Chapare Virus- Symptoms, Causes, Complications, And Treatment

Discovered in the lands of Bolivia in 2004, the Chapare virus is a rare illness that is quite identical to another virus known as the Ebola virus. Both of the viruses belong to the same arenavirus category.

Viruses that are usually spread through direct or indirect contact with infected rodents or their droppings ( urine or feces) are known as arenavirus. The name “Chapare” was derived from its place of origin in bolivia.

It was first found out by the US Centers for Disease Control and Prevention (CDC) that The Chapare virus was also a contagious disease and it can spread through human-to-human contact, which can lead to Chapare hemorrhagic fever (CHHF).

Since the virus is not well researched and there are only two documented outbreaks of CHHF till now, the symptoms of the virus can be confused with other mosquito or rodent-borne illnesses.

The first one happened back in 2003 in Chapare Province, Bolivia and the second outbreak occurred in 2019 in Caranavi Province, Bolivia, both times the results were life_threatening and fatal.

The inheritance of the Chapare virus in rodents is still unknown, it is present in their DNA or they get exposed to the virus and still need to be discovered. But most of the arenaviruses show identical roots, that is habitat and lifestyle choices of both rodents and humans. For instance, an infected rodent located in the fields of agriculture can infect the agricultural workers.

The infected rodent species can be found in both rural and urban, and domestic, agricultural, or healthcare settings. Contagious spread of CHHF can also occur through primary ( direct contact) or secondary ( indirect contact) mode of transmissions.

The primary form of transmission, that is rodent to human can occur through direct contact or indirect contact. Direct contact may include bite or scratch or contact with saliva, urine, and droppings of infected rodents.

On the other hand, Indirect mode of contact may include respiration in the infected air and consumption of contaminated consumables like food, water, medications, etc.

The secondary mode of transmission, that is human to human contact can also spread the Chapare virus. Human-to-human transmission mostly occurs in the original place of infection or the healthcare sector where the virus is cured or researched.

The direct form of infection may include, direct contact with body fluids like blood, saliva, semen, respiratory secretion, urine. Etc. The indirect transmission includes contact with contaminated medical equipment, respiration aerosolized environment during medical treatment like chest compressions, CPR, and intubation.

To avoid situations like this, members of the patients and medical professionals are advised to wear personal protective equipment (PPE) and use disinfection procedures to prevent any contact or further spread of illness.

The symptoms of Chapare hemorrhagic fever resemble many other illnesses such as:

• South American hemorrhagic fevers
• Arenavirus family illnesses
• Mosquito-borne illness

As mentioned earlier, the virus is not well researched leading to limited information about its specific signs to look for, and incubation periods of the virus in the body.

Commonly most of the arenaviruses incubation period varies between 4-21 days, depending upon the amount of exposure to the virus and once immune system.

According to the two documentations, the symptoms of the Chapare virus are very much identical to other arenaviruses Ebola. Some of the symptoms are:

• fever
• Headache
• Irritability
• Joint and muscle pain
• Stomach pain
• Vomiting
• Pain behind the eyes
• Bleeding gums
• Diarrhea
• Rash

These symptoms occur post bleeding stage in which the Chapare hemorrhagic fever can develop a life-threatening illness which can lead to multiple organ damage and blood vessel rupture.

To this date, there are only two identified outbreaks of CHHF, the first outbreak lead to the death of the patient after 14 days of Chapare virus signs and the second outbreak leads to a 60% death rate of the total infections.

Scientists are still looking for its possible long term complication in different age groups, gender, and their immune system respectively. Although it has been discovered that other arenaviruses can infect once pregnant leading to complications and even pass the illness to their offspring, it is still a mystery that CHHF can also cause the same.

Since symptoms of Chapare hemorrhagic fever resemble other viral infections like Machupo virus or other South American arenaviruses, hantavirus, leptospirosis, dengue, yellow fever, and others, it is important to examine the region and clinical epidemiological picture of the patient and conduct diagnosis for exact results.

If none of the results shows any possibility of other viral infections, the doctors will conduct specific molecular detection assays to identify the Chapare virus.

In the earlier documentation, it was discovered that the Chapare virus can successfully be identified from both serum and blood during the incubation period of illness.

So, like other identical arenaviruses, this virus can also be detected through bodily fluids like blood, serum, semen, respiratory secretions, and urine, through a real-time reverse transcription-polymerase chain reaction (rRT-PCR).

The test will facilitate the development of specific molecular detection assays, which gives them the complete genomic analysis of the Chapare virus.

Furthermore, the Chapare virus is highly contagious and can spread quickly through direct or indirect contact, so the test should be conducted using the highest biosecurity standards available.

Medical professionals that are handling the sample are strictly instructed to use Personal protective kits and other sanitary and waste disposal precautions to prevent the spread.

Note:The symptoms should be monitored frequently before, during, or even after the treatment for any sign, the patient should be discharged only when the test results show no signs of Chapare virus whatsoever.

There is no specific treatment has been discovered yet to cure Chapare hemorrhagic fever. Usually, supportive care has been conducted to cure the surface symptoms of the Chapare virus. The supportive care includes the following:

• Maintaining optimum Hydration level of the body - a balanced concentrate of minerals like electrolytes, glucose, and sodium will be effective to rehydrate the body of the patient. Other than the injection of fluids, the patient must increase the consumption of fluids like juices, water, shakes, and other liquids in their diet for effective results.
• Shock management ( includes fluid resuscitation, administration of vasopressin stocks) - is maintained by identifying and treating acute, reversible causes for the disease to restore intravascular volume by infusing vasoactive drugs and mechanical adjuncts until recovery.
• Pain relief
• Sedation
• Blood transfusions (when necessary)

Other than the supporting therapy, antiviral drugs like ribavirin (Rebetol, Virazole) might be prescribed by your medical expert to slow down the spread of viral infections in the body and prevent further complications.

Scientists were not sure that the medical treatment of the disease is ideal, as they were the very first cases recorded in the past two outbreaks, as even after recovery patients infected for arenaviruses may continue to have a downfall in blood count, saliva production, urine, and semen secretion.

This can be continued for months, even without any specific signs or symptoms.

Doctors recommend the patient to have frequent medical checkups and tests to monitor the levels of body fluids along with any potential relapse for the Chapare virus.

Also, it is advisable to isolate oneself from close ones ( especially sexual partners or other household members) to prevent any spread of the virus.

The long-term complication and other life threats are still under the shades and may need a little more research to know the Chapare virus to the core.

Here is the list of precautions that will prevent you from getting infected by Chapare viruses in private and public spaces:

• The root cause of the illness is the inheritance of rodents in your surroundings. It is important to control the rodents inside or around your homes and other buildings to prevent yourself from Chapare viruses or any other arenaviruses.
• Avoid any direct or indirect contact with rodents. Seal up all kinds of spaces and holes that are susceptible to rodent entrance. You can also put rat traps, poison, or other methods to eliminate any kind of rodent.
• Keep your surroundings clean. If located, dispose of any food item that has been contaminated by rodents or any other small mammals. Clean utensils and other products with hot water and disinfectants that might be contaminated through direct contact with rodents.
• Avoid areas that might be infested with rodents, places like dumpsters or other isolated areas should be visited with proper precautions.

Precautions need to be taken around a Chapare hemorrhagic fever patient:

• The Chapare virus is highly contagious, that is, it can be transmitted person-to-person through direct and indirect contact. One should practice social distancing with the Chapare virus patient as any contact from their body fluids like blood, saliva, urine, semen, respiratory secretions can be infectious.

  Not only before or during the recovery period, but also after full recovery the patients might inherit the virus without having any symptoms for months.

• Avoid any direct or indirect contact with the patient's bodily fluids, especially the members of the household, healthcare workers, and potentially sexual partners.
• One should monitor the presence of the Chapare virus through regular checkups and prescribed examinations. Also, the patient needs to monitor themselves for any signs of relief from any external symptoms or unusual secretion of any sort of bodily fluid.
• Use gloves and other precautions while handling the patient’s clothing, bedspreads, toiletries and utensils, and other used products. Use cleaning products that are specifically used for cleaning any traces of the virus.

  If possible separate the domestic items of the patient from the healthy members of the household for effective prevention.

• Separate the bathroom and toilet area, especially the ones used for excretion and urination, and or disinfect the complete area after the patient’s use.
• It is mandatory for both the patient and the members of the household to wear a mask to avoid any direct or indirect respiratory contact with the viral infection. Also, maintain personal hygiene and maintain social distancing for the best prevention.

Prevention methods for medical professionals dealing with an infected patient or their fluid samples:

• Avoid any direct or indirect contact with the patient or its bodily fluids. Close contact with patients during aerosol-generating procedures can lead to life-threatening situations.

  Wear PPE kits and follow all prevention guidelines before preceding the treatment or examination of the samples.

• Take Airborne precautions while performing procedures like suctioning, chest compressions, endotracheal intubation, bronchoscopy, or endoscopy to avoid any respiration of the virus.
• Also, eye protection via droplet precautions must be followed during the management of the patient's overall treatment.
• While handling any samples, the medical professionals are advised to use the highest biosecurity standards available. CDC ( Center fo Disease Control and Prevention) recommends biosafety level 4 in all the laboratories that will be or have been used for sample examination and diagnosis.