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