Case Study 4

Unsuspecting Honeymooners

Dengue
Viral disease Same family as W. Nile virus Aedes mosquito vector Also transmits yellow fever CDC recommends using DEET Geographic spread similar to malaria

Epidemiology
4 different strains allow for multiple epidemics to occur at once A major out break happens ~ 5 years Feb 2002 a serious outbreak in Rio De Janeiro, affected ~ one million people but only killing sixteen. With treatment mortality rate can be as low as 1 in 1000

Rio de Janeiro

Favelas
rio is one of the most violent cities on Earth with 18 homocides/day

Pop ~ 14 mil Denisty 328 people/km2 Pghs density: 2324 people/km2

Why call it dengue

The term "dengue" is a Spanish attempt at the Swahili phrase "ki denga pepo", meaning "cramp- like seizure caused by an evil spirit". It emerged during a Caribbean outbreak in 18271828.

1. Definitions Bradycardia: slow heart rate >60 bpm Hypotension: low bp Lymphadenopathy: abnormal enlargement of the lymph nodes Cervical lymph Nodes: in neck Inguinal lymph nodes: in groin Albuminuria: presence of albumin in the urine Petechiae: small purplish spot on a body surface

What do your lymph nodes do?

Filters out bacteria and viruses Youve got 500-600 Spleen and tonsils do similar jobs

Jasons WBC: 2,840/ L Marys WBC: 3,600/ L Normal WBC: 4,50011,000/L They are low

Leukocytosis: abnormally large increase in number of WBC in the blood, often occurring during an acute infection or inflammation. Leukopenia: abnormally low number of leukocytes in the circulating blood. No leukocytosis, Yep Leukopenia

 If you were an epidemiologist charged with controlling dengue fever, what important steps might you take? Whats an epidemiologist do? Tracks the spread of disease.
Check hospital records for reported cases of Dengue Create awareness, but isnt that tricky Require blood tests as part of passports

 If you were a government employee charged with writing a tourist advisory statement on dengue fever for people traveling in the Caribbean what precautions would you advise tourists to take?

4. Would the invasion of a cell by viruses increase, decrease, or have no effect on the osmolarity of a cell.
Increases particles whether theyre salts or viruses decreases the concentration of water. If there is a higher extra cellular concentration of water than intra cellular then water will flow down its conc. gradient and the cell will swell hypotonicly

5. Why are cells with the highest metabolic rate, like neurons and muscle cells, the most severely affected by mitochondrial cytopathy?
Because mitochondria is the site of glycolysis and the Krebs cycle which make energy transferring ATP

Do you think parasitic worms and arthropods are prokaryotes or eukaryotes Prokaryotes: no membrane bound organelles. Circular DNA Eukaryotes: membrane bound organelles, chromosomal DNA
Theyre Eukaryotes

7 . Explain why children never inherit Kearns-Sayre syndrome from their fathers. Kearns-Sayre: a mitochondrial cytopathy. Since all the sperms mitochondria dont survive in the egg all of a childs mtDNA comes from its mother. Rare: Less than 200,000 people in the U.S. Have it It hurts It doesnt kill you, but reduces life expectancy

 You are an epidemiologist charged with investigating and putting a stop to repeated outbreaks of giardiasis in an old run-down urban public school. Discuss the hypothesis you would form and the investigations you would undertake. Giardiasis (beaver fever) affects 200 mil world wide.
Common cause of gastroenteritis Fecal-oral transmission

Whats an epidemiologists to do
Consider the following statements 1. Smoking has been consistently linked to health problems such as lung cancer and coronary heart disease in several large prospective studies, this link has been deemed causal by a complex process of induction, consensus, and modeling. 2. Smoking may kill you.

 First is more accurate, but second will have more of an impact on public.
Is one more scientific than the other?

Epidemiologists are advocates for public health.

There is a scientific as well as political aspect

Arr. Beware the dengue fever of the Caribbean