RIFT VALLEY

FEVER INFECTIOUS

DISEASES

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 (+)

10/3/2010 11/3/2010 12/3/2010 13/3/2010 14/3/2010

AST 4742 3195 4508 > 10 000 8791

ALT 2991 2269 2334 3701 2378

HB 14.3 12 10 8.6 8.8

PL 1 2 12 59 39

PT (s) 16 63 > 120 56

PTT (s) 49 22 35

UREA 59 59 13 45.1 28.9

CREATININE 1421 1481 1525 1480 1075

• 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.

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

• Renal failure, deranged liver enzymes as well as thrombocytopenia

• He died 2 days after admission to Multi @ Pelonomi.

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

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

• Multi-organ failure

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

13/4/2010 14/4/2010 15/4/2010 16/4/2010

AST 8192 2672 1893 2063

ALT 3395 1464 1161 1149

HB 14.5 11.2 9.0 8.4

PL 7 8 19 13

PT 20 14 15

PTT 49 40 37 36

UREA 27 36.5 40 44.6

CREATININE 286 524 534 563

• PCR (+), IgM (+)

• Died after massive GIT bleeding

Patient no 5

• 18 yr old male from Bainsvlei

• No contact with any livestock

• Presented with bloody diarrhoea and heamatemesis

• Serology confirmed RVF

• Deranged liver enzymes and thrombocytopenia

• Discharged

• Seen yesterday @ COE with no residual complications

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

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

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

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

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

RIFT VALLEY FEVER

• Family: Bunyaviridae• Genus: Phlebovirus

Distribution

Zoonosis Epizoonosis

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

VECTOR

AEDES MCINTOSHI

Culex, Plebotomus

Culex, Plebotomus

Clinical picture

• Incubation period 2-5 days

• Flue-like picture: Febrile-myalgic syndrome

• Hepatitis / liver necrosis• Haemorrhagic (1%) --- 50% mortality• Renal failure

Clinical picture

• Meningo- encephalitis

• Retinopathy – 3/52 - up to 10% - macular oedema - retinitis - infarctions blindness

Diagnosis

• History• PCR• Antibodies

Diagnosis

• History• PCR• Antibodies

EXCLUDE Crimean Congo Fever

Treatment

• No specific treatment• Supportive

• Isolate haemorrhagic cases until CCHF excluded

• Standard infection control measures• Confirmed cases need not be isolated

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

Personal protection

• DEET containing insect repellents

Vaccines

• Live and attenuated• Formalin inactivated vaccine – not registered

in SA

In short…

• Preventative measures • Exclude CCHF in endemic areas

• High index of suspicion for complicated cases

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

Acknowledgements

• 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

• Dr S. Moholo• Dr P. Sonnekus • Dr D. v Jaarsveld• Dr R. Swart • Mr G. Carter • Dr Gouws• Lucille Bloomberg (NICD) • NHLS