Diseases Named for Places Trivia Quiz

Answer: West Nile district in Uganda

West Nile Virus was first described in Uganda (in the West Nile District) in 1937 when it was isolated from a woman with fever who was included in testing for yellow fever. She did not have serious illness. The first large outbreak described occurred near Haifa, Israel in the 1950s - about one third of the small village's population became ill. There were no fatalities, and the disease seemed to affect children more than adults. It was found to be endemic along the Nile, with the majority of people showing serologic evidence of past infection and children acquiring symptomatic disease.

Things changed drastically in 1999, when several cases cropped up in the New York City environs; the US epidemic spread across the country rapidly and by 2003 most states had reported cases. Senior citizens were more likely to develop the serious, neurologic manifestations of disease and were at higher risk of death. The virus is transmitted by mosquitos and is carried by birds, so it is suspected that the US epidemic was triggered by migrating birds harboring the pathogen.

Answer: Rocky Mountains

Rocky Mountain Spotted Fever was first described in the Snake River Valley of Idaho in 1896. The premiere US institution studying this disease and other tick-borne illnesses is the National Institute of Allergy and Infectious Diseases Rocky Mountain Laboratory in Hamilton, Montana. Despite this long association with the Rocky Mountains, the majority of US cases occur in North Carolina, Tennessee, Arkansas Missouri and Oklahoma. All of the contiguous US states have reported cases, and the condition is seen in Canada, Mexico and parts of South America as well.

All ages are affected, but children under age 10 are most likely to die from the infection. In the classical manifestation of the disease, fever & chills, muscle aches and headache begin 3-12 days after a tick bite. The rash appears later - many patients have already sought care before the rash, which is seen on the wrists and ankles, palms and soles predominantly. If recognized, the infection is successfully treated with antibiotics. The pathogen is a type of bacterium that lives inside cells, and in humans predominantly infects the cells lining blood vessels.

Answer: Ebola River in Democratic Republic of the Congo (then Zaire)

Ebola virus disease was first noted in a 1976 outbreak near the eponymous river, but has been reported in other areas of Africa - a second outbreak in the Sudan (now South Sudan) also happened in 1976. Disease outside of Africa has predominantly been imported by people who acquired infection in Africa and traveled to another location before falling ill. Research has indicated that the virus existed in the area long before these outbreaks, which likely happened because of further encroachment of human civilization on forest areas and increased interactions with wildlife. Great apes and fruit bats are thought to be important reservoirs. Infection is acquired through exposure to blood or other secretions of infected people or animals.

Symptoms generally begin 8-10 days after exposure and are initially similar to many other infections, with fever, body aches and fatigue. Vomiting, diarrhea and kidney and liver failure also occur. The hemorrhagic symptoms of unexplained bleeding and bruising follow. The fatality rate varies, but is high even with excellent care - from a low of 25% to a high of 90%. A vaccine was approved in the US for pre-exposure prophylaxis for high-risk individuals (such as healthcare workers who are expected to care for Ebola patients, laboratory workers), but the best prevention is strict attention to avoidance of exposure to infection through handwashing and protective equipment. Changes in funeral and burial practices in the affected regions has helped decrease the spread, as contact with the bodies of people who died from Ebola virus disease was a contributor to rapid spread previously.

Answer: San Joaquin Valley, California

Valley Fever is the common name for coccidioidomycosis, a rare infection caused by inhalation of fungal spores. It was named for the San Joaquin Valley of California, which has a fairly high incidence of disease. In the US, the organism is found in dry soils from western Texas to California and as far north as Utah, and more recently southern Washington state. The disease also occurs in Central and South America. Outbreaks have followed large disruptions of soil, such as after the Northridge earthquake in 1994.

Healthy people who acquire coccidioidomycosis are often asymptomatic, or may develop classic "Valley Fever" with fever, dry cough and sometimes a skin rash called erythema nodosum. Medication is often provided to people with Valley Fever, but many will recover on their own. However, pregnant women or people immunocompromised by disease or immune suppression following transplantation or chemotherapy are at high risk of disseminated disease, which can spread throughout the body. Fungal meningitis is the most serious manifestation of disseminated disease, and during the early years of the HIV epidemic it was a major cause of mortality.

Answer: Norwalk, Ohio

A 1968 outbreak in a school in Norwalk, Ohio led to the discovery of this virus, now called norovirus. This is an extremely contagious, very common cause of gastrointestinal illness. Often called "stomach flu," the virus bears no relation to influenza. Symptoms strike quickly, within 12-48 hours of exposure. Stomach cramps, vomiting, diarrhea and sometimes fever are seen - young children are at special risk for dehydration.

It can be spread through food or water contamination, contact with infected people, or even from touching surfaces contaminated by someone suffering from the illness and then putting your hands/fingers in your mouth. The best defense is thoroughly washing food before consumption and to use soap and water to wash your hands. Unfortunately, hand sanitizer is not very effective against norovirus.

Cruise ships have had notable outbreaks of norovirus, probably partly because they are required to report onboard illness whereas most cases of norovirus are silently suffered at home. Close quarters and shared surfaces likely also contribute. Foodborne outbreaks have been traced to a wide variety of comestibles, most commonly leafy greens, fresh fruit and shellfish.

Answer: Tulare County in California

Tularemia was named for Tulare County, California. The causative bacterium was initially isolated in 1911 during research on bubonic plague (caused by a different bacterium) in ground squirrels. The disease has several distinct forms, all of which have fever as one of the symptoms. The ulceroglandular form is the most common, following contact with an infected animal or carcass or through the bite of a tick or deerfly. An ulcer forms on the skin where the bacteria entered the body, and the lymph nodes draining that region become swollen.

The most feared manifestation of disease is pneumonic, which occurs following inhalation of the agent - this is the mode of transmission explored for the use of tularemia as a biological weapon. The condition is treatable with antibiotics, although the rarity of the condition may lead to a delay in diagnosis and treatment. Without treatment, patients with the pneumonic form have a 30-60% fatality rate, but therapy drops this to less than 2%.

There is no current vaccine for tularemia. Avoid handling animal carcasses (especially rabbits) without gloves and practice good handwashing - your local public health agency should be alerted if excessive die-off of rabbits occurs locally.

Answer: Ziika Forest in Uganda that can be spelled without another "i" in its name

The Ziika forest (also sometimes spelled Zika) is the source of the name for the Zika virus. It was first isolated in 1947 from a rhesus monkey, and found in local mosquitos shortly thereafter. A viral infection laboratory is located in the forest, which is outside Entebbe.

The capability of Zika virus to cause human disease was noted in 1952 when studies of antibodies in people living in Uganda and Tanzania revealed evidence of past infection. Occasional infections were noted in Africa, and then in Asia. The first outbreak of symptomatic disease that was recognized was in 2007, on the island of Yap in the Federated States of Micronesia. From there, several other Pacific islands noted cases, and in 2015 Brazil reported over 7000 cases, with mild disease and skin rash. In 2016, the association of Zika virus infection and birth defects, especially microcephaly (very small head/brain with subsequent intellectual disability) was declared a public health emergency by the World Health Organization.

Most people who acquire Zika virus do not develop notable symptoms. For those that do, the typical course for Zika virus disease is a mild illness approximately 2-7 days after the mosquito bite, with mild fever, skin rash, red eyes, muscle and joint aches. Approximately 5% of women who develop Zika virus infection during pregnancy, whether symptomatic or not, will have affected babies. Transmission and birth defects are more common if Zika is acquired early in pregnancy but may occur at any time in gestation. Pregnant women, or those planning to conceive, are cautioned to consult with their physician before traveling. Online resources can be used to check the recent and past activity of Zika virus in the area.

Answer: Lyme, Connecticut

Lyme Disease was first described in 1975 following an outbreak of arthritis in children in Lyme, Connecticut. It was quickly recognized to be associated with ticks, but the causative organism (Borrelia burgdorferi), wasn't discovered until 1982. Review of the medical literature uncovered earlier descriptions of the disease from Germany in the 1800s, and the bacterium's genome has been recovered from the famous European mummy, "Otzi the Iceman," indicating that it has been circulating for a long time. The huge increase in cases has been attributed to "suburbanization," bringing humans and deer, deer ticks and white-footed mice (all important in the lifecycle of Lyme disease) closer together. In the US, the disease is most prevalent in the north Atlantic states, Great Lakes, and California. A mimic named STARI (southern tick-associated rash illness) occurs in southeastern states; a different tick species is involved and the disease does not progress beyond a rash.

80% of affected people will develop erythema migrans, the classic "bulls-eye" rash of Lyme disease. Treatment with antibiotics in the early stages prevents the later manifestations of disease, which may include arthritis, meningitis and conduction abnormalities in the heart. Another unusual form of the disease is the development of Bell's palsy, paralysis of the nerve responsible for movements of the face on one side. Not all Bell's palsy is Lyme disease. Lyme disease has been blamed for a litany of chronic symptoms, with many lucrative businesses offering unproven treatments for unproven illness. A quick search will return with many official-appearing websites that help spread misinformation about this condition; check your sources.

Answer: Japan

Japanese encephalitis occurs throughout a large swath of Asia and Australia, but the disease was first recognized through epidemics in Japan in the 1870s. The virus was isolated in 1935, and is closely related to West Nile virus and several other viruses that cause encephalitis. As is seen with other viruses in this group, most people who contract it will be asymptomatic or may have mild disease. However, some affected patients develop encephalitis, or inflammation of the brain. About one quarter of patients with encephalitis will die, and at least half of survivors will have ongoing neurologic problems.

The potential severity of the infection and because it is fairly widespread led to the development of a vaccine, which is part of the routine schedule in many countries where the disease occurs. Travelers to areas with Japanese encephalitis activity are cautioned to consider vaccination, especially if they will be staying more than a month or if they plan to participate in lots of outdoor activities in rural areas. As with all mosquito-borne infections, use of chemical repellants, wearing long sleeves and pants and sleeping under mosquito netting are good preventive efforts.

Answer: Coxsackie, New York

Coxsackie virus was first isolated in 1948 during an investigation of paralytic polio in the small village of Coxsackie, New York. This virus is related to poliovirus and was found to cause paralysis in suckling mice. In humans, there is a wide range of conditions known to result from infection with coxsackie virus, including pneumonia, diarrhea, and hepatitis.

One commonly seen manifestation is hand, foot and mouth disease, which is a childhood illness that leads to easily popped blisters on, not surprisingly, the hands, feet and in the mouth. The lesions also occur on the buttocks, but that didn't make it to the common name of the disease. In children with skin disorders like eczema, the virus can spread to other areas of the skin and the child may be quite ill with high fever. The lesions do not scar, unlike chickenpox, and the vast majority of children get over the condition fairly quickly.

More serious types of disease seen from coxsackie virus are viral meningitis and myocarditis. Viral meningitis (also called "aseptic meningitis") causes severe headache, stiff neck and fever, but most people recover completely. There is no specific treatment, so supportive measures such as providing pain relief and fluids are all that can be offered. Myocarditis can be much more serious - direct infection of the muscle of the heart can lead to heart failure. Coxsackie infection of the pancreas has been linked to damage to the cells that produce insulin and later development of type I diabetes.