world?1) tropics 2) subtropics 3) S. E. United States 4) Southwest
Where is Aedes albopictus confined to what parts of the world?1) tropics 2) subtropics 3) temperate 4) cold temperate (including many parts of the US)
How is the infection spread through nosocomial transmission?occurs with exposure to infected blood or organs (including corneas)
How is the infection spread through vertical transmission?when neonates become infected from others who are viremic at the time of delivery
Regarding vertical transmission, transmission is ________ and is Cesarean section protective?intrapartum; no
Is there any evidence of congenital infection (or any adverse effects) with in utero exposure?no
Clinical manifestations in acute infection starts abruptly with what two symptoms? After an incubation period of ___ to ___ days (range 1-14 days)?1) fever; malaise 2) two to eight days
The persistent fever lasts ___ to ___ days (range 1-10 days) and is high-grade (e.g. ____ C / ____F)?1) 3-5 2) 40; 104
The fever is followed by _________ which occurs 2-5 days after fever onset, often involving ____ or more joint groups?polyarthralgia; 10
Which joints are affected more (proximal vs. distal)?distal
Skin manifestations occur in ___ to ___% of those affected?40-75
Most commonly, there is a macular or maculopapular rash that usually appears ____ days after onset of illness, starting where on the body, but possibly involving the face?3; limbs and trunk
Describe the rash?1) patchy or 2) diffuse with islands of normal skin 3) itchy in 25-50% of all patients
What type of skin lesions can occur, especially in children?bullous skin lesions
Hemorrhagic manifestations can occur but are uncommon and usually _____?mild
List other physical signs and symptoms?1) headache 2) myalgia 3) nausea 4) periarticular edema/swelling 5) lymphadenopathy (primarily cervical) 6) conjunctivitis
Are vomiting, diarrhea and LAD typically present?no
What are the lab abnormalities seen most commonly?1) lymphopenia 2) thrombocytopenia 3) liver enzymes may be elevated 4) creatinine may be elevated
Are symptoms generally self-limited? How long do they last?1) yes 2) last 2-3 days with the virus remaining in the system for 5-7 days
List the 4 sequelae for cases of persistent symptoms?1) relapsing or unremitting and incapacitating arthralgia usually involving joints affected during the acute illness 2) carpal tunnel syndrome with hypertrophic tenosynovitis 3) new-onset Raynaud phenomena in the second or third month after infection 4) cryoglobulinemia
Severe complications primarily affect patients > ____ years of age or what patient types?1) 65 2) those with chronic medical problems (respiratory failure, cardiovascular decompensation , myocarditis, acute hepatitis, nephritis)
Neurologic involvement, most commonly _________?meiningoencephalitis
List the other neurologic involvement?1) acute flaccid paralysis 2) Guillain-Barre syndrome 3) sensorineural hearing loss 4) cranial nerve palsies 5) ocular manifestations
What is the duration of symptoms and what may occur?1) variable (may last months to years) 2) death
Differential dx depends on what?1) residence 2) travel hx 3) exposures
List some diff dx?Dengue fever (which is transmitted by the same mosquitoes)
Is coinfection possible?yes
If the clinical course is atypical or if the fever persists longer than 5-7 days, one should consider what diseases?1) Dengue fever 2) Zika virus 3) yellow fever 4) amebiasis
Where is testing for CHIKV done?1) CDC 2) several state health departments 3) one commercial lab
What is the primary tool in the clinical setting of testing for the virus, as culture and molecular techniques are primarily research tools?serology
Acute serology samples should be collected during the _____ week after the onset of symptoms and convalescent samples at _____ weeks?1st; 3
What type of antibodies are present starting about 5 days following onset of symptoms (range, 1-12 days) with highest levels at 3-5 weeks and persistence for up to 3 months?IgM
What type of antibodies begin about 2 weeks following onset of symptoms and persist for years, if not lifelong?IgG
Is viral culture primarily utilized as a research tool?yes
The virus can be isolated from blood during the first ____ weeks of illness?few
*** What can be detected by reverse transcription polymerase chain reaction (RT-PCR) during the first 5 days following symptom onset. This is faster than viral culture, with better sensitivity and specificity?Viral RNA
There is no disease-specific treatment for CHIKV, however, there is active research in developing what for treatment?monoclonal antibodies
What does treatment consist of?supportive care
What medication can provide symptomatic relief?Acetaminophen
Patients with suspected CHIKV should be managed in the same way as what disease? What is the initial choice for analgesic? Once Dengue fever is ruled out, what analgesics can be used? 1) Dengue fever 2) acetaminophen 3) NSAIDS
*** There is also active research underway to develop a vaccine. Until a vaccine is developed, what can be done to prevent CHIKV?1) minimizing mosquito exposure 2) use of mosquito repellants containing DEET, IR3535 or Icardin on exposed skin 3) protective clothing (long-sleeve shirts, long pants, permethrin-treated clothing) 4) environmental adjustments (air conditioning, screens, devices to reduce indoor biting) 5) avoidance of standing water in outdoor containers 6) people at increased risk for severe disease should consider not traveling to areas with ongoing outbreaks
*** SUMMARY = True or false? Number of cases is increasing, primarily acquired abroad?true
*** SUMMARY = List the most common clinical manifestations?fever, malaise, polyarthralgia, rash
*** SUMMARY = What is treatment?supportive
*** SUMMARY = What testing is available to test for CHICV?serology