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Snapshot
  • A 14-year-old boy presents to the emergency department with a severe headache. His headache is diffuse and is associated with fever, nausea, and 2 episodes of emesis. He denies any sick contacts but his mother stated they traveled to Ohio  and returned to New York City approximately 5 days ago. His temperature is 102°F (38.9°C), blood pressure is 118/78 mmHg, pulse is 105/min, and respirations are 19/min. During the physical examination, the patient undergoes generalized tonic-clonic epileptic movements, requiring sedation. A non-contrast CT scan of the head is unremarkable. A lumbar puncture is performed and cerebral spinal fluid analysis is notable for a lymphocytic pleocytosis. IgM specific antibodies for arboviruses eventually returns positive for California encephalitis virus.
Introduction
  • Classification
    • arthropod-borne viruses (hence arboviruses), which are RNA viruses
      • note that hantavirus is not an arbovirus
  • Microbiology
    • segmented, negative, single-stranded RNA viruses
  • Associated condition
    • bunyaviruses cause
      • California encephalitis
      • Rift Valley fever
      • Crimean-Congo hemorrhagic fever
      • hantavirus pulmonary syndrome
 
Bunyaviruses
Disease
Presentation
Diagnostic Studies Treatment
California encephalitis
  • Symptoms
    • headache
    • nausea
    • vomiting
  • Physical exam
    • fever
    • seizures
    • focal neurologic deficit (e.g., aphasia)
  • Lumbar puncture
    • testing the cerebral spinal fluid with an enzyme-linked immunosorbent assay (ELISA)
  • Supportive treatment (e.g., monitoring and treating seizures)
Rift valley fever
  • Symptoms
    • headache
    • myalgias
    • malaise
    • arthralgias
  • Physical exam
    • fever
    • seizures
  • Cell culture
  • Polymerase chain reaction (PCR)
  • ELISA
  • Supportive treatment
Crimean-Congo hemorrhagic fever
  • Symptoms
    • headache
    • arthralgia
    • abdominal pain
    • vomiting
  • Physical exam
    • fever
    • erythematous oropharynx
    • palatal petechiae
  • ELISA
  • Real-time PCR (RT-PCR)
  • Supportive treatment
Hantavirus cardiopulmonary syndrome
  • Symptoms
    • headache
    • chills 
    • myalgias
    • dry cough
  • Physical exam
    • fever
    • respiratory compromise (e.g., increased oxygen demand)
  • Radiography of the chest
    • bilateral diffuse interstitial edema
  • Laboratory
    • rapid decline in platelets
    • left-shifted granulocytic series
    • increased immunoblast
  • ELISA can be used
  • Supportive treatment (e.g., aggressive cardiopulmonary support)
 
 

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