filoviruses - enivdsymptoms of ebola virus disease (evd) • beginning with high fever...
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Filoviruses
Dr. Olga Dolnik Philipps-University Marburg
Institute of Virology 24.2.2015
ECDC Training Course – Ebola and Marburg Diagnostic 24th February to 27th February 2015
Robert Koch Institute, Berlin
Taxonomy
Order
Family
Genus
Species
Mononegavirales (ss –RNA)
Rhabdoviridae Paramyxoviridae Filoviridae Bornaviridae
Ebolavirus Marburgvirus Cuevavirus
Zaire
EBOV
Sudan
SUDV
Tai Forest
TAFV
Reston
RESTV
Bundibugyo
BDBV
First documented Filovirus Outbreak
• Marburg, Frankfurt, Belgrade. • Primary cases: Lab workers
with contact to tissue of imported monkeys (Uganda).
• Secondary cases: relatives, health care workers.
• 32 cases, CFR: 25%.
Werner Slenczka Rudolf Siegert 100 nm
Conjunctivitis Enanthema
Thrombocytopenia Diarrhea Exanthema Hepatitis
Hemorrhages
Marburg virus hemorrhagic fever
Imported Marburg fever (Netherlands 2008)
• July 5: – Dutch tourist (41) returning from holiday in Uganda (June 5 – 28) – Presents to the general practitioner with high fever (39°C, 3d) – Admission to the local hospital – Placed in a room with 3 other patients – Malaria diagnostics negative – Bacteriological tests, treatment with ceftriaxone (2 g/day)
• July 7: – Rapid deterioration, liver failure: Hemorrhagic fever as differential
diagnosis included – Transfer to Leiden University Hospital; patient developed rash,
conjunctivitis, diarrhea, liver and kidney failure, hemorrhages. – Extensive bacteriological and virological analyses
• July 10: – Tested positive for Marburg virus at the Bernhard-Nocht-Institut in
Hamburg.
• July 1: – Patient died of cerebral edema.
The Python cave, Uganda
© René Gottschalk © René Gottschalk
Marburg virus RNA in animal species collected in the Goroumbwa gold mine, Durba
Swanepoel et al., EID, 2007
Durba: Bat and human MARV isolates
Phylogenetic tree
Swanepoel et al., EID, 2007
Since 1976 emerging EBOV outbreaks in central Africa
EBOV outbreaks in humans
Ebola virus Reston circulates in Philippines
- Epizootics since 1989 - non pathogenic in humans - pathogenic for cynomolgus macaques (systemic) - symptomatic disease in pigs (lung), asymptomatic infections - transmission to humans (IgG) - REBOV-specific IgG in Rousetttus amplexicaudatus bats
Transmission and Reservoir
Detection of specific antibodies Isolation of virus specific RNA
Distribution of fruit bats in equatorial Africa
Baize et al., 2014
Emergence of Zaire Ebola virus in Guinea
Regional distribution of confirmed and suspected cases of EVD in October 2014 (WHO)
1. Densely populated regions with big cities, Conakry (Guinea), Monrovia (Liberia) und Freetown (Sierra Leone)
2. Poor medical infrastructure in rural regions, traditional burial practices 3. Cross-boarder trade and social activities
Three major factors driving continuous transmission of EBOV in West Africa
Human to human transmission
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- direct body contact with symptomatic patients - direct contact with body fluids of patients (blood, urine, stool, sweat, saliva, sputum,
semen, breast milk) - direct contact with contaminated surfaces - no air transmission - low kontagiosity (R0 Ebola 1-4, R0 measles 12-18) - moderate thermostability (4°C weeks, room temperature days, 60°C 30min, 5min boiling) - sensitive to UV, detergents, formaldehyde, acids - anti-viral disinfectant (enveloped viruses!), chloric bleach
SW Mitchell end JB McCormic, 1984 Piercy et al., 2010
Prevention
Ebolavirus
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Glycoprotein, GP
ribonucloproteincomplex
matrix, VP40
lipidenvelope
L. Kolesnikova
1977 W. Slenczka
3´ Leader Trailer 5´ NP 35 40 GP 24 30 L
sGP
Replication cycle
Dolnik et al., Cell Mol Life Sci. 2008
NPC1 actin
Pathogenesis
Nature reviews Immunology 2007
• Incubation time 2-21 days
Symptoms of Ebola virus disease (EVD)
• Beginning with high fever (>38,5°C), muscle pain, nausea
• Multiplication of the virus in vital organs like liver, kidney, spleen and lung which causes organ failure
• abdominal pain, diarrhea
• destruction of the vascular endothelium
• sever cases die due to multi-organ failure and shock
Case definition EVD
clinical, epidemiological, high-risk exposer and laboratory criteria
clinical criteria: fever ≥ 38,6°C and any of the following: - severe headache - vomiting, diarrhea, abdominal pain - unexpected hemorrhagic signs - multi-organ failure epidemiological criteria: within 21 days before the onset of symptoms:- having been in an area with community transmission of EVD - having contact with probable or confirmed EVD case high-risk exposer criteria: - close contact (within 1m) without appropriate personal protection with a probable or confirmed case who was coughing, vomiting bleeding, had diarrhea, unprotected sexual contact with a case up to three month after recovery - direct contact with body fluids from a probable or confirmed case - percutaneous injury or mucosal exposure to body fluids, tissue or laboratory specimens of a probable or
confirmed case - participation in funeral rites with direct exposure to human remains in or from affected area without
personal protection - direct contact with bats, rodents, primates, living or dead, in or from affected area, or bush meat
laboratory criteria: detection of nucleic acid, Ag-ELISA, EM in clinical specimens
Management of patients with haemorrhagic fevers
• Isolation units, Personnel under full protection • Meldung an das jeweils zuständige
Gesundheitsamt.
(Meldepflicht bei Auftreten und beim Verdacht auf hämorrhagisches Fieber (IfSG).
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BSL 4 Laboratory at the Philipps-University in Marburg
BSL4 Lab
Diagnostic Direct virus detection: Real-time-PCR (Altona Filovirus screen) > RNA detection! Antigen-ELISA (Matrix protein specific antibodies) (Senova) Electron microscopy > detection of virus particles in patient samples Virus cell culture (BSL-4) > CPE
Diagnostic Antibody detection (Serology): IgM-IgG ELISA Indirect Immunofluorescence Test (IFT) Virus neutralization test
Vaccine
Experimental drugs and vaccines in clinical trials
Thank you for your attention!
Questions?