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{{Bourbon virus infection}}
{{Bourbon virus infection}}


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==Overview==
==Overview==
 
Bourbon virus infection is caused by Bourbon virus, a type of [[Thogotovirus]], which belongs to [[Orthomyxoviridae]] family. A tick bite is usually responsible for Bourbon virus infection. The virus is transmitted by arthropods like tics and replicates in both [[Arthropod|arthropods]] and [[vertebrate]] hosts. Bourbon virus infection must be differentiated from other diseases that may cause [[arthralgia]], [[fever]], and skin manifestations with the history of exposure to ticks. Only 5 cases of Bourbon virus infection have been confirmed in the United States since its disovery in 2014. The most potent risk factor in the development of Bourbon virus infection is a tick bite. Other risk factors include traveling, residing or working in the endemic regions will increase chances of infection. If left untreated patients with Bourbon virus infection, may develop [[hemophagocytic lymphohistiocytosis]] and eventually death. Complications that can develop as a result of Bourbon virus infection are [[meningitis]], [[encephalitis]] and [[multiorgan failure]]. A detailed history and physical exam is very helpful in the diagnosis of Bourbon virus infection. Infected individuals are treated with symptomatic therapy since a specific treatment has not yet been established. Preventing bites from ticks and other insects is the is helpful in the prevention of Bourbon virus infection.


==Historical Perspective==
==Historical Perspective==
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==Classification==
==Classification==
There is no established classification system for Bourbon virus infection.
Bourbon virus infection can be classified under [[tick-borne diseases]].


==Pathophysiology==
==Pathophysiology==
Bourbon virus is a [[Negative-sense|negative sense]] segmented [[RNA viruses|RNA virus]] belonging to the genus [[Thogotovirus]], family [[Orthomyxoviridae|Orthomyxovirida]]. It is transmitted by insects and replicates in both [[Arthropod|arthropods]] and [[vertebrate]] hosts. The [[Negative-sense ssRNA virus|negative sense]] [[RNA viruses|RNA virus]] replicates within the [[Cell nucleus|nuclei]] of the host cells. [[Thogotovirus|Thogoto]] virus Infection induces a sustained [[type 1 interferon]] response in the host until the [[Adaptive immune system|adaptive immunity]] takes effect. Microscopically, bourbon viruses are 80-120nm in diameter with a [[genome]] size of approximately 10Kb.


==Causes==
==Causes==
Bourbon virus infection is caused by a type of thogotovirus, which belongs to Orthomyxoviridae family. It is a  single-stranded, negative-sense RNA virus, which is segmented and exists in two different morphologies.<ref name="pmid26609638">{{cite journal |vauthors=Lambert AJ, Velez JO, Brault AC, Calvert AE, Bell-Sakyi L, Bosco-Lauth AM, Staples JE, Kosoy OI |title=Molecular, serological and in vitro culture-based characterization of Bourbon virus, a newly described human pathogen of the genus Thogotovirus |journal=J. Clin. Virol. |volume=73 |issue= |pages=127–32 |year=2015 |pmid=26609638 |doi=10.1016/j.jcv.2015.10.021 |url=}}</ref>
Bourbon virus infection is caused by a type of [[thogotovirus]], which belongs to [[Orthomyxoviridae]] family. It is a  single-stranded, negative-sense RNA virus, which is segmented and exists in two different morphologies.<ref name="pmid26609638">{{cite journal |vauthors=Lambert AJ, Velez JO, Brault AC, Calvert AE, Bell-Sakyi L, Bosco-Lauth AM, Staples JE, Kosoy OI |title=Molecular, serological and in vitro culture-based characterization of Bourbon virus, a newly described human pathogen of the genus Thogotovirus |journal=J. Clin. Virol. |volume=73 |issue= |pages=127–32 |year=2015 |pmid=26609638 |doi=10.1016/j.jcv.2015.10.021 |url=}}</ref>


==Differentiating Bourbon virus infection from other Diseases==
==Differentiating Bourbon virus infection from other Diseases==
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
There have been a very limited number of Bourbon virus disease cases identified in the United States since 2014. <ref name="urlBourbon virus | Division of Vector-Borne Diseases (DVBD) | NCEZID | CDC">{{cite web |url=https://www.cdc.gov/ncezid/dvbd/bourbon/index.html |title=Bourbon virus &#124; Division of Vector-Borne Diseases (DVBD) &#124; NCEZID &#124; CDC |format= |work= |accessdate=}}</ref>
Only 5 cases of Bourbon virus infection have been confirmed in the United States since its disovery in 2014. <ref name="urlBourbon virus | Division of Vector-Borne Diseases (DVBD) | NCEZID | CDC2">{{cite web |url=https://www.cdc.gov/ncezid/dvbd/bourbon/index.html |title=Bourbon virus &#124; Division of Vector-Borne Diseases (DVBD) &#124; NCEZID &#124; CDC |format= |work= |accessdate=}}</ref>


==Risk Factors==
==Risk Factors==
The most potent risk factor in the development of Bourbon virus infection is a tick bite. Other risk factors include traveling or residing within endemic regions will increase chances of infection.
The most potent risk factor in the development of Bourbon virus infection is a tick bite. Other risk factors include traveling, residing or working in the endemic regions will increase chances of infection.


==Screening==
==Screening==
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==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
 
If left untreated patients with Bourbon virus infection, may develop [[hemophagocytic lymphohistiocytosis]] and eventually death. Complications that can develop as a result of Bourbon virus infection are [[meningitis]], [[encephalitis]] and [[multiorgan failure]]. From 2014 to 2017 only 5 cases of Bourbon virus infection have been reported and all have resulted in death.


==Diagnosis==
==Diagnosis==
===History and Symptoms===
===History and Symptoms===
 
The patient with bourbon virus infection has a typical history of exposure to ticks or travel to endemic areas. A history of multiple [[tick]] bites is also common in individuals suspected of Bourbon virus infection. The patient of Bourbon virus infection may present with nausea, weakness, and [[diarrhea]]. Furthermore, symptoms such as [[fever]], [[anorexia]], [[chills]], [[headache]], [[myalgia]], and [[arthralgia]] may develop.


===Physical Examination===
===Physical Examination===
 
The physical examination findings of bourbon virus infection may present with several tick bites and [[maculopapular rash]] on the trunk. The patient may appear as very weak, [[hypertensive]] and [[dyspneic]].


===Laboratory Findings===
===Laboratory Findings===


 
There are no specific laboratory findings associated with Bourbon virus infection. Laboratory findings in bourbon virus infection may reveal [[leukopenia]] and [[thrombocytopenia]].
===X ray===
===X ray===
 
There are no specific X-ray findings associated with Bourbon virus infection. A chest X-ray may reveal findings of pulmonary venous congestion and [[interstitial edema]].


===CT scan===
===CT scan===
 
There are no CT  findings associated with bourbon virus infection. Contrast [[CT]] scan of the chest, abdomen, and pelvis may show trace [[Pleural effusion|pleural effusions]], bibasilar [[atelectasis]], and multiple prominent abdominal lymph nodes. <ref name="pmid25899080">{{cite journal |vauthors=Kosoy OI, Lambert AJ, Hawkinson DJ, Pastula DM, Goldsmith CS, Hunt DC, Staples JE |title=Novel thogotovirus associated with febrile illness and death, United States, 2014 |journal=Emerging Infect. Dis. |volume=21 |issue=5 |pages=760–4 |year=2015 |pmid=25899080 |pmc=4412252 |doi=10.3201/eid2105.150150 |url=}}</ref>


===MRI===
===MRI===
There are no MRI findings associated with bourbon virus infection.


 
===Ultrasound/Echocardiography===
===Ultrasound===
There are no ultrasound findings associated with Bourbon virus infection. Echocardiogram of bourbon virus infection, may show global [[hypokinesia]]. <ref name="pmid25899080">{{cite journal |vauthors=Kosoy OI, Lambert AJ, Hawkinson DJ, Pastula DM, Goldsmith CS, Hunt DC, Staples JE |title=Novel thogotovirus associated with febrile illness and death, United States, 2014 |journal=Emerging Infect. Dis. |volume=21 |issue=5 |pages=760–4 |year=2015 |pmid=25899080 |pmc=4412252 |doi=10.3201/eid2105.150150 |url=}}</ref>
 


===Other Imaging findings===
===Other Imaging findings===
 
There are no other imaging findings for Bourbon virus infection.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
 
There are no other diagnostic studies for Bourbon virus infection.


==Treatment==
==Treatment==
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[[Category:Viral diseases]]
 
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Pulmonology]]
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[[Category:Infectious disease]]
[[Category:Infectious disease]]

Latest revision as of 20:40, 29 July 2020

Bourbon virus infection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Bourbon virus infection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

CT

MRI

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Ultrasound

Other Imaging Findings

Other Diagnostic Studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2], Usama Talib, BSc, MD [3], Syed Hassan A. Kazmi BSc, MD [4], Aravind Reddy Kothagadi M.B.B.S[5]

Overview

Bourbon virus infection is caused by Bourbon virus, a type of Thogotovirus, which belongs to Orthomyxoviridae family. A tick bite is usually responsible for Bourbon virus infection. The virus is transmitted by arthropods like tics and replicates in both arthropods and vertebrate hosts. Bourbon virus infection must be differentiated from other diseases that may cause arthralgiafever, and skin manifestations with the history of exposure to ticks. Only 5 cases of Bourbon virus infection have been confirmed in the United States since its disovery in 2014. The most potent risk factor in the development of Bourbon virus infection is a tick bite. Other risk factors include traveling, residing or working in the endemic regions will increase chances of infection. If left untreated patients with Bourbon virus infection, may develop hemophagocytic lymphohistiocytosis and eventually death. Complications that can develop as a result of Bourbon virus infection are meningitisencephalitis and multiorgan failure. A detailed history and physical exam is very helpful in the diagnosis of Bourbon virus infection. Infected individuals are treated with symptomatic therapy since a specific treatment has not yet been established. Preventing bites from ticks and other insects is the is helpful in the prevention of Bourbon virus infection.

Historical Perspective

In 2014, Olga Kosoy, from the Centers for Disease Control and Prevention isolated Bourbon virus for the first time from a blood sample of an infected person in Bourbon County, Kansas, United States.

Classification

Bourbon virus infection can be classified under tick-borne diseases.

Pathophysiology

Bourbon virus is a negative sense segmented RNA virus belonging to the genus Thogotovirus, family Orthomyxovirida. It is transmitted by insects and replicates in both arthropods and vertebrate hosts. The negative sense RNA virus replicates within the nuclei of the host cells. Thogoto virus Infection induces a sustained type 1 interferon response in the host until the adaptive immunity takes effect. Microscopically, bourbon viruses are 80-120nm in diameter with a genome size of approximately 10Kb.

Causes

Bourbon virus infection is caused by a type of thogotovirus, which belongs to Orthomyxoviridae family. It is a single-stranded, negative-sense RNA virus, which is segmented and exists in two different morphologies.[1]

Differentiating Bourbon virus infection from other Diseases

Bourbon virus infection must be differentiated from other diseases that may cause arthralgia, fever, and skin manifestations with the history of exposure to ticks. The differential diagnosis of Bourbon virus disease includes Lyme disease, ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever, leptospirosis, and influenza.

Epidemiology and Demographics

Only 5 cases of Bourbon virus infection have been confirmed in the United States since its disovery in 2014. [2]

Risk Factors

The most potent risk factor in the development of Bourbon virus infection is a tick bite. Other risk factors include traveling, residing or working in the endemic regions will increase chances of infection.

Screening

According to CDC, there is insufficient evidence to recommend routine screening for Bourbon virus infection.[3]

Natural History, Complications and Prognosis

If left untreated patients with Bourbon virus infection, may develop hemophagocytic lymphohistiocytosis and eventually death. Complications that can develop as a result of Bourbon virus infection are meningitis, encephalitis and multiorgan failure. From 2014 to 2017 only 5 cases of Bourbon virus infection have been reported and all have resulted in death.

Diagnosis

History and Symptoms

The patient with bourbon virus infection has a typical history of exposure to ticks or travel to endemic areas. A history of multiple tick bites is also common in individuals suspected of Bourbon virus infection. The patient of Bourbon virus infection may present with nausea, weakness, and diarrhea. Furthermore, symptoms such as fever, anorexia, chills, headache, myalgia, and arthralgia may develop.

Physical Examination

The physical examination findings of bourbon virus infection may present with several tick bites and maculopapular rash on the trunk. The patient may appear as very weak, hypertensive and dyspneic.

Laboratory Findings

There are no specific laboratory findings associated with Bourbon virus infection. Laboratory findings in bourbon virus infection may reveal leukopenia and thrombocytopenia.

X ray

There are no specific X-ray findings associated with Bourbon virus infection. A chest X-ray may reveal findings of pulmonary venous congestion and interstitial edema.

CT scan

There are no CT findings associated with bourbon virus infection. Contrast CT scan of the chest, abdomen, and pelvis may show trace pleural effusions, bibasilar atelectasis, and multiple prominent abdominal lymph nodes. [4]

MRI

There are no MRI findings associated with bourbon virus infection.

Ultrasound/Echocardiography

There are no ultrasound findings associated with Bourbon virus infection. Echocardiogram of bourbon virus infection, may show global hypokinesia. [4]

Other Imaging findings

There are no other imaging findings for Bourbon virus infection.

Other Diagnostic Studies

There are no other diagnostic studies for Bourbon virus infection.

Treatment

Medical Therapy

There is no specific treatment, cure, or vaccine for Bourbon virus infection. Early diagnosis, hospitalization, and supportive therapy are fundamentals of treatment.

Surgery

Surgical intervention is not recommended for the management of Bourbon virus infection.

Primary Prevention

There is no vaccine or drug to prevent Bourbon virus disease. Therefore, preventing bites from ticks and other insects is the best way to prevent infection.[5]

Secondary Prevention

Secondary preventive measures for Bourbon virus infection are similar to primary prevention.

References

  1. Lambert AJ, Velez JO, Brault AC, Calvert AE, Bell-Sakyi L, Bosco-Lauth AM, Staples JE, Kosoy OI (2015). "Molecular, serological and in vitro culture-based characterization of Bourbon virus, a newly described human pathogen of the genus Thogotovirus". J. Clin. Virol. 73: 127–32. doi:10.1016/j.jcv.2015.10.021. PMID 26609638.
  2. "Bourbon virus | Division of Vector-Borne Diseases (DVBD) | NCEZID | CDC".
  3. "Bourbon virus | Division of Vector-Borne Diseases (DVBD) | NCEZID | CDC".
  4. 4.0 4.1 Kosoy OI, Lambert AJ, Hawkinson DJ, Pastula DM, Goldsmith CS, Hunt DC, Staples JE (2015). "Novel thogotovirus associated with febrile illness and death, United States, 2014". Emerging Infect. Dis. 21 (5): 760–4. doi:10.3201/eid2105.150150. PMC 4412252. PMID 25899080.
  5. Schweon, Steven J. (2016). "Bourbon virus". Nursing. 46 (4): 65. doi:10.1097/01.NURSE.0000481418.81092.98. ISSN 0360-4039.

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