Bolivian hemorrhagic fever (BHF), also known as black typhus or Ordog Fever, is a
hemorrhagic fever
Viral hemorrhagic fevers (VHFs) are a diverse group of animal and human illnesses in which fever and hemorrhage are caused by a viral infection. VHFs may be caused by five distinct families of RNA viruses: the families ''Filoviridae'', ''Flav ...
and
zoonotic
A zoonosis (; plural zoonoses) or zoonotic disease is an infectious disease of humans caused by a pathogen (an infectious agent, such as a bacterium, virus, parasite or prion) that has jumped from a non-human (usually a vertebrate) to a human. ...
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
originating in
Bolivia
, image_flag = Bandera de Bolivia (Estado).svg
, flag_alt = Horizontal tricolor (red, yellow, and green from top to bottom) with the coat of arms of Bolivia in the center
, flag_alt2 = 7 × 7 square p ...
after infection by ''Machupo mammarenavirus''.
[Public Health Agency of Canada: ''Machupo Virus Pathogen Safety Data Sheet'', http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/machupo-eng.php, Date Modified: 2011-02-18.]
BHF was first identified in 1963 as an ambisense
RNA virus
An RNA virus is a virusother than a retrovirusthat has ribonucleic acid (RNA) as its genetic material. The nucleic acid is usually single-stranded RNA ( ssRNA) but it may be double-stranded (dsRNA). Notable human diseases caused by RNA viruses ...
of the ''
Arenaviridae'' family,
by a research group led by
Karl Johnson. The mortality rate is estimated at 5 to 30 percent. Due to its
pathogenicity
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
, Machupo virus requires
Biosafety Level Four conditions, the highest level.
[Center for Food Security & Public Health and Institute for International Cooperation in Animal Biologics, Iowa State University: ''Viral Hemorrhagic Fevers Caused by Arenaviruses'', http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_arenavirus.pdf, last updated: February 23, 2010.]
During the period between February and March 2007, some 20 suspected BHF cases (3 fatal) were reported to the Servicio Departamental de Salud (SEDES) in
Beni Department
Beni (), sometimes El Beni, is a northeastern department of Bolivia, in the lowlands region of the country. It is the second-largest department in the country (after Santa Cruz), covering 213,564 square kilometers (82,458 sq mi), and it was cre ...
, Bolivia. In February 2008, at least 200 suspected new cases (12 fatal) were reported to SEDES.
[Aguilar PV, Carmago W, Vargas J, Guevara C, Roca Y, Felices V, et al. Reemergence of Bolivian hemorrhagic fever, 2007–2008 ]etter Etter is a surname. Notable people with the surname include:
*Albert Etter (born 1872), American horticulturist
*Bill Etter (born 1950), American football quarterback
*Bob Etter (born 1945), American football placekicker, bridge player, and profess ...
Emerg Infect Dis erial on the Internet2009 Sep. Available from http://wwwnc.cdc.gov/eid/article/15/9/09-0017.htm. Accessed 2 Dec 2011. In November 2011, a second case was confirmed near the departmental capital of
Trinidad
Trinidad is the larger and more populous of the two major islands of Trinidad and Tobago. The island lies off the northeastern coast of Venezuela and sits on the continental shelf of South America. It is often referred to as the southernmos ...
, and a serosurvey was conducted to determine the extent of Machupo virus infections in the department. A SEDES expert involved in the survey expressed his concerns about the expansion of the virus to other provinces outside the endemic regions of
Mamoré and
Iténez province
Iténez is a province
A province is almost always an administrative division within a country or state. The term derives from the ancient Roman '' provincia'', which was the major territorial and administrative unit of the Roman Empire's te ...
s.
["Caso confirmado de fiebre hemorrágica alerta a autoridades benianas," ''Los Tiempos.com'', , 16/11/2011.]["SEDES movilizado para controlar brote de fiebre hemorrágica en Beni; También se Capacita a Los Comunarios y Estudiantes," ''Lost Tiempos.com'', , 30/11/2011.]
Epidemiology
History
The disease was first encountered in 1962, in the Bolivian village of San Joaquín, hence the name "Bolivian" Hemorrhagic Fever. When initial investigations failed to find an arthropod carrier, other sources were sought before finally determining that the disease was carried by infected mice. Although mosquitoes were not the cause as originally suspected, the extermination of mosquitoes using DDT to prevent malaria proved to be indirectly responsible for the outbreak in that the accumulation of DDT in various animals along the food chain led to a shortage of cats in the village; subsequently, a mouse plague erupted in the village, leading to an epidemic.
Vectors
The
vector
Vector most often refers to:
*Euclidean vector, a quantity with a magnitude and a direction
*Vector (epidemiology), an agent that carries and transmits an infectious pathogen into another living organism
Vector may also refer to:
Mathematic ...
is the
large vesper mouse (''Calomys callosus''), a
rodent
Rodents (from Latin , 'to gnaw') are mammals of the order Rodentia (), which are characterized by a single pair of continuously growing incisors in each of the upper and lower jaws. About 40% of all mammal species are rodents. They are na ...
indigenous to northern Bolivia. Infected animals are asymptomatic and shed the virus in excreta, thereby infecting humans. Evidence of person-to-person transmission of BHF exists but is believed to be rare.
[ Kilgore, et al., (1995).]
Symptoms
The
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
has a slow onset with
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
,
malaise
As a medical term, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. The word has existed in French since at least the 12th century.
The term is often used ...
,
headache
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a result ...
and
myalgia
Myalgia (also called muscle pain and muscle ache in layman's terms) is the medical term for muscle pain. Myalgia is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likel ...
, very similar to
Malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
symptoms.
Petechia
A petechia () is a small red or purple spot (≤4 mm in diameter) that can appear on the skin, conjunctiva, retina, and Mucous membrane, mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian , 'freckle,' ...
e (blood spots) on the upper body and bleeding from the
nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...
and gums are observed when the disease progresses to the
hemorrhagic
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vagi ...
phase, usually within seven days of onset.
Severe hemorrhagic or neurologic symptoms are observed in about one third of patients. Neurologic symptoms involve tremors, delirium, and convulsions. The mortality rate is about 25%.
Prevention
Measures to reduce contact between the vesper mouse and humans may have contributed to limiting the number of outbreaks, with no cases identified between 1973 and 1994. Although there are no cures or vaccine for the disease, a vaccine developed for the genetically related
Junín virus
''Argentinian mammarenavirus'', better known as the ''Junin virus'' or ''Junín virus'' (JUNV), is an arenavirus in the ''Mammarenavirus'' genus that causes Argentine hemorrhagic fever (AHF). The virus took its original name from the city of Jun ...
which causes
Argentine hemorrhagic fever
Argentine hemorrhagic fever (AHF) or O'Higgins disease, also known in Argentina as ''mal de los rastrojos'' (stubble disease) is a hemorrhagic fever and zoonotic infectious disease occurring in Argentina. It is caused by the '' Junín virus'' (an a ...
has shown evidence of cross-reactivity to Machupo virus, and may therefore be an effective
prophylactic
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
measure for people at high risk of infection. Post infection (and providing that the person survives the infection), those that have contracted BHF are usually immune to further infection of the disease.
Weaponization
Bolivian hemorrhagic fever was one of three hemorrhagic fevers and one of more than a dozen agents that the United States researched as potential
biological weapon
A biological agent (also called bio-agent, biological threat agent, biological warfare agent, biological weapon, or bioweapon) is a bacterium, virus, protozoan, parasite, fungus, or toxin that can be used purposefully as a weapon in bioterroris ...
s before the nation suspended its biological weapons program in 1969.
[Chemical and Biological Weapons: Possession and Programs Past and Present]
, ''James Martin Center for Nonproliferation Studies'', Middlebury College
Middlebury College is a private liberal arts college in Middlebury, Vermont. Founded in 1800 by Congregationalists, Middlebury was the first operating college or university in Vermont. The college currently enrolls 2,858 undergraduates from all ...
, April 9, 2002, accessed November 14, 2008. Albert Nickel, a 53-year old animal caretaker at
Fort Detrick
Fort Detrick () is a United States Army Futures Command installation located in Frederick, Maryland. Historically, Fort Detrick was the center of the U.S. biological weapons program from 1943 to 1969. Since the discontinuation of that program, i ...
, died in 1964 from the disease after being bitten by an infected mouse. Nickel Place, on Fort Detrick, is named in his honor. It was also under research by the Soviet Union, under the
Biopreparat
The All-Union Science Production Association Biopreparat (russian: Биопрепарат, p=bʲɪəprʲɪpɐˈrat, lit: "biological preparation") was the Soviet agency created in April 1974, which spearheaded the largest and most sophisticated ...
bureau.
Vaccine research
Investigational vaccines exist for Argentine hemorrhagic fever and RVF; however, neither is approved by FDA or commonly available in the United States.
The structure of the attachment glycoprotein has been determined by X-ray crystallography and this glycoprotein is likely to be an essential component of any successful vaccine.
References
Bibliography
*
*Medical Microbiology 2nd Edition Mims et al. Mosby Publishing 1998 p 371
External links
{{DEFAULTSORT:Bolivian Hemorrhagic Fever
Arthropod-borne viral fevers and viral haemorrhagic fevers
Hemorrhagic fevers
Rodent-carried diseases
Biological weapons