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Ross River Fever

Ross River Disease

Ross river fever is caused by an arbovirus infection following mosquito bites. The most prominent clinical features are arthralgia, rashes, myalgia and fever, which respond favorably to nonsteroidal anti-inflammatory agents. The virus is native to Australia and its main reservoir hosts are marsupials.


Presentation

Ross river fever (RRF) related epidemics of polyarthritis can occur in tropical parts of Australia and the western Pacific, often after heavy rain favoring the mosquito-mammal cycle of an arthropod- borne alphavirus (type A arbovirus) [1] [2]. The virus resides in several reservoirs, particularly marsupials, e.g. kangaroos and wallabies [3] [4]. The alphavirus genus to which arboviruses belong are small enveloped viruses with a single positive strand of RNA [5]. More than 40 types of female mosquitoes can act as vectors [3] [4].

Clinical symptoms after the bite usually appear after an incubation period of 7-9 days following transmission of the virus by a bite from the mosquito enzootic vector (e.g., Aedes vigilax); however, development of the disease can begin within a few days or appear after as long as three weeks [5]. Children usually present with a short-lived mild fever and malaise [4]. In contrast, affected adults (typically in the 25-44 age range) can suddenly develop a combination of symptoms, in particular, arthralgia of the wrists, knees, and ankles, due to severe polyarthritis [1] [5] [6], which affects the overwhelming majority of patients.

Ross river virus (RRV) from the bite becomes bound to monocytes in the blood and is then carried into the tissues. There is evidence that connective tissue in the joints infiltrated by virus-laden macrophages may be where initial replication occurs [7]. The macrophages may then subsequently invade adjacent skeletal muscle. Through the innate immune response, the invading inflammatory macrophages cause necrosis of connective tissue and skeletal muscle [1] [7] [8], leading to polyarthritis in the small joints, together with myalgia, an important symptom in over 60% of patients [1]. Arthritis may persist for up to a year and can be disabling. A rash, which can be maculopapular, purpuric or vesicular may appear on the torso and limbs and is present in more than half of those affected by the virus. In some cases, it may be the only symptom [5]. Fatigue, lethargy, and malaise with mild fever are frequent features of RRF [1] [4] [5]. Other symptoms may occur, and in addition to hematuria, splenomegaly, and glomerulonephritis, rare cases of meningitis have been reported [5].

Fever
  • Ross River fever is a debilitating viral illness spread by mosquitoes that can leave you bedridden for weeks, sometimes longer. [Image source: iStockphoto ] Ross River fever is caused by a viral infection, transmitted through mosquito bites.[abc.net.au]
  • Children usually present with a short-lived mild fever and malaise.[symptoma.com]
  • A blood test is the only way to confirm a case of Ross River Fever. Several types of blood tests may be used to examine antibody levels in the blood.[en.wikipedia.org]
  • Symptoms of Ross River fever include fever, chills, painful and swollen joints, rash and fatigue Treatment Unfortunately, there is no current vaccine or medication that has proven to prevent or cure Ross River fever.[study.com]
  • Mr Corben said there have been low numbers of Ross River fever cases in the area due to dry conditions during summer.[manningrivertimes.com.au]
Malaise
  • Children usually present with a short-lived mild fever and malaise.[symptoma.com]
  • Progression of Epidemic Polyarthritis (Ross River virus) The disease usually begins as a viral illness with fever and malaise, but can then lead to symptoms of joint pains (arthritis) usually involving many joints.[myvmc.com]
  • Children usually develop a mild, short term, fever and malaise. Adults develop arthritis in the small joints of the hands and feet that usually lasts 30 to 40 weeks. About 30% of adults also develop a short-term fever and/or rash.[theconversation.com]
Weight Gain
Aspiration
  • As a control, synovial aspirates from three osteoarthritis patients were also analyzed. Synovial aspirates from osteoarthritis patients were obtained from the John James Hospital, Canberra, Australia.[jvi.asm.org]
Arthritis
  • Abstract Ross River fever, or epidemic arthritis, is caused by the Ross River virus and usually mild and short-lived although persisting joint symptoms can develop.[ncbi.nlm.nih.gov]
  • Taken together, these findings indicate that complement activation occurs in the tissues of humans and mice infected with RRV and suggest that complement plays an essential role in the effector phase, but not the inductive phase, of RRV-induced arthritis[ncbi.nlm.nih.gov]
  • In contrast to our findings, which demonstrate a role for complement independent of inflammatory cell recruitment, complement activation in collagen-induced arthritis, as well as type II collagen MAb-induced arthritis, plays a critical role in the recruitment[jvi.asm.org]
  • Symptoms of the disease vary widely in severity, but major indicators are arthralgia, arthritis, fever, and rash. The incubation period is 7–9 days. About a third of infections are asymptomatic, particularly in children.[en.wikipedia.org]
Arthralgia
  • More recent prospective studies have reported a steady improvement in symptoms over the first few months, with 15–66% of patients having ongoing arthralgia at 3 months. Arthralgias have resolved in the majority by 5–7 months.[en.wikipedia.org]
  • The most prominent clinical features are arthralgia, rashes, myalgia and fever, which respond favorably to nonsteroidal anti-inflammatory agents. The virus is native to Australia and its main reservoir hosts are marsupials.[symptoma.com]
  • More recent prospective studies have reported a steady improvement in symptoms over the first few months, with 15-66% of patients having ongoing arthralgia at 3 months. Arthralgia have resolved in the majority by 5 –7 months.[travelvaccines.com.au]
  • This report serves to create awareness among physicians to consider travel-related RRV disease in differential diagnosis of patients with fever, arthralgia and/or rash returning from the South Pacific area, and to promote awareness among professionals[eurosurveillance.org]
Myalgia
  • The most prominent clinical features are arthralgia, rashes, myalgia and fever, which respond favorably to nonsteroidal anti-inflammatory agents. The virus is native to Australia and its main reservoir hosts are marsupials.[symptoma.com]
  • […] particularly in children.[2][3] Acute illness About 95% of symptomatic cases report joint pain.This is typically symmetrical and with acute onset, affecting the fingers, toes, ankles, wrists, back, knees and elbows.[3] Fatigue occurs in 90% and fever, myalgia[travelvaccines.com.au]
  • Fatigue occurs in 90% and fever, myalgia and headache occur in 50–60%.A rash occurs in 50% of patients and is widespread and maculopapular. Lymphadenopathy occurs commonly; sore throat and coryza less frequently. Diarrhea is rare.[en.wikipedia.org]
  • Magnesium – has been found to be effective and will help with the myalgia (muscle soreness). Take a good powder – one teaspoon twice a day. 4. Fish Oils – being anti-inflammatory, these are highly recommended.[santosorganics.com.au]
Joint Swelling
  • The virus is not killed by antibiotics, although doctors can advise on treatment to relieve the aches, pains and joint swelling. Aspirin and other analgesics can help.[abc.net.au]
  • Almost all patients develop joint swelling (arthritis) affecting fingers, wrists, and knees. Some patients get a rash on their body, legs, and arms which disappears after 7 to 10 days.[iamat.org]
  • Both can cause joint swelling and pain, fatigue and muscle aches which can persist for many months. A rash and fever may also develop.[expeditionaustralia.com.au]
  • Other symptoms include: fever body aches rash headache joint swelling, pain and stiffness fatigue swollen lymph nodes Symptoms usually ease within 3 to 6 months. Visit your doctor if you are concerned or need relief from symptoms.[healthdirect.gov.au]
Hematuria
  • Other symptoms may occur, and in addition to hematuria, splenomegaly, and glomerulonephritis, rare cases of meningitis have been reported. The symptoms of Ross River Fever resemble those of Barmah Forest virus most closely.[symptoma.com]
  • Less common manifestations include splenomegaly, hematuria and glomerulonephritis. Headache, neck stiffness, and photophobia may occur. There have been three case reports suggesting meningitis or encephalitis.[en.wikipedia.org]
Headache
  • Headache, neck stiffness, and photophobia may occur. There have been some case reports suggesting meningitis or encephalitis.[travelvaccines.com.au]
  • Headache, neck stiffness, and photophobia may occur. There have been three case reports suggesting meningitis or encephalitis.[en.wikipedia.org]
  • The symptoms of Ross River Fever include a fever, headache, aching muscles and joints, and fatigue. Occasionally, a rash will develop. The virus is not considered fatal, but its symptoms can linger for months.[examiner.com.au]
Neck Stiffness
  • Headache, neck stiffness, and photophobia may occur. There have been some case reports suggesting meningitis or encephalitis.[travelvaccines.com.au]
  • Headache, neck stiffness, and photophobia may occur. There have been three case reports suggesting meningitis or encephalitis.[en.wikipedia.org]
Limb Weakness
  • (A) Mice were scored for the development of hind-limb dysfunction and disease based on the following scale: 0, no disease signs; 1, ruffled fur; 2, very mild hind-limb weakness; 3, mild hind-limb weakness; 4, moderate hind-limb weakness and dragging of[jvi.asm.org]

Workup

The symptoms of Ross River Fever resemble those of Barmah Forest virus most closely [9]. Direct isolation of RRV is often impractical since it soon disappears from the circulation [5] [10]. A variety of serological methods have been developed to confirm RRF, with both anti-RRV immunoglobulin G (IgG) and anti-IgM being used in the tests. Although hemagglutination inhibition, complement fixation, and the neutralization procedures are available [11] [12], enzyme-linked immunosorbent assay (ELISA) against anti-RRV IgG or IgM is the preferred technique [13]. ELISA using IgM is often used to confirm RRF in suspected new cases, and has excellent specificity and sensitivity [11]; however, IgM against RRV may persist following exposure, and false positives can occur because of this or the presence of other viruses, such as rubella, or autoimmune conditions [5] [14]. A four-fold increase in IgG antibody titer (seroconversion) from the acute phase until convalescence two weeks later is necessary to confirm RRF [15] [16]. Commercial ELISA test kits for Barmah Forrest and Ross River viruses infections are available. Reference laboratories may be needed to confirm results.

Treatment

  • Diagnosis and treatment Ross River fever is diagnosed by a blood test. People who have been exposed to Ross River virus develop antibodies to the organism in their blood and the test detects these. Unfortunately there are no specific treatments.[abc.net.au]
  • Use of paracetamol medication will be recorded on a daily basis during the treatment period. Dr Griffin said researchers are confident of the safety of the treatment.[medicine.uq.edu.au]
  • This article reviews the cause, diagnosis and treatment of this sometimes debilitating disease.[ncbi.nlm.nih.gov]
  • What is the treatment for Ross River Fever? The treatment for RRF is rest, regular paracetamol and NSAIDS like ibuprofen, and sometimes splints for very painful joints. There is no cure, specific treatment or vaccination.[brisbanekids.com.au]
  • Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.[betterhealth.vic.gov.au]

Prognosis

  • Prognosis of Epidemic Polyarthritis (Ross River virus) There is no known cure for this viral infection.[myvmc.com]
  • The prognosis in children born with CRS is poor. [ 19 ] Epidemiology Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates.[sites.google.com]
  • Prognosis Progressive resolution over 3-6 months is usual. [ 9 , 10 ] A prolonged relapsing-remitting course with arthralgias, tiredness and depression over years following diagnosis has been described.[patient.info]

Epidemiology

  • The Arboviruses: Epidemiology and Ecology, Volume IV. CRC Press, Florida, pg: 93-112.[myvmc.com]
  • Where to get help Your GP (doctor) Your local council Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services , Victorian Government Tel. 1300 651 160 Content Partner This page has been produced in consultation with[betterhealth.vic.gov.au]
  • The Arboviruses: Epidemiology and Ecology, Volume IV. CRC Press, Florida, pg: 93-112. RUSSELL, R.C. (1995). Arboviruses and their vectors in Australia: an update on the ecology and epidemiology of some mosquito-borne arboviruses.[medent.usyd.edu.au]
  • Objective/s This article aims to increase clinicians’ awareness of the epidemiological and clinical features of Ross River virus and provide information regarding prevention, diagnosis and management.[racgp.org.au]
  • […] genome SECTION II - HEALTH HAZARD PATHOGENICITY: Characterized by arthralgia or arthritis typically in the knee, ankle and small joints of the extremities, followed by a maculopapular rash; buccal and palatal enanthema can occur; mild or absent fever EPIDEMIOLOGY[msdsonline.com]
Sex distribution
Age distribution

Prevention

  • Dr Webb advises the best way to prevent falling ill is to prevent mosquito bites. “Covering up with long sleeved shirts and pants will help and using insect repellent,” he said.[manningrivertimes.com.au]
  • Prevention Travellers should take measures to prevent mosquito bites both indoors and outdoors. There is no preventive vaccine or medication against Ross River Fever. Use a repellent containing 20%-30% DEET or 20% Picaridin on exposed skin.[iamat.org]
  • Wearing insect repellent, long sleeves, and long pants can all help prevent mosquito bites and, therefore, prevent the transmission of this disease.[study.com]
  • For more information on how to prevent mosquito bites visit HealthyWA.[busseltonmail.com.au]
  • Prevention A vaccine to protect against infection by the Ross River virus is currently being developed.[abc.net.au]

References

Article

  1. Rulli NE, Suhrbierb A, Huestonc L, et al. Ross River virus: molecular and cellular aspects of disease pathogenesis Pharmacology & Therapeutics 2005;107:329–342.
  2. Kelly-Hope LA, Kay BH, Purdie DM. The risk of Ross River and Barmah Forest virus disease in Queensland: implications for New Zealand. Aust N Z J Public Health 2002;26(1):69–77.
  3. Claflin SB, Webb CE. Ross River Virus: Many Vectors and Unusual Hosts Make for an Unpredictable Pathogen. PLoS Pathog. 2015; 11: e1005070.
  4. Russell RC Ross River virus: Ecology and distribution. Annu Rev Entomol. 2002;47:1-31.
  5. Harley D, Sleigh A, Ritchie, S. Ross River Virus Transmission, Infection, and Disease: a Cross-Disciplinary Review Ross River Virus Transmission, Infection, and Disease. Clin. Microbiol. Rev. 2001;14:909-932.
  6. Fraser JRE. Epidemic polyarthritis and Ross River virus diseases. Clin Rheum Dis. 1986; 12: 369–388.
  7. Lidbury BA, Simeonovic C, Maxwell GE, Marshall ID, and Hapel AJ. Macrophage-induced muscle pathology results in morbidity and mortality for Ross River virus-infected mice. J. Infect. Dis. 2000;181:27-34.
  8. Morrison TE, Whitmore AC, Shabman RS, Lidbury BA, Mahalingam S, Heise MT. Characterization of Ross River virus tropism and virus-induced inflammation in a mouse model of viral arthritis and myositis. J Virol. 2006 Jan;80(2):737-749.
  9. Jacups SP, Whelan PI, Currie BJ. Ross River virus and Barmah Forest virus infections: a review of history, ecology, and predictive models, with implications for tropical northern Australia. Vector Borne Zoonotic Dis. 2008;8:283-297.
  10. 124 Mackenzie JS, Smith DW. Mosquito-borne viruses and epidemic polyarthritis. Med J Aust. 1996 Jan 15;164(2):90-93.
  11. Hossain I, Tambyah PA, Wilder-Smith A, Ross River virus disease in a traveler to Australia. J Travel Med. 2009;16:420-423.
  12. Suhrbier A, Linn ML. Clinical and pathologic aspects of arthritis due to Ross River virus and other alphaviruses. Current Opinion in Rheumatology 2004; 6(4):374 – 379.
  13. Oseni RA, Donaldson MD, Dalglish DA, Aaskov JG. Detection by ELISA of IgM antibodies to Ross River virus in serum from patients with suspected epidemic polyarthritis 1983 Bulletin of the World Health Organization, 1983;61:703-708.
  14. Mackenzie JS, Broom AK, Calisher CH, et al. Diagnosis and reporting of arbovirus infections in Australia. Arbovirus Res. Aust. 1993;6:89–93.
  15. Harley D, Ritchie S, Bain C, Sleigh AC. Risks for Ross River virus disease in tropical Australia. Int J Epidemiol 2005;34:548–555.
  16. Flexman JP, Smith DW, Mackenzie JS, et al. A comparison of the diseases caused by Ross River virus and Barmah Forest virus. Med J Aust. 1998 Aug 3;169(3):159-163.

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Last updated: 2019-07-11 21:45