Vanoi fever
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| Vanoi fever | |
|---|---|
| Other names | Vanoi encephalitic fever[note 1], Vanoi hemorrhagic fever[note 2] |
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| Transmission electron micrograph of PC-60 | |
| Pronunciation | |
| Specialty | Infectious diseases |
| Symptoms | Fever, cough, dizziness, meningitis, encephalitis, delirium, extreme aggression |
| Complications | Seizures, paralysis, hypovolemic shock |
| Usual onset | 2–21 days after exposure |
| Causes | PC-60 |
| Risk factors | Direct contact with blood of infected people |
| Diagnostic method | Blood test |
| Treatment | Supportive care |
Vanoi fever, also known as Vanoi encephalitic fever (VEF)[note 1] and Vanoi hemorrhagic fever (VaHF)[note 2], is a viral hemorrhagic fever caused by the PC-60 virus that affects most mammalian sapient species. Vanoi fever was first identified in the Vanoi Medical Center in Voskakova, Valokchia in May 2018, and caused the following Vanoi fever pandemic.
Symptoms usually begin from two days to three weeks after exposure and initially takes the form of influenza-like illness, followed by progressive inflammation of the meninges and central nervous system causing paranoia and insomnia before resulting in extreme aggression resembling furious rabies. Vanoi fever has a fatality rate of about 93% once it is allowed to progress to a late stage.
Vanoi fever is spread primarily through direct contact with body fluids, especially blood. There have been a handful of documented cases of Vanoi fever spreading through air, though airborne transmission of Vanoi fever remains rare.
Signs and symtoms
Onset
Vanoi fever's incubation period, or the time it takes for symptoms to develop after initial exposure, is between 2 and 21 days, though about 60% of cases take between 4 and 10 days to develop.
The symptoms and severity of Vanoi fever vary between species but the disease is usually fatal if left untreated. Initial symptoms take the form of influenza-like illness characterized by fever, cough, fatigue, dizziness, and malaise.
Encephalitis
If not prevented, after about 7–10 days, the infection enters the central nervous system, causing progressive encephalitis and meningitis in 90% of untreated cases. This is accompanied by the onset of paranoia, insommnia, and eventually delirium by day 12–20.
After the onset of delirium, hosts become hyper-reactive to stimuli. This stage infamously causes extreme and irrational aggression in the host similar to that in rabies, which aids in the transmission of the virus through attacks from the host. Vanoi fever is always fatal if it progresses to this "aggressive" stage.
As damage to the central nervous system worsens, hosts will typically start developing seizures and may become paralyzed due to damage to the spinal cord. Damage to the blood-brain barrier may lead to cerebral edema. Eventually the host falls into a coma, with death following shortly afterwards.
The incidence of encephalitis untreated cases varies by species and can be as high as 95% in vulnerable populations. Survivors are typically left with chronic health issues due to damage to the blood-brain barrier.
Bleeding
Regardless of whether encephalitis occurs, after 25–30 days of the infection, bleeding may occur, accompanied with decreased blood clotting. Petechiae, purpura, and hematomas may also develop. Blood loss may cause hypovolemic shock, which is the main cause of death among cases that do not develop encephalitis.
Vanoi fever was initially believed to not be a hemorrhagic fever due to the relatively late development of hemorrhagic symptoms compared to other viral hemorrhagic fevers, and since most early cases of Vanoi fever typically died due to encephalitic symptoms before hemorrhagic symptoms could develop.
Cause
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Vanoi fever is caused by PC-60, a single-strand negative-sense RNA virus of the family Filoviridae. It is closely related to marburgviruses.
Virology
PC-60 contains a single-stranded genome that contains seven genes, 3'-UTR-NP-VP35-VP40-GP-VP30-VP24-L-5'-UTR. Like other filoviruses, PC-60 virions take the form of filaments 80 nm in length and vary in length from 837 to 963 nm.
As it targets cell receptors common to most mammals, PC-60 is able to infect a wide range of both animals and sentient species, though most non-sapient mammals will not manifest symptoms if infected. Only a handful of non-sapient mammals that can be infected with PC-60 are capable of spreading Vanoi fever to sapient species, though most non-sapient animals can spread the virus with each other.
Transmission
Vanoi fever is transmitted most efficiently through direct contact with body fluids (especially blood) from infected individuals. PC-60 does not occur in measurable levels in saliva, feces, or vomit of infected people, but does exist in low levels in mucus. The virus also occurs in semen, so it can spread via sexual intercourse.
Due to the extreme aggression that often results due to Vanoi fever, the resulting violence can further transmission if blood is spilt. This became the most well-known method of blood-borne transmission due to media coverage, though blood transfusions, needle reuse, and needlestick injuries also spread the disease.
Vanoi fever can be spread via air due to the virus existing in airborne aerosols, but the risk of airborne transmission of Vanoi fever is comparatively low.
Due to its ability to infect a wide range of animals, Vanoi fever can use a number of mammals as natural reservoirs, namely dogs, bats, and monkeys.
Pathophysiology
PC-60 initially infects primarily liver cells, endothelial cells, and some immune cells. Infection of immune cells allow for the spread of the infection to lymph nodes, which allows for further spread of the virus. PC-60 also quickly infects endothelial cells, like in other hemorrhagic fevers, though PC-60 doesn't cause endothelial cell death as quickly as other hemorrhagic fevers due to differences in PC-60 glycoproteins compared to similar viruses. Though this effect is delayed, PC-60 infection eventually results in endothelial cells detaching from the surrounding structure and dying, causing damage to the blood vessel, bleeding, and liver damage that decreases clotting.
Once the viral load within blood is high enough, PC-60 becomes increasingly able to cross the blood-brain barrier into the central nervous system, where it infects nervous tissue and causes inflammation of both the brain and the spinal cord. The progressive encephalitis that occurs as a result of central nervous infection is responsible for delirium and associated symptoms in Vanoi fever.
Diagnosis
Upon onset of symptoms, testing for the disease is strongly encouraged.
Viral tests
Vanoi fever can be detected through IgM antibodies in the blood or by detecting viral RNA through a nucleic acid test that relies on polymerase chain reaction to amplify viral RNA for detection. The first rapid antigen test for PC-60 was developed by July 2018, and quickly became the most common form of testing for Vanoi fever due to its comparatively low cost, though laboratory blood tests to confirm diagnosis was encouraged .