View source for Medicine:Alkhurma virus

{{Short description|Species of virus}}
{{Infobox medical condition (new)
| name            =  Alkhurma hemorrhagic fever (AHF)
| synonyms        =  Alkhurma hemorrhagic fever virus (AHFV)<ref name="PMC18J1">{{cite journal |last1=Tambo |first1=Ernest |last2=El-Dessouky |first2=Ashraf |title=Defeating re-emerging Alkhurma hemorrhagic fever virus outbreak in Saudi Arabia and worldwide |journal=PLOS Negl Trop Dis |volume=12 |issue=9 |pages=e0006707 |date=27 September 2018 |doi=10.1371/journal.pntd.0006707 |pmid=30260960 |pmc=6159858 |doi-access=free }}</ref>
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| field           = [[Medicine:Infectious disease (medical specialty)|Infectious disease (medical specialty)]]
| symptoms        = Mild symptoms: [[Medicine:Fever|Fever]], [[Physics:Chills|chills]], [[Medicine:Headache|headache]], [[Medicine:Vomiting|vomiting]]<br>
Severe symptoms: Epistaxis, [[Medicine:Purpura|purpura]], [[Medicine:Leukopenia|leukopenia]]
| complications   = [[Medicine:Thrombocytopenia|Thrombocytopenia]], meningoencephalitis<ref>{{cite web |title=Tick-Borne Encephalitis Virus Complex Fact Sheet |url=https://www.aabb.org/tm/eid/Documents/TBEV.pdf |website=aaBB |access-date=19 January 2019 |archive-date=6 September 2017 |archive-url=https://web.archive.org/web/20170906094234/http://www.aabb.org/tm/eid/Documents/TBEV.pdf |url-status=dead }}</ref>
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| causes          = Alkhurma virus
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| diagnosis       = Molecular detection of PCR, virus isolation, serologic testing
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| prevention      = Tick repellents, limit contact with animals
| treatment       = Supportive therapy, monitoring of blood pressure and oxygen status
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'''Alkhurma virus''' ('''ALKV''') ({{lang-ar|فيروس الخرمة}}) is a zoonotic virus of the ''[[Biology:Flaviviridae|Flaviviridae]]'' virus family (class IV). ALKV causes '''Alkhurma hemorrhagic fever''' ('''AHF'''), or alternatively termed as Alkhurma hemorrhagic fever virus, and is mainly based in Saudi Arabia.<ref>{{cite web|title=Alkhurma Hemorrhagic Fever (AHF)|url=https://www.cdc.gov/vhf/alkhurma/pdf/factsheet.pdf|website=CDC|access-date=10 October 2017}}</ref><ref>{{cite web |title=Tick-borne Encephalitis (TBE) |url=https://www.cdc.gov/vhf/tbe/index.html |website=Centers for Disease Control and Prevention |publisher=US Government |access-date=16 January 2019}}</ref>

==Signs and symptoms==
After an incubation period lasting as short as 2–4 days or as long as 8 days, people with AHF develop symptoms including fever, headache, joint pain, muscle pain, vomiting, [[Medicine:Anorexia nervosa|a loss of appetite]], feeling of great discomfort, and chills. Less than 10% of people develop severe neurologic, central nervous system, and hemorrhagic symptoms, such as purpura, epitasis, hallucinations, disorientation, convulsions, and life-threatening epistaxis.<ref name="PMC18J1" /><ref name="GR">{{cite web |title=Alkhurma Virus (AHFV) |url=http://www.gesundes-reisen.eu/view_artikel_details.php?contentType=3&themaID=649 |website=Gesundes Reisen (German) |publisher=MD Medicus Reise- und Tropenmedizin GmbH |access-date=20 January 2019}}</ref> Elevated liver enzymes, leukopenia, proteinuria and thrombocytopenia, which leads to hemorrhagic fever and [[Medicine:Encephalitis|encephalitis]] (which can result in death), have been found in hospitalized patients.<ref>{{cite journal |author=Zaki AM |title=Isolation of a flavivirus related to the tick-borne encephalitis complex from human cases in Saudi Arabia |journal=Trans. R. Soc. Trop. Med. Hyg. |volume=91 |issue=2 |pages=179–81 |year=1997 |pmid=9196762 |doi= 10.1016/S0035-9203(97)90215-7}}</ref><ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) |url=https://www.cdc.gov/vhf/alkhurma/symptoms/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Department of Health & Human Services |access-date=16 January 2019}}</ref><ref name="GR"/>

==Taxonomy==
{{Virusbox
| image = Ijms-20-04657-g002.webp
| image_alt = Flavivirus structure and genome 
| image_caption = Flavivirus structure and genome 
| parent = Flavivirus
| species = Kyasanur Forest disease virus
| species_ref = <ref>ICTV 2nd Report {{cite journal | last1 = Fenner | first1 = F | year = 1976 | title = Classification and nomenclature of viruses. Second report of the International Committee on Taxonomy of Viruses | url = https://ictv.global/ictv/proposals/ICTV%202nd%20Report.pdf | journal = Intervirology | volume = 7 | issue = 1–2| pages = 1–115 | doi = 10.1159/000149938 | pmid = 826499 | doi-access = free }}</ref>
| subdivision_ranks = Strain
| subdivision = Alkhurma virus
}}

The [[Biology:Strain|ALKV prototype strain 1776]] was retrieved from a person in Saudi Arabia during the 1990s. It was found to contain over 10,000 nucleotides, with a single [[Biology:Open reading frame|ORF]] encoding over 3,000 amino acid polyproteins. The AnhC, PrM, M, NS2A, NS2B, NS3, NS4A, 2K, NS4B and NS5 proteins are all of the same length. ALKV owns the largest polyprotein of all TB-flaviviruses calculated as of yet.<ref name="SAJ1">{{cite journal |last1=Charrel |first1=Rémi |last2=Zaki |first2=Ali |last3=Attoui |first3=Houssam |last4=Fakeeh |first4=Mazen |last5=Billoir |first5=Frédérique |last6=Yousef |first6=Amany |last7=Chesse |first7=Reine |last8=Micco |first8=Philippe |last9=Gould |first9=Ernest |last10=Lamballerie |first10=Xavier |title=Complete Coding Sequence of the Alkhurma Virus, a Tick-Borne Flavivirus Causing Severe Hemorrhagic Fever in Humans in Saudi Arabia |journal= Biochemical and Biophysical Research Communications|volume=287 |issue=2 |pages=455–461 |date=17 August 2001 |doi=10.1006/bbrc.2001.5610 |pmid=11554750 |url=https://www.moh.gov.sa/en/HealthAwareness/Campaigns/Alkhurma/Documents/study02.pdf |access-date=20 January 2019}}</ref> ALKV has been found to be closely related to the [[Medicine:Kyasanur Forest disease|Kyasanur Forest disease]] (KFD), with which it shares 89% nucleotide sequence homology.<ref>{{cite journal|doi=10.1086/656326|title=In the Literature|journal=Clinical Infectious Diseases|volume=51|issue=4|pages=iii–iv|year=2010|doi-access=free}}</ref> Close similarities indicate that these viruses diverged 700 years ago.<ref name=Dodd2011>{{cite journal | last1 = Dodd | first1 = KA | last2 = Bird | first2 = BH | last3 = Khristova | first3 = ML | last4 = Albariño | first4 = CG | last5 = Carroll | first5 = SA | last6 = Comer | first6 = JA | last7 = Erickson | first7 = BR | last8 = Rollin | first8 = PE | last9 = Nichol | first9 = ST | year = 2011 | title = Ancient ancestry of KFDV and AHFV revealed by complete genome analyses of viruses isolated from ticks and mammalian hosts | journal = PLOS Negl Trop Dis | volume = 5 | issue = 10| page = e1352 | doi=10.1371/journal.pntd.0001352| pmid = 21991403 | pmc = 3186760 | doi-access = free }}</ref>
Related viruses include Omsk hemorrhagic fever and Royal Farm virus.

==Diagnosis==
Laboratory diagnosis of ALKV can be performed in the early stages of the illness by molecular detection of PCR or virus isolation from the blood. Serologic testing using enzyme-linked immunosorbent serologic assay (ELISA) can be made afterward.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) - Diagnosis |url=https://www.cdc.gov/vhf/alkhurma/diagnosis/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Government |access-date=16 January 2019}}</ref> Treatment consists of supportive therapy which balances the person's fluids and electrolytes, oxygen status and blood pressure monitored and maintained, and additional treatment for any further complications. The mortality rate of hospitalized patients ranges  from 1 to 20%.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) - Treatment |url=https://www.cdc.gov/vhf/alkhurma/treatment/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Government |access-date=16 January 2019}}</ref>

==Treatment==
Due to limited information pertaining to ALKV, no specific treatment, such as a [[Biology:Vaccine|vaccine]], has been created or made readily available. The best measures for combating ALKV are basic tick bite prevention, such as using tick repellents and avoiding regions where ticks are found in abundance, and raising awareness. Limiting non-casual contact with livestock and domestic animals is also another way of prevention. Individuals should appropriately check for attached ticks and remove them as soon as possible if found. Tick collars for domestic animals and the use of acaricides are efficient in killing ticks on livestock. People working with animals or animal products in farms or slaughterhouses should refrain from making unprotected contact with the blood, tissues, or fluids (such as consuming unpasteurized milk) of any potentially infected animal.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) - Prevention |url=https://www.cdc.gov/vhf/alkhurma/prevention/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Government |access-date=16 January 2019}}</ref>

==Epidemiology==

The route of transmission for ALKV is not fully understood and is filled with huge knowledge gaps, though camels and sheep have been linked to be the natural hosts of this virus. There appears to be more than one possible route of transmission seen in people who have become infected with this virus: one or more bites by an infected tick, crushing an infected tick with unprotected fingers, ingestion of unpasteurised camel milk, or entry via a skin wound.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever |url=https://www.malacards.org/card/alkhurma_hemorrhagic_fever |website=MalaCards |publisher=Weizmann Institute of Science |access-date=16 January 2019}}</ref> There is evidence pointing to the sand tampan, ''[[Biology:Ornithodoros savignyi|Ornithodoros savignyi]]'', as the vector.<ref>{{cite journal | pmc = 2725816 | pmid=17370534 | doi=10.3201/eid1301.061094 | volume=13 | issue=1 | title=Alkhurma hemorrhagic fever virus in Ornithodoros savignyi ticks | year=2007 | journal=Emerging Infect. Dis. | pages=153–5 | last1 = Charrel | first1 = RN | last2 = Fagbo | first2 = S | last3 = Moureau | first3 = G | last4 = Alqahtani | first4 = MH | last5 = Temmam | first5 = S | last6 = de Lamballerie | first6 = X}}</ref> No cases of human-human transmission of AHF have ever been recorded.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) - Transmission |url=https://www.cdc.gov/vhf/alkhurma/transmission/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Government |access-date=16 January 2019}}</ref>

The geographic distribution of the virus has extended beyond Saudi Arabia; reports of ALKV have been documented in countries where there is no endemic vector of the disease, such as [[Place:Egypt|Egypt]], Djibouti, and {{wipe|India}}.<ref>{{cite journal | last1 = Carletti | first1 = F | last2 = Castilletti | first2 = C | last3 = Di Caro | first3 = A | last4 = Capobianchi | first4 = MR | last5 = Nisii | first5 = C | last6 = Suter | first6 = F | display-authors = etal   | year = 2010 | title = Alkhurma hemorrhagic fever in travelers returning from Egypt, 2010 | journal = [[Biology:Emerging Infectious Diseases|Emerging Infectious Diseases]] | volume = 16| issue = 12| pages = 1979–1982| doi = 10.3201/eid1612.101092 | pmid = 21122237 | pmc = 3294557 }}</ref><ref name="PMC18J1" />  In a 2014 case study, researchers found that most cases of the virus have been reported from the Najran Region, where agriculture is heavily emphasised.{{cn|date=October 2022}}

As a response to the troubling illness, the KSA (Kingdom of Saudi Arabia) is treating ALKV as one of the nationally notifiable diseases in the country. An effective surveillance system was established by the Ministry of Health, where any suspected case of ALKV must be reported immediately. Three forms must be filled out to properly ensure the virus is being sufficiently monitored: A suspect case form, an epidemiological investigation form, and a laboratory requisition form. The hospitals and health centers, either governmental or private, report the potential ALKV case to the desk officers in charge of viral hemorrhagic fevers at the Directorate of Health Affairs in their respective region. Afterward, the desk officer forwards the report to the Directorate of Infectious Diseases at the Preventive Medicine Department at the Ministry of Health. Before entering the case into the database system, the desk officer in charge of AHFV reviews the case reports for accuracy and completion. Subsequently, the desk officer at the Ministry of Health formulates daily reports for the higher directors at the Ministry of Health and forwards them as feedback to the regions and their respective health units.<ref name="ncbi.nlm.nih.gov">{{cite journal |last1=Memish |first1=Ziad |last2=Fagbo |first2=Shamsudeen |last3=Ali |first3=Ahmed |last4=AlHakeem |first4=Rafat |last5=Elnagi |first5=Fatherlrhman |last6=Bamgboye |first6=Elijah |title=Is the Epidemiology of Alkhurma Hemorrhagic Fever Changing? : A Three-Year Overview in Saudi Arabia |journal=PLOS ONE |volume=9 |issue=2 |pages=e85564 |date=6 February 2014 |doi=10.1371/journal.pone.0085564 |pmid=24516520 |pmc=3916301 |bibcode=2014PLoSO...985564M |doi-access=free }}</ref>

In 2018, the tick species ''[[Biology:Ticks of domestic animals#Hyalomma ticks|H. rufipes]]'', another possible vector for this virus, has been found to be infecting migratory birds in Europe.<ref>{{cite journal |title = Alkhurma Hemorrhagic Fever Virus RNA in Hyalomma rufipes Ticks Infesting Migratory Birds, Europe and Asia Minor | journal=Emerging Infectious Diseases| volume=24| issue=5| pages=879–882| doi=10.3201/eid2405.171369| pmid=29664386| pmc=5938767| year=2018| last1=Hoffman| first1=Tove| last2=Lindeborg| first2=Mats| last3=Barboutis| first3=Christos| last4=Erciyas-Yavuz| first4=Kiraz| last5=Evander| first5=Magnus| last6=Fransson| first6=Thord| last7=Figuerola| first7=Jordi| last8=Jaenson| first8=Thomas G.T.| last9=Kiat| first9=Yosef| last10=Lindgren| first10=Per-Eric| last11=Lundkvist| first11=Åke| last12=Mohamed| first12=Nahla| last13=Moutailler| first13=Sara| last14=Nyström| first14=Fredrik| last15=Olsen| first15=Björn| last16=Salaneck| first16=Erik}}</ref><ref name="UPPSALA2019">{{cite news |title=Ticks on migratory birds carriers of hemorrhagic fever virus |url=http://www.uu.se/en/news-media/news/article/?id=10824&area=2,10,16,24,34,40&typ=artikel&lang=en |access-date=28 January 2019 |work=Uppsala University |agency=Uppsala University: News |publisher=Uppsala University |date=1 June 2018}}</ref>

==History==

This virus<ref>Sometimes misidentified as "Al-Khumra" virus—"It's Al-Khurma, not Al-Khumra, says official", ''The Saudi Gazette'',  13 Jan 2010, http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentID=2010011360023 {{Webarchive|url=https://archive.today/20140119200841/http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentID=2010011360023 |date=2014-01-19 }}.</ref> was first isolated from the blood of a 32-year-old male butcher at Dr. Soliman Fakeeh Hospital, Saudi Arabia during the 1990s, who became sick with an acute, fatal hemorrhagic [[Medicine:Fever|fever]] after slaughtering a [[Biology:Sheep|sheep]] imported from the small city of Alkhurma, Mecca province.<ref>{{cite web |title=Alkhurma Hemorrhagic Fever (AHF) |url=https://www.cdc.gov/vhf/alkhurma/index.html |website=Centers for Disease Control and Prevention |publisher=U.S. Department of Health and Human Services |access-date=16 January 2019}}</ref><ref>{{cite journal |last1=Memish |first1=Ziad |last2=Fagbo |first2=Shamsudeen |last3=Assiri |first3=Abdullah |last4=Rollin |first4=Pierre |last5=Zaki |first5=Ali |last6=Charrel |first6=Remi |last7=Mores |first7=Chris |last8=MacNeil |first8=Adam |title=Alkhurma Viral Hemorrhagic Fever Virus: Proposed Guidelines for Detection, Prevention, and Control in Saudi Arabia |journal=PLOS Negl Trop Dis |volume=6 |issue=7 |pages=e1604 |date=31 July 2012 |doi=10.1371/journal.pntd.0001604 |pmid=22860139 |pmc=3409106 |doi-access=free }}</ref> Since then, over 40 cases of ALKV, with case fatality rates less than 1%, have been reported. ALKV is classified as a BSL-3 or BSL-4 agent, depending on the country's regulations.<ref name="PMCEIDJournal">{{cite journal |last1=Alzahrani |first1=Abdullah |last2=Al Shaiban |first2=Hassan |last3=Al Mazroa |first3=Mohammed |last4=Al-Hayani |first4=Osama |last5=MacNeil |first5=Adam |last6=Rollin |first6=Pierre |last7=Memish |first7=Ziad |title=Alkhurma Hemorrhagic Fever in Humans, Najran, Saudi Arabia |journal=Emerg Infect Dis |volume=16 |issue=12 |pages=1882–1888 |date=December 2010 |doi=10.3201/eid1612.100417 |pmid=21122217 |pmc=3294564 }}</ref><ref>{{cite web |title=Facts about Alkhurma haemorrhagic fever |url=https://ecdc.europa.eu/en/alkhurma-haemorrhagic-fever/facts |website=European Centre for Disease Prevention and Control |publisher=European Union |access-date=16 January 2019 |archive-date=16 January 2019 |archive-url=https://web.archive.org/web/20190116100213/https://ecdc.europa.eu/en/alkhurma-haemorrhagic-fever/facts |url-status=dead }}</ref><ref name="ncbi.nlm.nih.gov"/>

== References ==
{{Reflist}}

==Further reading==
* {{cite journal |author=Charrel RN |title=Low diversity of Alkhurma hemorrhagic fever virus, Saudi Arabia, 1994-1999 |journal=Emerging Infect. Dis. |volume=11 |issue=5 |pages=683–8 |year=2005 |pmid=15890119 |doi= 10.3201/eid1105.041298|name-list-style=vanc |author2=Zaki AM |author3=Fakeeh M |display-authors=3 |last4=Yousef |first4=AI |last5=De Chesse |first5=R |last6=Attoui |first6=H |last7=De Lamballerie |first7=X |pmc=3320364}}
* {{cite journal |author=Charrel RN |title=Complete coding sequence of the Alkhurma virus, a tick-borne flavivirus causing severe hemorrhagic fever in humans in Saudi Arabia |journal= Biochemical and Biophysical Research Communications|volume=287 |issue=2 |pages=455–61 |year=2001 |pmid=11554750 |doi=10.1006/bbrc.2001.5610 |name-list-style=vanc |author2=Zaki AM |author3=Attoui H |display-authors=3 |last4=Fakeeh |first4=Mazen |last5=Billoir |first5=Frédérique |last6=Yousef |first6=Amany Ibrahim |last7=De Chesse |first7=Reine |last8=De Micco |first8=Philippe |last9=Gould |first9=Ernest A}}

==External links==
* [https://ecdc.europa.eu/en/alkhurma-haemorrhagic-fever Alkhurma haemorrhagic fever - European Centre for Disease Prevention and Control] {{Webarchive|url=https://web.archive.org/web/20190925202446/https://ecdc.europa.eu/en/alkhurma-haemorrhagic-fever |date=2019-09-25 }}
{{Zoonotic viral diseases}}
{{Tick-borne diseases}}
{{Taxonbar|from=Q3560885}}

{{DEFAULTSORT:Alkhurma Virus}}
[[Category:Tick-borne diseases]]

{{Sourceattribution|Alkhurma virus}}