View source for Northern Keltia respiratory syndrome

{{Infobox medical condition
| name = Northern Keltia respiratory syndrome<br />(NKRS)
| synonyms = 
| image = 
| alt =
| caption = 
| field = [[wikipedia:Infectious disease (medical specialty)|Infectious disease]]
| symptoms = Fever, cough, shortness of breath
| complications = ARDS
| onset = 2 to 14 days post exposure
| duration = {{AN|11|2024}}-''ongoing''
| types =
| causes = Northern Keltia respiratory syndrome-related virus (NKRS-V)
| risks = Contact with infected humans and mosquito's bites
| diagnosis = [[wikipedia:Reverse transcription polymerase chain reaction|rRT-PCR testing]]
| differential =
| prevention = 
| treatment = Symptomatic treatment and supportive treatment
| medication =
| prognosis = 34.5% risk of death ([[Vegno]])
| frequency = 1.122 cases (as of {{AN|11|2024}})
| deaths = 392
}}

'''Northern Keltia respiratory syndrome''' ('''NKRS''') is a viral respiratory infection caused by ''[[Northern Keltia respiratory syndrome Virus]]'' (NKRS-V). Symptoms may range from none, to mild, to severe depending on age and risk level. Typical symptoms include [[wikipedia:fever|fever]], [[wikipedia:cough|cough]], [[wikipedia:diarrhea|diarrhea]], and shortness of breath. The disease is typically more severe in those with other health problems. It is believed to have played part in the collapse of [[Cerulea]] and [[Normark]], 1736–1737.

The [[1738 NKRS outbreak|first case]] was identified by [[San Lucido|lucidese]] physician [[Mark O' Munn]] at the San Pepinho Hospital in [[Santa Markovia]], [[San Lucido]], [[Vegno]].
As it stands, 1.122 documented cases were reporte and about 35% of those who are diagnosed with the disease die from it.

NKRS-V is a virus in the [[wikipedia:filoviridae|Filoviridae]] family believed to be originally from bats. However, humans are typically infected from mosquitoes that are part of the typical fauna at these latitudes, and for this reason, the disease is currently limited to this geographical region.
From the first scientific findings, it is thought that this virus is a mutated version of the [[Alexandrian flu]] virus; the animal reservoir of this virus seems to have been cattle, in which the virus has no pathogenetic potential, subsequently spreading to other species, up to bats, in which the mutation occurred which allowed the virus to be pathogenic and transmitted to humans .
[[wikipedia:Human-to-human transmission|Spread between humans]] typically requires close contact with an infected person. Diagnosis is by [[wikipedia:Reverse transcription polymerase chain reaction|rRT-PCR testing]] of blood and respiratory samples.

As of {{AN|1738}}, there is no specific [[wikipedia:vaccine|vaccine]] or treatment for the disease, but a number are being studied and developed on the basis of the [[AndeVax]] by [[Farmacéutica del Ande]], used in the [[Alexandrian flu]].

==Signs and symptoms==
The first person, [[1738 NKRS outbreak|in 1738]], had a [[wikipedia:fever|fever]], [[wikipedia:cough|cough]], [[wikipedia:expectoration|expectoration]], and shortness of breath. One review of 47 laboratory confirmed cases in [[San Lucido]] gave the most common presenting symptoms as fever in 98%, cough in 83%, shortness of breath in 72% and [[wikipedia:myalgia|myalgia]] in 32% of people. 

There were also frequent gastrointestinal symptoms with diarrhea in 26%, vomiting in 21%, abdominal pain in 17% of people. 72% of people required [[wikipedia:mechanical ventilation|mechanical ventilation]]. There were also 3.3 males for every female. One study of a hospital-based outbreak of NKRS had an estimated [[wikipedia:incubation period|incubation period]] of 5.5 days.

NKRS can range from asymptomatic disease to severe [[wikipedia:pneumonia|pneumonia]] leading to [[wikipedia:acute respiratory distress syndrome|acute respiratory distress syndrome]] (ARDS). [[wikipedia:Kidney failure|Kidney failure]], [[wikipedia:disseminated intravascular coagulation|disseminated intravascular coagulation]] (DIC), and [[wikipedia:pericarditis|pericarditis]] have also been reported.

==Cause==

===Virology===
{{Main|Northern Keltia respiratory syndrome virus}}

Northern Keltia respiratory syndrome is caused by the [[Northern Keltia respiratory syndrome virus|NKRS virus]] (NKRS-V), a species with [[wikipedia:RNA virus|single-stranded RNA]] belonging to the family of [[wikipedia:Filoviridae|Filoviridae]]. It has been ascertained that this virus originated from a mutation of the [[Alexandrian flu]] virus, with which it shares many virological characteristics. Its genomes are phylogenetically classified into two clades, Clades A and B.  The virus grows readily on [[wikipedia:Vero cells|Vero cells]] and LLC-MK2 cells. 

===Transmission===
====Mosquitoes====
The bite of mosquitoes is the main transmission route for the disease and the reason why it is currently limited to this geographical area. Transmission is specific to a particular type of mosquito, [[wikipedia:Aedes|Aedes]], which is especially resistant to the region’s cold temperatures. The mechanism involves a healthy mosquito biting an infected animal, such as a bat, or an infected human and then, with its next bite, injecting the virus into the next healthy individual.

====Between people====
There has been evidence of spread of NKRS-V from person to person, in particular in health care settings like hospitals. At the moment most transmission has occurred "in the circumstances of close contact with severely ill persons in healthcare settings" but there are no evidences of transmission from asymptomatic cases.

==Diagnosis==
According to Vegnese Health Ministry, the interim case definition is that a confirmed case is identified in a person with a positive lab test by "molecular diagnostics including either a positive [[wikipedia:Polymerase chain reaction|PCR]] on at least two specific genomic targets or a single positive target with sequencing on a second".

===Centers for Disease Control===
The [[Government of Vegno]] established Centers for Disease Control and Prevention in [[San Lucido]] recommend investigating any person with:
*Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence) and either:
**close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in North Keltia or
**a member of a cluster of people with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown cause in which NKRS-V is being evaluated, in consultation with state and local health departments.
*Fever and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near North Keltia in which recent healthcare-associated cases of NKRS have been identified.
*Fever or symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and close contact with a confirmed NKRS case while the case was ill.

===Laboratory testing===
NKRS cases have been reported to have [[wikipedia:leucopenia|low white blood cell count]], and in particular [[wikipedia:lymphopenia|low lymphocytes]].

==Prevention==
While the mechanism of spread of NKRS-V is currently not known, based on experience with the [[Alexandrian flu]], the Vegnese Health Ministry currently recommends that all individuals coming into contact with NKRS suspects should (in addition to standard precautions):
*Wear a medical mask
*Wear eye protection (i.e. goggles or a face shield)
*Wear a clean, non sterile, long sleeved gown; and gloves (some procedures may require sterile gloves)
*Perform hand hygiene before and after contact with the person and his or her surroundings and immediately after removal of personal protective equipment

The duration of infectivity is also unknown so it is unclear how long people must be isolated, but current recommendations are for 24 hours after resolution of symptoms.

It is believed that the existing [[Alexandrian flu]] researches may provide a useful template for developing vaccines and therapeutics against a NKRS-V infection.

==Treatment==
As of {{AN|1738}}, there is no specific [[wikipedia:vaccine|vaccine]] or treatment for the disease.
Neither the combination of antivirals and [[wikipedia:interferon|interferon]]s nor [[wikipedia:corticosteroids|corticosteroids]] improved outcomes.

==Political Actions and Consequences==
[[Category:Vegno]]
[[Category:Disease]]