Kyasanur Forest disease

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Kyasanur forest disease
Other namesMonkey disease, monkey fever
SpecialtyInfectious disease

Kyasanur forest disease (KFD) is a tick-borne viral haemorrhagic fever endemic to South India.[1] The disease is caused by a virus belonging to the family Flaviviridae, which also includes yellow fever and dengue fever which are transmitted by mosquitoes.

Signs and symptoms[edit]

The symptoms of the disease include a high fever with frontal headaches, followed by haemorrhagic symptoms, such as bleeding from the nasal cavity, throat, and gums, as well as gastrointestinal bleeding.[2] Other symptoms include vomiting, muscle stiffness, tremors, absent reflexes, and mental disturbances.[3][4]

An affected person may recover in two weeks time, but the convalescent period is typically very long, lasting for several months. There will be muscle aches and weakness during this period and the affected person is unable to engage in physical activities.



Kyasanur forest disease virus
Virus classification
Group IV ((+)ssRNA)
Kyasanur forest disease virus

The genome of KFDV consists of 10,774 nucleotides of single-stranded positive sense RNA.[5] Its genome was discovered to only code for one polyprotein: C-prM-E-NS1-NS2A-NS2B-NS3-NS4A-NS4B-NS5.[6][7] The genome of KFDV is very similar (>92% homologous) to that of Alkhurma Hemorrhagic Fever Virus which is primarily found in Saudi Arabia. These two species both belong to the family Flaviviridae and diverged over 700 years ago and have thus remained geographically separated.[8]


There are a variety of animals thought to be reservoir hosts for the disease, including porcupines, rats, squirrels, mice and shrews.[2] The vector for disease transmission is Haemaphysalis spinigera, a forest tick.[9] Humans contract infection from the bite of nymphs of the tick.


The pathogenesis of KFDV is not completely understood, but studies have been undertaken that have given insight to the pathology that was previously unknown. Research using mice models found that KFDV primarily replicated in the brain.[10] Other research has expanded on this by described neurological changes that occurred within infected organisms. This experiment was completed by using KFDV-infected mice and discovered that KFDV caused gliosis, inflammation, and cell death in the brain. Within their discussion, the authors presented the idea that KFDV could be primarily a neuropathic disease and other symptoms are due to this pathogenesis.[11]


Previous methods of diagnosis included HI, complement fixation, neutralization tests, and injecting the serum of infected individuals into mice. However, new research has introduced more efficient methods to diagnose KFDV. These methods include: nested RT-PCR, TaqMan-based real-time RT-PCR, and immunoglobin M antibodies detection by ELISA. The two methods involving PCR are able to function by attaching a primer to the NS-5 gene which is highly conserved among the genus to which KFDV belongs. The last method allows for the detections of anti-KFDV antibodies in patients.[12]

Prevention and treatment[edit]

Prevention is by vaccination, as well as preventive measures like protective clothing, tick control, and mosquito control are advised. The vaccine for KFDV consists of formalin-inactivated KFDV. The vaccine has a 62.4% effectiveness rate for individuals who receive two doses. For individuals who receive an additional dose, the effectiveness increases to 82.9%.[13] Specific treatments are not available.


The disease was first reported from Kyasanur Forest of Karnataka in India in March 1957. The disease first manifested as an epizootic outbreak among monkeys killing several of them in the year 1957. Hence the disease is also locally known as "monkey disease" or "monkey fever".[14] The similarity with Russian spring-summer encephalitis was noted and the possibility of migratory birds carrying the disease was raised.[15] Studies began to look for the possible species that acted as reservoirs for the virus and the agents responsible for transmission. Subsequent studies failed to find any involvement of migratory birds although the possibility of their role in initial establishment was not ruled out. The virus was found to be quite distinctive and not closely related to the Russian virus strains. Antigenic relatedness is however close to many other strains including the Omsk hemorrhagic fever (OHF) and birds from Siberia have been found to show an antigenic response to KFD virus. Sequence based studies however note the distinctiveness of OHF.[16] Early studies in India were conducted in collaboration with the US Army Medical Research Unit and this led to controversy and conspiracy theories.[17][18]

Subsequent studies based on sequencing found that the Alkhurma virus, found in Saudi Arabia is closely related.[19] In 1989 a patient in Nanjianin, China was found with fever symptoms and in 2009 its viral gene sequence was found to exactly match with that of the KFD reference virus of 1957. This has however been questioned since the Indian virus shows variations in sequence over time and the exact match with the virus sequence of 1957 and the Chinese virus of 1989 is not expected. This study also found using immune response tests that birds and humans in the region appeared to have been exposed to the virus.[20] Another study has suggested that the virus is recent in origin dating the nearest common ancestor of it and related viruses to around 1942, based on the estimated rate of sequence substitutions. The study also raises the possibility of bird involvement in long-distance transfer.[21] It appears that these viruses diverged 700 years ago.[22]


The disease has a fatality rate of 3-10%, and it affects 400-500 people annually.[9][12]

The disease was first noted at Kyasanur village near Sagar in Shivamogga district of Karnataka. The virus has been detected in monkeys in parts of Bandipur National Park (Chamarajnagar) and parts of the Nilgiris. Human infection occurred in Bandipur through handling of dead monkeys that were infected. A human carrier was also detected in Wayanad (Kerala).[23] The disease has shown its presence in the adjacent states of Karnataka including Kerala, Maharashtra, Goa, Tamil Nadu and Gujarat.[24][25][26]


  1. ^ EA Gould; T Solomon (February 9, 2008). "Pathogenic flaviviruses". The Lancet. 371 (961): 500–509. doi:10.1016/S0140-6736(08)60238-X. ISSN 0140-6736. PMID 18262042.
  2. ^ a b Gerhard Dobler (27 January 2010). "Zoonotic tick-borne flaviviruses". Veterinary Microbiology. 140 (3–4, Zoonoses: Advances and Perspectives): 221–228. doi:10.1016/j.vetmic.2009.08.024. ISSN 0378-1135. PMID 19765917.
  3. ^ Dobler, Gerhard (2010). "Zoonotic tick-borne flaviviruses". Veterinary Microbiology. 140 (3/4): 221–228. doi:10.1016/j.vetmic.2009.08.024. PMID 19765917.
  4. ^ Mourya, Devendra; Yadav, Pragya; Sandhya, V; Reddy, Shivanna (2013). "Spread of Kyasanur Forest Disease, Bandipur Tiger Reserve, India, 2012-2013". Emerging Infectious Diseases. 19 (9): 1540–1541. doi:10.3201/eid1909.121884. PMC 3810911. PMID 23977946.
  5. ^ Cook, Bradley; Cutts, Todd; Court, Deborah; Theriault, Steven (2012). "The generation of a reverse genetics system for Kyasanur Forest Disease Virus and the ability to antagonize the induction of the antiviral state in vitro". Virus Research. 163 (2): 431–438. doi:10.1016/j.virusres.2011.11.002. PMID 22100401.
  6. ^ Cook, Bradley; Ranadheera, Charlene; Nikiforuk, Aidan; Cutts, Todd; Kobasa, Darwyn; Court, Deborah; Theriault, Steven (2016). "Limited Effects of Type I Interferons on Kyasanur Forest Disease Virus in Cell Culture". PLoS Neglected Tropical Diseases. 10 (8): e0004871. doi:10.1371/journal.pntd.0004871. PMC 4968803. PMID 27479197.
  7. ^ Dodd, Kimberly; Bird, Brian; Khristova, Marina; Albariño, César; Carroll, Serena; Comer, James; Erickson, Bobbie; Rollin, Pierre; Nichol, Stuart (2011). "Ancient Ancestry of KFDV and AHFV Revealed by Complete Genome Analyses of Viruses Isolated from Ticks and Mammalian Hosts". PLoS Neglected Tropical Diseases. 5 (10): e1352. doi:10.1371/journal.pntd.0001352. PMC 3186760. PMID 21991403.
  8. ^ Dodd, Kimberly; Bird, Brian; Jones, Megan; Nichol, Stuart; Spiropoulou, Christina (2014). "Kyasanur Forest Disease Virus Infection in Mice Is Associated with Higher Morbidity and Mortality than Infection with the Closely Related Alkhurma Hemorrhagic Fever Virus". PLOS One. 9 (6): e100301. doi:10.1371/journal.pone.0100301. PMC 4065072. PMID 24950196.
  9. ^ a b Holbrook, Michael (2012). "Kyasanur forest disease". Antiviral Research. 96 (3): 353–362. doi:10.1016/j.antiviral.2012.10.005. PMC 3513490. PMID 23110991.
  10. ^ Sawatsky, Bevan; McAuley, Alexander; Holbrook, Michael; Bente, Dennis (2014). "Comparative Pathogenesis of Alkhumra Hemorrhagic Fever and Kyasanur Forest Disease Viruses in a Mouse Model". PLoS Neglected Tropical Diseases. 8 (6): e2934. doi:10.1371/journal.pntd.0002934. PMC 4055546.
  11. ^ Basu, Atanu; Yadav, Pragya; Prasad, Sharda; Badole, Sachin; Patil, Dilip; Kohlapure, Rajendra; Mourya, Devendra (2016). "An Early Passage Human Isolate of Kyasanur Forest Disease Virus Shows Acute Neuropathology in Experimentally Infected CD-1 Mice". Vector Borne & Zoonotic Diseases. 16 (7): 496–498. doi:10.1089/vbz.2015.1917. PMID 27171207.
  12. ^ a b Mourya, Devendra; Yadav, Pragya; Mehla, Rajeev; Barde, Pradip; Yergolkar, Prasanna; Kumar, Sandeep; Thakare, Jyotsna; Mishra, Akhilesh (2012). "Diagnosis of Kyasanur forest disease by nested RT-PCR, real-time RT-PCR and IgM capture ELISA". Journal of Virological Methods. 186 (1/2): 49–54. doi:10.1016/j.jviromet.2012.07.019. PMID 22874757.
  13. ^ Kasabi, Gudadappa; Murhekar, Manoj; Sandhya, Vijay; Raghunandan, Ramappa; Kiran, Shivani; Channabasappa, Gowdra; Mehendale, Sanjay (2013). "Coverage and Effectiveness of Kyasanur Forest Disease (KFD) Vaccine in Karnataka, South India, 2005-10". PLoS Neglected Tropical Diseases. 7 (1): e2025. doi:10.1371/journal.pntd.0002025. PMC 3554520. PMID 23359421.
  14. ^ Nichter, Mark (1987). "Kyasanur Forest Disease: An Ethnography of a Disease of Development". Medical Anthropology Quarterly. New Series. 1 (4): 406–423. doi:10.1525/maq.1987.1.4.02a00040.
  15. ^ Work, Telford H.; Roderiguez, FR; Bhatt, PN (1959). "Virological Epidemiology of the 1958 Epidemic of Kyasanur Forest Disease" (PDF). American Journal of Public Health. 49 (7): 869–874. doi:10.2105/AJPH.49.7.869. PMC 1372906. PMID 13661478.
  16. ^ Lin D, Li L, Dick D, Shope RE, Feldmann H, Barrett AD, Holbrook MR (2003). "Analysis of the complete genome of the tick-borne flavivirus Omsk hemorrhagic fever virus". Virology. 313 (1): 81–90. doi:10.1016/S0042-6822(03)00246-0. PMID 12951023.
  17. ^ Harry Hoogstraal; Makram N. Kaiser; Melvin A. Traylor; Ezzat Guindy; Sobhy Gaber (1963). "Ticks (Ixodidae) on birds migrating from Europe and Asia to Africa, 1959-61". Bull. World Health Organ. 28 (2): 235–262. PMC 2554471. PMID 13961632.
  18. ^ Lewis, Michael (2002). "Scientists or Spies? Ecology in a Climate of Cold War Suspicion". Economic and Political Weekly. 37 (24): 2324–2332.
  19. ^ Charrel RN, Zaki AM, Attoui H, Fakeeh M, Billoir F, Yousef AI, de Chesse R, De Micco P, Gould EA, de Lamballerie X (2001). "Complete coding sequence of the Alkhurma virus, a tick-borne flavivirus causing severe hemorrhagic fever in humans in Saudi Arabia". Biochem. Biophys. Res. Commun. 287 (2): 455–61. doi:10.1006/bbrc.2001.5610. PMID 11554750.
  20. ^ Jinglin Wang; Hailin Zhang; Shihong Fu; Huanyu Wang; Daxin Ni; Roger Nasci; Qing Tang; Guodong Liang (2009). "Isolation of Kyasanur Forest Disease Virus from Febrile Patient, Yunnan, China". Emerg. Infect. Dis. 15 (2): 326–328. doi:10.3201/eid1502.080979. PMC 2657630. PMID 19193286.
  21. ^ Rajeev Mehla; Sandeep R.P. Kumar; Pragya Yadav; Pradip V. Barde; Prasanna N. Yergolkar; Bobbie R. Erickson; Serena A. Carroll; Akhilesh C. Mishra; Stuart T. Nichol; Devendra T. Mourya (2009). "Recent Ancestry of Kyasanur Forest Disease Virus". Emerging Infectious Diseases. 15 (9): 1431–1437. doi:10.3201/eid1509.080759. PMC 2819879. PMID 19788811.
  22. ^ Dodd KA, Bird BH, Khristova ML, Albariño CG, Carroll SA, Comer JA, Erickson BR, Rollin PE, Nichol ST (2011). "Ancient ancestry of KFDV and AHFV revealed by complete genome analyses of viruses isolated from ticks and mammalian hosts". PLoS Negl Trop Dis. 5 (10): e1352. doi:10.1371/journal.pntd.0001352. PMC 3186760. PMID 21991403.
  23. ^ Mourya DT, Yadav PD, Sandhya VK, Reddy S (2013). "Spread of Kyasanur Forest disease, Bandipur Tiger Reserve, India, 2012–2013 [letter]". Emerging Infectious Diseases. 19 (9): 1540–1541. doi:10.3201/eid1909.121884. PMID 23977946.
  24. ^ Awate, P.; Yadav, P.; Patil, D.; Shete, A.; Kumar, V.; Kore, P.; Dolare, J.; Deshpande, M.; Bagde, S.; Sapkal, G.; Gurav, Y.; Mourya, D.T. (2016). "Outbreak of Kyasanur Forest disease (monkey fever) in Sindhudurg, Maharashtra State, India, 2016". Journal of Infection. 72 (6): 759–761. doi:10.1016/j.jinf.2016.03.006. PMID 26997635.
  25. ^ Patil, D.Y.; Yadav, P.D.; Shete, A.M.; Nuchina, J.; Meti, R.; Bhattad, D.; Someshwar, S.; Mourya, D.T. (2017). "Occupational exposure of cashew nut workers to Kyasanur Forest disease in Goa, India". International Journal of Infectious Diseases. 61: 67–69. doi:10.1016/j.ijid.2017.06.004. PMID 28627428.
  26. ^ Sadanandane, C.; Elango, A.; Marja, Noonu; Sasidharan, P.V; Raju, K.H.K; Jambulingam, P. (2017). "An outbreak of Kyasanur forest disease in the Wayanad and Malappuram districts of Kerala, India". Ticks and Tick-borne Diseases. 8 (1): 25–30. doi:10.1016/j.ttbdis.2016.09.010. PMID 27692988.

External links[edit]