engleski

Pathomorphosis of acute infectious diarrhoea

West Nile virus (WNV) is an RNA virus and a member of a flavivirus family, and is distributed in tropical and mediate regions of the world. It primarily infects birds but also humans and various domestic and wild animals. Interhuman infection has not been demonstrated, and virus can not be transmitted between humans and birds directly. Migrating birds are responsible for worldwide spread of the virus. In birds virus amplifies, reaches levels high enough for transmission via vectors (mosquitoes) to other birds, human, domestic and wild animals. It is speculated that disease has been present for over thousand years and that it might have caused the death of Alexander the Great. West Nile virus was first isolated in 1937 in West Nile district of Uganda during investigation of yellow fever epidemic. Between 1939 and 1957 virus was isolated in Congo, Sudan, Egypt and Israel. In 1957 it was recognized as cause of meningoencephalitis in elderly patients in Israel. The first outbreak in the Western Hemisphere occurred in 1999 in USA and after that in Canada. Seroepidemiological investigations showed that virus is present in many European countries in horses and in humans. Outbreaks of human encephalitis were described in Israel, Algeria, Romania, Czech Republic, USA, and Canada. After transmission of virus from birds to humans the majority of human infections with West Nile virus are asymptomatic, than it can manifest as fever with or without rash and lastly as CNS disease. Ratio between these 3 groups of clinical manifestations is 110:30:1. However in 2006 outbreak in USA ratio between West Nile virus fever and neurological disease was 2324:1339. In that year there were 3830 reported cases of WNV infections with 119 death cases. According to evidence published in 2007 there is a presence of antibodies against WNV in horses in Slavonija part of Croatia. The main vectors of WNV are Culex species mosquitoes (Culex pipens, Culex tarsalis, etc.). Experimental evidence shows that Asian tiger mosquitoes (Aedes albopictus) can also be infected. Migrating birds from Africa arrive in Croatia in late spring and early summer, there is a confirmed infection in horses in Croatia, there are also possible vectors for disease transmission in Croatia. Therefore all natural factors for human infection are established. There are a number of etiologically unconfirmed cases of severe encephalitis in Croatia in mosquito season as well. The emergence of cases of severe encephalitis with death outcomes in patients that were exposed to mosquitoes, but also cases of meningitis, Guillain-Barre syndrome and acute flaccid paralysis must be suspicious of West Nile virus infection and there should be means of diagnosing this infection at least in one place in Croatia if not in all four regional centers which would be optimal. To my knowledge there are no confirmed cases of human infection with WNV in Croatia. In this lecture we will discuss natural disease development, its clinical manifestations, and current possibilities of diagnostics and treatment of neurological manifestations of WNV infection. Also we will discuss possibilities of both equine and human disease prevention.

dirrhoea; infectious diseases; pathomorphosis

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