Wednesday, November 18, 2020

Anglican Patriarchate Health Note: While Global Focus is on COVID, a Seemingly Deadlier Virus Emerges in Bolivia

By Keith, Duke of Westphalia, MD

Firenze-Nuova Roma 18 November 2020 (ORCNS)

A man in Bolivia.
Source: Pub. Dom.
While it seems that much of the world has developed a concerning, almost phobic tunnel vision regarding the novel Coronavirus (COVID-19), with ever expanding and sweeping series of health guidelines and activity restrictions; a new and potentially far more dangerous virus has emerged from the rain forests of South America. Recently, the American Society of Tropical Medicine and Hygiene announced the identification of a novel arenavirus capable of passing from vector host to human and then from human to human, causing a hemorrhagic fever syndrome, in La Paz, Bolivia. Chapare virus, the causative agent, had a cluster in 2019 infecting three healthcare workers and resulting in two fatalities.(1,2) 

The arenaviruses are a large group of viruses that typically affect rodents. Human zoonotic infection occurs when rodent contact is increased due either from environmental change, agricultural practice, or human presence. (1,2,3) The most familiar of the human disease causing arenaviruses include lymphocytic choriomeningitis virus (LCMV) and the several hemorrhagic fever syndromes caused by Lassa virus (West Africa), Machupo, Junin, and Chapare viruses (South America). Common routes of infection include mucosal exposure to aerosols and direct contact with infectious material, with those at highest risk environmentally exposed to rodent excreta within their homes, at industrial or agricultural sites, or other places infested by rodents. Factors that tend to increase relative risk of adverse outcome include age, sex, degree of contact with rodent excreta, and comorbid conditions.(1,2,3,4)

Of note, a high degree of clinical suspicion is important to early identification and treatment; patients with early onset of symptoms typically present with a picture common to other viral disease processes such as Dengue, endemic to South America. The potential risk to the public health in such a misdiagnosis cannot be understated, as unlike Dengue, the capacity for human to human transfer with Chapere is concerning. Supportive therapy and early antiviral treatment with Ribavirin reduces morbidity and mortality in arenavirus infection, particularly Lassa and Junin -- though Ribavirin therapy is not without its risks and adverse effects, and if started late in disease progression, enjoys only mixed success.(4,5,6)

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1. Gompf, SG; Smith, KM; Choe, U; Arenaviruses (May 2019). https://emedicine.medscape.com/article/212356-overview, accessed 17 November, 2020.
2. Radoshitzky, SR; Buchmeier, MJ; Charrel, RN; Clegg, JCS; Gonzalez, JJ; G√ľnther, S; Hepojoki, J; Kuhn, JH; Lukashevich, IS; Romanowski, V; Salvato, MS; Sironi, M; Stenglein, MD; de la Torre, JC; ICTV Report, Consortium (August 2019). "ICTV Virus Taxonomy Profile: Arenaviridae". The Journal of General Virology. 100 (8): 1200–1201.
3. Botten, J; Whitton, JL; Barrowman, P; Sidney, J; Whitmire, JK; Alexander, J; Kotturi, MF; Sette, A; Buchmeier, MJ (2010). "A Multivalent Vaccination Strategy for the Prevention of Old World Arenavirus Infection in Humans". Journal of Virology. 84 (19): 9947–56.
4. Emonet, SE; Urata, S; De La Torre, JC (2011). "Arenavirus reverse genetics: New approaches for the investigation of arenavirus biology and development of antiviral strategies". Virology. 411 (2): 416–425.
5. Lee, AM; Pasquato, A; Kunz, S (2011). "Novel approaches in anti-arenaviral drug development". Virology. 411 (2): 163–169.
6. Mendenhall, M; Russell, A; Juelich, T; Messina, EL; Smee, DF; Freiberg, AN; Holbrook, MR; Furuta, Y; et al. (2010). "T-705 (Favipiravir) Inhibition of Arenavirus Replication in Cell Culture". Antimicrobial Agents and Chemotherapy. 55 (2): 782–787.