Bourbon Virus and Acute Kidney Injury - Symptoms, Diagnosis, and Treatment

Introduction:

The Bourbon virus is thought to be transmitted from an infected tick’s bite. The virus was first discovered in 2014 and named after Bourbon County, Kansas, where it was first discovered. A small number of bourbon virus disease cases have been reported in the Midwest and South of the United States. It is unknown if the virus is found in other parts of the United States. Lone-star tick is the carrier of this virus. Bourbon virus testing is only available in specialized laboratories such as the United States Centers for Disease Control and Prevention (CDC). Therefore, tests are not widely available, and the incidence may need to be reported more.

What Is Bourbon Virus-Induced Acute Kidney Injury?

Acute kidney injury (AKI), or acute renal failure (ARF), is a sudden onset of kidney failure or injury that occurs within hours or days. Other organs, like the brain, heart, and lungs, can also be affected by AKI. Acute kidney injury caused by Bourbon virus found in the lone-star tick.

What Are the Reasons and Risk Factors That Cause Bourbon Virus-Induced Acute Kidney Injury?

A tick bite from a tick carrying the Bourbon virus causes this acute kidney injury. The virus that causes this illness belongs to the thogotovirus family and is transmitted through the lone star tick’s bite (Amblyomma americanum). Therefore, risk factors for Bourbon virus disease include activities that increase the risk of tick bites. The lone star tick was initially local to the southeastern and Midwestern United States but has spread to the north and west. However, it is not known yet how the virus is spread to other areas through this tick or other insects.

What Are the Symptoms of Bourbon Virus-Induced Acute Kidney Injury?

Little is known about Bourbon virus disease. However, based on the small number of cases reported to date, symptoms and signs include the following:

• Fever.

• Fatigue.

• Pale pink rash.

• Nausea.

• Vomiting.

• Headache.

• Body aches.

• Low white blood cell count.

• Low platelet count.

• Elevated liver enzyme.

• Diarrhea.

• Disorientation.

• Severe joint pain.

What Are the Possible Complications of Bourbon Virus-Induced Acute Kidney Injury?

The possible complications of Bourbon virus-induced acute kidney injury are listed below:

• Acute kidney failure.

• Cardiac arrest.

• Multi-organ failure.

• Death.

When to Get Help for Bourbon Virus-Induced Acute Kidney Injury?

Emergency medical help should be sought in case of a suspected tick bite. If the tick is still firmly attached to the body, trained practitioners should remove it carefully. In addition, if any of the following signs are noticed, medical help should be sought:

• Diarrhea.

• Fever.

• Chills.

• Blood in Urine.

• Nausea.

How Is Bourbon Virus-Induced Acute Kidney Injury Diagnosed?

To detect bourbon virus disease, the CDC uses polymerase Chain Reaction (PCR) technology to detect the virus’s genetic material. People with suspected tick bites and subsequent fever are screened for the Bourbon virus disease. Signs of acute kidney injury may prompt the physician to run urine and blood tests to check for kidney injury. Imaging tests of kidneys like ultrasounds and magnetic resonance imaging may be done to check for any changes in the anatomy of the kidney.

How Is Bourbon Virus-Induced Acute Kidney Injury Treated?

Currently, there are no vaccines to prevent infection from this virus. Since bacteria do not cause the Bourbon virus-induced kidney disease, it does not respond to antibiotics. Although there are ways to relieve symptoms, no specific medications can eliminate the Bourbon virus. Medicines are prescribed to reduce pain and fever. A few measures that can be helpful with the recovery from kidney injury are:

• Low protein diet.

• Increased water intake.

• Drugs that control blood pressure and regulate electrolytes in the blood may be given. Treatments to keep the body hydrated (for example, water pills to rid the body of excess water).

• If AKI is severe and the kidneys have completely failed, dialysis may be required for a short period.

Dialysis is a treatment that cleans blood with a machine. Dialysis does what the kidneys have to do until they recover. So first, at home, help the kidneys recover by following a kidney-friendly diet. Then, the doctor may refer further to a licensed nutritionist.

How to Prevent Bourbon Virus-Induced Acute Kidney Injury?

There is no cure or specialized treatment for the Bourbon virus, so the next best thing to be done is to prevent it. While ticks are active year-round, single-star ticks are most active between April and September. The measures listed below can be taken to prevent infection with the Bourbon virus illness:

• Wearing full-length trousers covering the legs while walking in an area with thick growths or tall grasses. The trouser legs should be tucked into the socks to keep the ticks out.

• Covering the arms with a long-sleeved shirt.

• Wear light-colored clothing to increase the visibility of the ticks when attached.

• Wear well-fitting shoes with socks.

• Staying on trails and avoiding bushes and grassy areas is recommended.

• Spraying insect repellent DEET (N, N-diethyl-meta-toluamide) all over the clothes. But read the safety information on the label first.

• Checking for ticks as soon as one walks indoors. Ticks typically attach themselves to the neck, armpits, and groin. Hence people should carefully check these areas.

• Remove ticks from the body with tweezers as soon as they are noticed.

• It is not yet known if pets can get the Bourbon virus. However, if living in an area where ticks are present, precautionary measures should be adopted and practiced.

• If the pet does exhibit strange symptoms, it should be taken to a veterinarian and treated.

How Is a Tick Removed Safely?

On discovering a tick on the skin, remove it as soon as possible. Several tick-removal devices are on the market, but simple fine-tipped tweezers are very effective.

• Using clean, fine-tipped tweezers, grasp the tick as close to the skin’s surface as possible.

• Make sure to grasp the tick by the head and not press the abdomen. The pathogens reside in the tick’s abdominal cavity. The pressure at the abdomen can cause the organisms in the abdomen cavity to be injected into the host’s body.

• Pull up with steady and even pressure. Do not twist or pull the tick. This can detach the head and the mouth and leave them embedded in the skin. In this case, remove the embedded parts with tweezers. If it cannot be easily plucked out with the help of tweezers, it is advised to leave it alone and seek immediate medical help.

• Once the tick has been detached from the skin, wash the affected area and hands thoroughly with rubbing alcohol, soap, and water.

• Do not crush the tick with your fingers. Discard live ticks by:

1. Putting alcohol on it.

2. Put in an airtight bag or container.

3. Wrap tightly with packing tape.

4. Flush it down the toilet.

Conclusion:

Bourbon virus is transmitted via the tick to humans. This virus belongs to the thogotovirus family and causes acute kidney injury. Due to the limited number of known cases, the prognosis and overall survival of the Bourbon virus disease have not been determined. At least two Bourbon patients have died, one in Kansas and one in Missouri, USA. As the prevalence of tick-borne diseases continues to rise across the United States, there is a growing concern about the potential for atypical manifestations, especially since early diagnosis and treatment can be curative and prevent further complications. Raising awareness is important.