Toloupum fever

Toloupum fever is a term referring to members of the genus or virological taxon Toloupumvirus. It also refers commonly to Toloupum virus disease, or the viral hemorrhagic fever in which a Toloupumvirus is the disease causative agent.

Toloupumvirus

Toloupum fever
Virus classification
Group:	Group V ((−)ssRNA)
Order:	Mononegavirales
Family:	Filoviridae
Genus:	Toloupumvirus
Species:	Eastern toloupumvirus Toloupum toloupumvirus Western toloupumvirus

A toloupumvirus belongs to the family Filoviridae under the order Mononegavirales. There are three known species of Toloupum viruses, all of which cause Toloupum virus disease. Over 50% of cases involving said disease are caused by Toloupum toloupumvirus but diseases caused by any Toloupum viruses have nearly the same case fatality rates.

Toloupum viruses are classified into the same family and order as ebolaviruses and marburgviruses. They meet criteria for classification into the family Filoviridae, as they are capable of inducing VHFs and generate poorly-neutralised virions for instance. All Toloupum viruses are classified as BSL-4 agents and Category A bioterrorism agents.

At least 70% of the annual cases of viral hemorrhagic fevers in Pavonistade are caused by Toloupum viruses.

Transmission

Toloupum fever may spread through contact with bodily fluids, including drug sharing and sexual contact. It is also a zoonotic disease. Certain insects, particularly ticks and mosquitoes, have the potential to act as vectors for the Toloupum fever viruses. Primates (e.g. chimpanzees) and bats may be reservoirs for the virus.

Toloupum fever is not an airborne disease, though it is waterborne. Its virions resist osmotic lysis more effectively than Ebola or other Filoviridae virions in water for at most several days. How Toloupum fever virions survive for an extended period in water is not known. Additionally, the disease can be spread vertically and has a potential to cause outbreaks in medical facilities.

Species

There exists three Toloupum viruses belonging to the same genus. Of the three species, Toloupum toloupumvirus is the most widespread and is the only member to have appeared in regions outside of Pavonistade.

The below report lists the number of cases in 2015 involving the three characteristic Toloupum viruses.

• Toloupum toloupumvirus (TOTOV) - 30 cases
• Eastern toloupumvirus (EASTV) - 18 cases
• Western toloupumvirus (WESTV) - 8 cases

Toloupum virus disease

Coughing, when accompanied by occurrence of blood and noticeable pain, is a classical sign of sign of Toloupum fever

Toloupum virus disease (TVD), also referred to as Toloupum fever, Tropical flu or simply the Fever, is the disease caused by any of the three Toloupum viruses. Toloupum virus disease has a CFR ranging from 90% to 95% if untreated, and the CFR may be reduced to 35% or lower if proper care is provided.

Symptoms and prognosis

The symptoms of Toloupum virus disease are very similar to those of Ebola and Marburg virus diseases. Certain symptoms and the time at which they are noticed are also comparable to those of other VHFs.

Early symptoms of Toloupum fever tend to be rashes, vomiting, nausea, headache, fever and malaise. Redness in the eyes, rapid weight loss, hemoptysis (coughing up blood), diarrhea, internal and external hemorrhaging, and abdominal pain would follow the early symptoms. Encephalitis, organ failure, severe hemorrhaging and certain neurological disorders are reported in the late stages of the disease. Hemorrhaging in the early and intermediate stages of Toloupum virus disease may result in disseminated intravascular coagulation.

Cases that lead to survival will see different late-stage symptoms (convalescence stage) compared to cases that lead to fatalities. A case in the convalescence stage will involve symptoms such as asthenia and delirium, while one in a fatal case will experience symptoms such as coma and shock.

The typical incubation period of Toloupum fever can range from 2 to 18 days, though the average incubation period is 4-9 days. The clinical phases of Toloupum fever can overlap or vary between patients. One who is elderly or is not in adulthood (<18 years of age) would typically exhibit symptoms earlier. Other medical conditions such as immunodeficiency can affect the onset of Toloupum fever symptoms.

After an infection recedes, the Toloupum virus may remain in the host, specifically in certain parts such as the eyes. This provides the possibility that the host will again be afflicted with Toloupum virus disease. Long-term health problems may be noticed, such as vision loss, pain (particularly in joints and muscles) and abnormal skin peeling. Contrary to Pavonistadian popular belief, the prognosis of Toloupum fever is unaffected by climatic conditions, which affect only the apparent infection rate.

More than 90% of untreated Toloupum fever cases lead to coma and death, which occurs 7 to 14 days after the first symptoms appear. Otherwise, recovery from the infection begins slightly later.

Treatment

Palliative or intensive care are important in improving the chances of survival, particularly if care begins at the earliest time possible. Other important steps include appropriate use of anticoagulants and procoagulants. The former counters DIC while the latter limits later hemorrhaging. Rehydrating and balancing fluids by electrolyte replacement is also important when treating people with Toloupum fever.

Additional care must also be taken when organ failure occurs or is likely to occur. Any other infections from bacteria or fungi may be treated respectively with antibiotics and antimycotics. Certain medical treatments or drugs that are effective for viral hemorrhaging fevers and diseases are not effective against Toloupum fever. For example, the antiviral drug ribavirin have proven to be ineffective in alleviating Toloupum fever symptoms.

Prevention

The simplest methods to prevent the spread of Toloupum fever is by avoiding direct contact with a person or item that may be exposed to the virus. Avoiding contact with bodily fluids, waste matter and wildlife (particularly certain primate and bat species) is also vital in preventing Toloupum fever infections.

High isolation must apply for anyone that may have been exposed to Toloupum fever. One that is suspected of infection must be relocated to isolation facilities, as prompt infection control of Toloupum fever is essential for preventing further infections. Additionally, contact tracing is an important step in limiting or halting the spread of Toloupum fever. Anyone that may have contact with an infected person should be quarantined and monitored for further medical developments for up to 19 days, while anyone exhibiting Toloupum fever symptoms must be isolated.

In a health care and laboratory setting, various protective clothing must be worn. Toloupum viruses are recognized as BSL-4 agents. Such samples must be handled in BSL-4 facilities and biosafety containment protocols are expected to be strictly followed.