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RNA VIRUSES OF MEDICAL IMPORTANCE

Nucleic Acid Symmetry Presence/Absence Physical State of Family Specific Pathogenic


Enveloped Nucleic Acid Virus

Poliovirus
S S Non-segmentedPicornaviridae Coxsackie A and B virus
Icosahedral Naked Hepatitis A virus
S S Non-segmented Caliciviridae Norwalk virus
Hepatitis E virus
D S Segmented REOviridae Rotavirus
Yellow Fever virus
Dengue virus
R Enveloped S S Non-segmented Flaviviridae St. Louis Encephalitis vi
Japanese Encephalitis v
Hepatitis C virus
S S Non-segmentedCoronaviridae Respiratory
Syncitial virus
California Encephalitis v
N S S Segmented Bunyaviridae Rift Valley Fever virus
Helical Enveloped Sandfly Fever virus
Orthomyxoviridae Influenza virus
Parainfluenza virus
S S Non-segmented
Paramyxoviridae Respiratory
Syncitial virus
A Mumps virus
Measles virus
S S Non-segmentedRhabdoviridae Rabies virus
Marburg virus
S S Non-Segmented Filoviridae (Acute
Hemorrhagic Fever)
Ebola virus
(Acute
Hemorrhagic Fever)
LymphaticChoriomengitis
S S Segmented Arenaviridae Lymphocytic meningitis
Lassa virus
Human Immunodeficiency
Complex Complex Coat S S Diploid Retroviridae virus
(HIV) type 1 & 11
(HTLV) type 1 & 11
Family Picornaviridae

Picornavirus
(small-rna virus)

= small-rna virus with single-stranded-rna genome,


non-segmented
= cubic/icosahedral nucleocapsid
= not provided with envelope (naked)
= 20-30nm diameter
= acid stable
= resistant to lipid solvent (ether, ethanol, detergents
= inactivated by UV light, formalin, chlorine, sodium
hypochlorite
= can remain viable for hours moist surfaces
= can survive GIT
2 Genera:

1. Genus Rhinovirus
= replicate at 330C, inactivated at pH3
= over 100 serotypes affecting human
= acid labile (destroyed by gastric acid)
= do not replicate in the GIT

Rhinovirus/Common cold virus (nose virus)


= worldwide distribution
= commonly isolated from nose, throat and
conjunctiva
= primary cause of common cold which
occurs
throughout the year with its peak during
summer
= human only natural host
Disease: Common Cold

= an upper respiratory tract infection charac. by


running
nose, sneezing, sore throat, mild cough &
headache
= fever may be present (low grade) or absent
= MOT- 1. Aerosol/Inhalation
2. Hand to nose contact (contaminated
nasal)
discharge
= incubation period 2-4 days
= more common in children than adult
= illness may last for weeks
= reputed to be one of the most common human
infection
Laboratory Diagnosis :
1. Isolation virus (nose, throat washing,
conjunctival)
discharge
Tissue Culture
1. Primary human embryonic cell
2. Hela cell
+ CPE
= Serological test not useful

Treatment: Symptomatic and Supportive


= no specific antiviral drug available

Prevention:
= no vaccine available due to many serotypes
2. Genus Enterovirus
= replicate 370C, acid stable at pH3-5
= inactivated when heated at 55OC for
30minutes = not affected by ether
= infect primarily in the GIT
Polio virus
Coxsackie virus A and B
ECHO virus
Hepatitis A virus

Poliovirus
= 3 serologic types:
Type 1 Brumhilde - most paralytogenic
Type 2 Lansing
Type 3 Leon - least paralytogenic
= protection from polio virus infection requires
antibodies
to all 3 serotypes
Disease: Poliomyelitis/Infantile Paralysis/Hein–Medlin
Dse.

= acute infectious disease that in serious form


affect CNS
= found worldwide
= epidemic occur year round
= spread rapidly among densely populated area
with
poor sanitary hygiene
= children (5 years & above) more susceptible than
adults
= human-only known reservoir of infection
= MOT-fecal-oral route
Clinical Manifestation:

= majority of infection (90-95%) are inapparent or


asymptomatic especially among infants and
children
1-3 year old

= older children 5-10 years have higher rates to


manifest
sign and symptoms of disease with paralysis

= can be found GIT of asymptomatic carrier


Pathogenesis:
Mouth (portal entry)
(ingestion of contaminated food H2O)
↓ ↓

Oropharyngeal mucosa (tonsil) Intestinal mucosa


(payers patches of small intestine)
↓ ↓
Cervical LN Mesenteric LN
(1o multiplication takes place)

Systemic circulation
(spread throughout the body)
↓ ↓
CNS Extranural tissues

(fibers motor neuron of ant. horn of spinal cord)
→ destroy nerve cell → flaccid paralysis
4 Clinical types of infection

1. Inapparent/Asymptomatic/Abortive poliomyelitis
= characterized by mild influenza-like
manifestation
such as fever, headache, malaise, sore
throat and vomiting
= appears few days after exposure
= no CNS involvement
= recovery spontaneous
= most common form

2. Non-paralytic poliomyelitis
= appears as Aseptic meningitis with fever,
headache, vomiting, stiff neck &
convulsion
= usually last 2-10 days
3. Paralytic Poliomyelitis (Spinal poliomyelitis)
= most severe form
= charac. by asymmetric flaccid paralysis of
limbs
with no sensory deficits, resulting from
lower
motor neuron damage
= recovery w/in 6 months with residual
paralysis lasting much longer or
permanent deformity

4. Bulbar poliomyelitis
= form of paralytic poliomyelitis which results
from
involvement of the brain stem and
Lab. Diagnosis:
1. Virological
= isolation of virus (stool, throat, CSF)
cell culture- Monkey Kidney cell

Indication of presence + Cytophatic effect


(CPE) 1. rounding of cell
2. formation of pyknotic nucleus

2. CSF studies →1. increase leucocyte count


2. protein content elevated

3. Serological: CF, NT (demonst. rise AB titer)


= serum pat. taken during acute/convalescent
stage
Treatment: Symptomatic & Supportive
= no antiviral drug available

1) reduction of pain and muscle spasm


2) maintenance of respiration &hydration
3) physiotherapy affected muscle

Prevention: Active immunization using killed or


attenuated
polio virus
1. Salk vaccine
= inactivated/killed polio virus contains all 3
serotypes
= parenterally given
= induce IgG in the blood
= does not induce secretory IgA
= refrigeration not needed
2. Sabin vaccine (Trivalent oral polio vaccine - TOPV)
= live attenuated polio virus contains all 3
erotypes
= given orally
= induce IgG and secretory IGA
= prepared vaccine and routinely administered
o
children U.S.
= widely used and 100% protection
= must be kept refrigerated

Immunity:
= lifetime immunity
= passive immunity transferred from mother→
eonate
= maternal antibodies disappear
during 6 months of life
Coxsackie virus

2 types based on pathogenicity (lesion induced in


suckling mice)

Coxsackie A

= 23 serotypes
= site of predilection: skin and mucous membrane
= causes widespread inflammatory reaction and
necrosis of skeletal muscle (myositis)
leading
to flaccid paralysis and death

MOT – 1) fecal-oral route


2) respiratory droplets
= virus replicate oropharynx and intestinal tract →
Disease produced:
1. Aseptic meningitis
= may be caused by either Coxsackie A &
B
= usually mild & may last 5-14 days
2. Herpangina
= mild self-limiting disease charac. fever &
sore
throat with vesicular nodule in soft
palate
3. Hands – Foot and Mouth disease
= vesicular rashes in the hands and
feet
with ulceration in the mouth
= common in children
Coxsackie B
= 6 serotypes
= site of predilection: heart and liver
= leading cause of viral myocarditis and pericarditis
Disease produced:
1) Pleurodynia (Bornholm Dse./Epidemic
Myalgia/Devils Grip)
= charac. by fever with severe pleuritic pain
especially
during inspiration
2) Aseptic meningitis
3) Primary pericarditis/Myocarditis
= infection and inflammation of the heart muscle
and
pericardial membrane
= charac. by fever, chest pain, sign of congestive
heart
failure
Laboratory Diagnosis:
1. Isolation virus - Intracerebral inoculation→suckling
mice
Cell culture – MKC/Hela cell + CPE

2. Serological – Neutralization test


= significant rise AB titer during convalescent
phase (diagnostic)

Treatment - No specific antiviral drug


- No vaccine available
ECHOvirus
(Enteric Cytophatogenic Human Orphan Virus)

= worldwide in distribution
= 30 serotypes (not all can cause human disease)
= called “orphan virus” not associated with any
disease
= diff. from Coxsackie by their failure to produce
pathological changes in newborn mice
(not pathogenic to mice)
= one of the leading cause of aseptic meningitis
= acquired by fecal oral route
Disease produced:
1. Aseptic Meningitis
2. Infantile Diarrhea
3. Febrile illness w/ or w/o rash (Boston Exanthem
Dse.)
4. Common Cold
5. Acute Hemorrhagic Conjunctivitis

Laboratory Diag.:
Isolation of virus – (throat/rectal swab)
Cell culture- MKC/Hela cell/Human/Ammion cell

Treatment: Symptomatic

Prevention: - No vaccine available


= avoid contact with the virus
Hepatitis A virus
(Enterovirus 72)
= only 1 serotype

Disease: Acute Hepatitis


= occurs after short incb. 14-40 days (ave. 4
weeks)
MOT- fecal-oral-route
Pathogenesis:
= virus replicate gastrointestinal mucosa → shed
up to
2 week before sign and symptoms appear
= spread → liver → via the bloodstream
= charac. by fever, loss appetite, nausea,
vomiting,
and jaundice
= mild undiagnosed cases common
= younger patients fewer symptoms
Lab. Diagnosis :
= detect IgM antibodies to HAV (most useful
test)
= isolation of virus from clinical specimen not
done

Treatment: Symptomatic

Prevention:
= Pooled-immunoglobulin (given to person
expose
to virus or during incubation period of the
disease)
= vaccine available given to people traveling to
endemic
areas (3 doses)
Enterovirus 70
(Acute Hemorrhagic Conjunctivitis)
= charac. by pain and swelling of the eyelids
= very contagious disease
= also seen with coxsackie A and B infection

Enterovirus 71
(Hand – Foot and Mouth Disease)
= charac. by the presence of herpetiform lesions
in the
hands, foot and mouth
Family REOviridae

REOviruses
(Respiratory-Enteric-Orphan virus)

2 Genera: 1. Genus Reovirus


2. Genus Rotavirus
Properties:
= segmented double-stranded rna genome
= doubled layered icosahedral nucleocapsid which
looks
like a “rim of wheel”
= no envelope (naked)
= 60-80 NM
= stable to heat
= resistant to ether
= inactivated by 70% ethanol
= can agglutinate human and bovine rbc
Reovirus (Orthoreovirus)
= 3 serotypes
= widely distributed in nature
= commonly infect human but asymptomatic hence
they
are called orphan virus
= isolated from feces and respiratory secretion of
apparently healthy human and among
patient
with minor URT and GIT infection
= MOT- 1) fecal-oral-route
2) aerosol
Disease produced: 1) Infantile diarrhea
2) Common cold
Treatment: Symptomatic
Lab. Diagnosis:
1. Virological-specimen from throat washing and
feces
Rotavirus

= 4 serotypes
= responsible for almost 50% of infantile
diarrheal
cases that requires hospitalization
= do not grow on tissue culture
= found worldwide
= peak of infection during winter and summer
= resistant to stomach acid hence can reach
GIT
= primary cause of gastroenteritis (acute
diarrhea)
in infants and children 6 to 2 years and
below
= disease can be very severe with a high
Disease: Viral Infantile Gastroenteritis

= major cause of death in underdeveloped


countries
= most common cause of death in infant less
than
3 year of age
= MOT- fecal-oral-route (contaminated
food/water)
= incubation period from 2-5 days
= charac. by nausea, vomiting, explosive
watery
non-bloody diarrhea and fever
= dehydration common in infant
= virus infect. cells of villi of small intestine
= no viremia
Lab. Diagnosis:
1. Direct demonst. virus particles from stool
specimen
during acute stage infection
Electron Microscopy
2. Serological - demonst. rise AB titer during
convalescent phase (diagnostic)
Elisa, RIA, HI, CF, PCR
Treatment:
= Supportive and Symptomatic
= No specific antiviral drug
= IV fluid replacement and oral rehydration
therapy
very important

Prevention:
= no human measure of controlling rotavirus
= Vaccine: live attenuated rotavirus
THE ARBOVIRUSES

Family Togaviridae

Togaviruses
(cloak/mantle)

= transmitted by bloodsucking arthropods (mosquito,


tick, flies)
= virus multiply both in bloodsucking arthropods &
human host
= man (incidental host)
Properties:
= ss rna genome (infectious)
= icosahedral nucleocapsid
= non-segmented
= enveloped with spikes containing
neuraminidase
and hemagglutinin enzymes
= 60-70nm (medium size)
= sensitive to ether
= replicate in the cytoplasm
= vector - mosquito

2 Genera of medical importance:


1. Genus Alphavirus
2. Genus Rubivirus
Genus Alphavirus

A) Agents causing encephalitis and skin rashes

Eastern Equine Encephalitis virus (EEE)


= the deadliest and rarest of the encephalitis
virus
= fatality rate 30-50%

Western Equine Encephalitis virus (WEE)


= second deadliest transmitted by horses →
mosquito, man (dead-end host)
= fatality rate 3 – 5%

Venezuelan Equine Encephalitis virus (VEE)

Russian Summer Spring Encephalitis virus


= all arboviruses transmitted by insect-vector
mosquitoes (except RSSE - tick)
= neurotropic
= most infection often inapparent and self limiting
= when apparent-condition very serious & mortality
rate high
= charac. fever, myalgia, severe headache, nausea,
vomiting
= presence of maculo-popular skin rash
= assoc. with changes in the mental status of patient
like:
confusion, stupor, signs of meningeal irritation
(rigidity of neck, convulsion, coma and paralysis)
Lab. Diagnosis:
1) Isolation of virus – CSF
Intracerebral inoculation → suckling mice

2) Serological - demonstration of the rising AB titer


NT, HI

Treatment: Symptomatic

Prevention: 1. No vaccine available for human

2. Mosquito eradication program


Genus Rubivirus

Rubella virus
(German Measles virus/3 Day Fever Virus)

Properties:
= envelope (contain hemaglutinin spike)
= only 1 serotype
= only genus not arthropod-borne
= replicate in the cytoplasm
= Man (natural host infection)
Disease: Rubella (German measles)
= acute febrile illness charac. fever, skin rash &
enlargement
of post-auricular and suboccipital lymph node
= acquired by: 1. aerosol/droplet inhalation
2. transplacental
= worldwide distribution
= infection occur throughout the year
= peak incidence during spring
= affect children and young adults
= very communicable
= most teratogenic of the virus disease

2 Clinical form:
1. Postnatal Rubella
= acquired after birth
= mild childhood disease (but can be seen in all
ages)
Pathogenesis: Inhalation

URT (nasopharynx and cervical LN)
initial site of infection

multiply

bloodstream
(viremia)

general circulation
(throughout body→ can pass placenta)

Skin
Clinical Findings:

= low grade fever, body malaise, maculopapular


“rubelliform”
skin rashes that forms small discrete blotch that
do not
coalase which starts from forehead → face →
trunk
→ extremities and last for 3-5 days
= enlargement of the postauricular & suboccipital
lymphnodes (characteristic of the disease)
= no conjunctivitis, no catarrhal manifestation
= arthritis → frequent complication
= after infection → permanent immunity
2. Congenital Rubella Syndrome

= transplacental transmission of rubella virus


acquired
by neonate during intrauterine life
= result from maternal infection of the virus
which also
involve infection of the placenta and fetus
producing congenital abnormalities
= mother can transmit the virus even if she is
asymptomatic
= congenital defect greatest if acquired during
first
trimester of pregnancy or even worst during
the
first month
= abnormalities to the fetus is the results of:
= Clinical findings of newborn w/ congenital rubella
syndrome:
1. Brain
Microcephaly, Mental retardation, Cerebral
palsy
2. Heart and Great vessel
Patent ductus arteriosus, Stenosis pulmonary
artery,
Atrial/Ventricular septal defect
3. Eyes
Total or partial blindness, Cataract, Glaucoma
and
Chorioretinitis
4. Deafness

= infants may also display transient symptoms of:


growth retardation, failure to thrive, hepato-
Lab. Diagnosis:
1. Virological = isolation of virus from clinical
materials
(maternal/cord blood)
Tissue culture - Monkey kidney cell
Viral Interference
2. Serological = demonstrate rising rubella AB titer
CF, NT, HI (most commonly used)
ELISA
= demonstrate anti-rubella IgM in fatal
cord blood
Congenital Rubella Syndrome
= demonstrate rubella AB of the IgM class in infant
serum
= indicate recent infection
= diagnostic of CRS
= if found in pregnant women should undergo
amniocentesis to check for the presence of
Treatment:
= Symptomatic and Supportive
= No specific antiviral drug

Prevention:
1.) Avoid contact of patient with rubella infection

2.) Exposed pregnant woman - Immune


gammaglobulin

3.) Active immunization–Rubella vaccine


= contains live attenuated rubella virus
= routinely administered subcutaneously to infan
in conjunction with mumps and measles
(MMR)
= effective and long lasting
Family Caliciviridae
(Calicivirus)
Species:
1. Norwalk virus
2. Hepatitis E virus
= all ill-defined group of enteric viruses that causes
diarrhea

Norwalk virus
= ss rna genome, non-segmented, naked (non-
enveloped)
= cup-shape depression on capsid
= major cause of gastroenteritis
= 35 - 39nm
= 5 antigenic types
= almost all children have antibodies to the virus by
the
age of 5 years
= transmitted fecal-oral (contaminated H2O &
shellfish)
= incubation period 1 - 2 days
= charac. by fever, nausea, severe vomiting,
abdominal
pain and diarrhea
= symptoms resolve within 4-5 days
= recovery rapid and complete
= infant death may be due loss of fluid and
electrolytes
(dehydration)
= infection can occur at only time of the year and in
people of all ages

Lab. Diagnosis: Virological


= Electron microscopy - detect virus in the stool
= ELISA
Hepatitis E virus

= major cause of GIT transmitted hepatitis


= most common cause of water-borne hepatitis in
Asia,
Africa, India and Mexico but uncommon in
U.S.
= acquired by fecal-oral route
= disease resembles hepatitis A
= high fatality rate among perinatal & pregnant
women
Family Flaviviridae

= arthropod-borne viruses causing fever, arthralgia &


jaundice
1.) Dengue fever virus
2.) Yellow fever virus
3.) Japanese B encephalitis virus
4.) St. Louis encephalitis virus
5.) Hepatitis C virus
Properties:
= ss RNA genome, non-segmented, icosahedral
ucleocapsid
= enveloped with E & M protein spikes
= antibodies against protein E are protective
= 40-55nm
= replicate in the cytoplasm
= vector: Aedes mosquito (Yellow fever & Dengue
ever virus)
Dengue Fever Virus

= found worldwide including Philippines


= mosquito-borne

Species:
1.) Aedes aegypti = domestic mosquito found
inside houses & buildings (urban areas)
2.) Aedes albopectus = found outside houses
and buildings, forested areas, bush,
le
= commonly breeds in standing water
ed
outdoors
= more efficient vector of dengue virus
n
A. aegypti
= female mosquito transmit virus
= 4 Serotypes
1- Hawaii
2- New Guinea
3 Philippines
4

= all serotypes shows cross-reactivity


= Serotype 2 most commonly assoc. with hemorrhage
= endemic in Southeast Asia and India
= affect all ages, but more common in children
= first reported case of Dengue hemorrhagic fever Phil.
1950
3 Clinical types of infection

1.) Classic Dengue Fever (Breakbone fever)


= most common & usually least serious arboviral
infection
= very hard to diagnose clinically
= mild, self-limiting and rarely a fatal disease
= charac. by: sudden onset high grade fever w/c
may
last for 2-7 days (saddle back/biphasic
charac.)
headache, malaise, weakness, severe muscle
and
joint pain (breakbone fever),
lymphadenopathy,
maculo-papular skin rashes (herman’s)
appears
2.) Dengue Hemorrhagic Fever (DHF)
= one of the leading cause of morbidity and mortality
among Southeast Asian children
= usually occurs among children with history of
previous
exposure to virus
= more severe type, mortality rate 10%
= due to production of large amount of cross –
reacting antibody (virus – antibody complex)
w/c are formed
few days during the second dengue infection
= WHO criteria of DHF: fever, hemorrhagic
manifestation,
thrombocytopenia, increase capillary
permeability
(hypoalbuminemia, hemoconcentration, pleural
effusion)
3.) Dengue Shock Syndrome (DSS)
Pathogenesis:
= patient w/ dengue caused by one of 4 serotypes–recover→
antibody
against that serotypes produced
= when that same patient is infected with another dengue
virus

serotypes

anammestic reaction occur

overproduction of cross-reacting AB

immune complex formed bet. virus & AB

activate the complement system

damage blood vessel

increase vascular permeability

loss of platelet (thrombocytopenia)
Lab. Diagnosis:
1) Patient with clinical manifestation and history of
going
to endemic areas (Tourniquet test)
2) Platelet count – below 50,000 (indication of
bleeding)
3) Virological
= demonst. virus by inoculating blood:

A.) Mosquito culture medium


= commonly used
= 2 weeks virus can be isolated
B.) Mouse Inoculation (suckling mice)
= Disadvantage: take 1 month before virus
isolated
4) Serological
1.) NT - commonly used method AB
detected within 7 days of
Treatment:
= No specific Rx (No antiviral drug available)
= Supportive and Symptomatic
= Fluid and Electrolyte
= Replace platelet with platelet concentrate

Prevention Control:
= General mosquito control measures
1.) Elimination of breeding places
2.) Insecticides
3.) Fogging
= Vaccine (still under study) Sabin – Schlessinger
Vaccine (attenuated dengue virus)
Yellow Fever Virus

= endemic in Central and South America, Central


Africa
and Caribbean Island
= mosquitoborne (A. aegypti)
= 2 patterns of transmission in nature
1. Urban - transmitted from infected person
to
uninfected person by mosquito bite
2. Sylvan or jungle type - normally
transferred
from monkey to insect to monkey cycle

= human as accidental host


= produce severe form of life-threatening disease
= charac. fever, chill, headache, myalgia,
arthralgia,
Lab. Diagnosis:
1. Virological – isolation virus from clinical material
(blood)

intracerebral inoculation (suckling mice)
2. Punch Biopsy Liver (histopathologic exam)
demonst.
↓ charac. inclusion
body
“councilman body”
3. Serological – CF, NT (detect rise in AB titer)

Treatment: Symptomatic

Prevention:
1. Eradication and control of mosquito breeding site
2. Vaccine – (live attenuated yellow fever virus
Japanese B Encephalitis Virus

= found throughout Asia


= most prevalent in Southeast Asia (Phil.)
= mosquitoborne→Culex species (endemic to asian
cefield)
= most common cause of Epidemic Encephalitis (Asia)
= charac.: sudden onset of fever, severe headache

nuchal rigidity, tremor, convulsion & altered state


of consciousness
= majority of infection mild/inapparent
= mortality rate high especially in children
= neurologic sequelae severe
= if patient recover → permanent immunity
Lab. Diagnosis:
1. Virological – isolation of virus from brain tissue of
infected person (at autopsy)
Fluorescent- Antibody staining
2. Serological – detect rise antibody titer

Treatment: Symptomatic

Prevention:
1. Immunization–Vaccine (inactivated purified
Japanese B)
encephalitis virus given
3 subcutaneous doses
= very effective
= recommended esp. for person living or
travelling endemic area
2. Mosquito – Eradication program
St Louis Encephalitis Virus (SLE)

= widespread throughout the U.S. especially in


Texas,
Mississippi and Florida
= most common arbovirus encephalitis in U.S.
= has been the major cause of arboviral-born
encephalitis
over the last 3 decades
= peak activity during summer and spring
= the only arbovirus infection which occurs in urban
areas
= disease mild but outbreak carry a 10% mortality
= mosquito (vector), wild birds (reservoir)
= more common in adults (55 years and above)
= no vaccine or treatment available
= human are dead-end-host
Hepatitis C
(Non A, Non B hepatitis virus)
= enveloped virion containing a single-stranded RNA
genome
= 6 serotypes
= most prevalent blood-borne virus

Disease: Hepatitis C

MOT: Parenteral route (blood transfusion)


= infect the body after parenteral entry causing
hepatitis after 14-20 days incubation
period
= most often leads to chronic hepatitis therefore
person infected are carrier of virus
= most common cause of post-transfusion
hepatitis
Lab. Dx: Elisa (detect antibodies)
Family Rhabdoviridae

Rhabdovirus
(Lyssavirus/Rabies virus)

Characteristic:
= rna virus with ss rna genome, non-segmented
= bullet-shaped nucleocapsid
= envelope with spikes containing 2 enzymes
neuraminidase and hemagglutinin
= size 180 nm
= replicate in the cytoplasm
= sensitive to chemical agents:
(phenol, formaldehyde, ether and chloroform)
= inactivated by physical agents: U-V radiation,
heat
50°C for 1 hour
= survive at temperature 4°C for weeks
= a zoonotic virus with wide host range
(all warm-blooded animals are reservoir of virus
like)
dog, cat, skunk, raccoon and foxes
= virus infect most mammals including human
(accidental host)
= not found human body
= human to human transmission rare
= normally present → vampire bat
(only known carrier and reservoir of the virus and
don’t)
manifest disease
= dog (animal reservoir), man (accidental host)
= rabbit and rodents are the only mammals unable to
transmit
Disease: Rabies/Hydrophobia

= acute infection of the CNS charac. by: chill, fever,


headache, sore throat, malaise, anorexia &
nausea
= tingling and burning sensation at site of bite
followed by
hyperactivity and agitation
= confusion, seizure, lethargy, nervousness and
apprehension, disorder of coordination
= painful contraction of pharyngeal muscle when
swallowing liquid → hydrophobia → foaming
of the
mouth
= profuse sweating, lacrimation, dilatation of pupil,
seizure,
= MOT: 1. bite of infected animals which introduced the
virus through the skin and mucous
embrane
2. licking of infected animals to damaged
ucous
membrane
3. aerosol transmission from an infected animal
usually a bat (rare)
= incubation period varies from 2 weeks to a year
(depends on how large the infecting dose and
ow fast)
the virus travels to the CNS
- human - 10 days to 1 year with most cases
curring
20 - 90 days after exposure
- bite occurring in the head, neck & upper
xtremity
Pathogenesis:

when human bitten → virus inoculated → grow & multiply →


peripheral nerve
at site bite locally at wound site
for few days

salivary ← peripheral nerve ← CNS


gland ↓
death of neuron
& demyelination

= prognosis very poor


= disease always fatal
= death is due to respiratory center dysfunction
Lab. Diagnosis:

Rapid diagnosis
a.) Direct microscopic demonst. of virus antigen
by:
Direct immunoflourescence staining → detect
virus in
brain tissue and corneal scrapings
(most rapid & accurate method to identify
rabies virus)
b.) Brain biopsy→ histologic staining of brain
tissue
(seller stain)

demonst. intracytoplasmic eosinophilic
inclusion body “negri body”

= negri bodies and rabies antigen are


c.) Animal inoculation → mice
(tissue or saliva inoculated intracerebrally into
mice)
= presence of rabies virus is indicated by
1. flaccid paralysis of leg
2. encephalitis
3. death

d.) Serological
= detect rabies antibodies by
1. Immunofluorescence test
2. Complement fixation test
3. Neutralization test
= antibodies are developed during
progression
of the disease
Treatment: Supportive & Symptomatic

Prevention:
= Vaccination of domestic animal (dogs, cats) using
attenuated virus vaccine grown in chick
embryo
LEP (low egg passive virus) - used for dogs
HEP (high egg passive virus) - used for cattle

= Effective urban control of dog population


Post exposure treatment:
1. If human is bitten by a suspected rabid dog:
a. Clean the wound with soap and water
b. Give passive and active immunization
(necessary to eliminate risk of infection)
Rabies Immune Globulin (RIG)
Human Diploid Cell Vaccine (HDCV)
Duck Embryo Vaccine (DEV)
= administered at site of the bite and IM followed
by 4
additional doses
= the idea is to develop immunity while the virus
is still in the prolonged incubation period
(variable length)
2. Suspected animal should be captured and
confined
= observe animal for 10 days - if no symptoms
develop → animal (-) for rabies virus
= Prophylactic vaccine against rabies (human)

1. Human Diploid Cell Vaccine (HDCV)


= given to people at high risk of exposure
= harvested & inactivated with beta–
propiolactone
= given for 4-6 dose (I. M)
= very antigenic

2. Nerve tissue vaccine (Semple vaccine)


= derived from brain of infected animals
inactivated with formaldehyde
(sheep, goat, mouse)
= not commonly use because it causes
sensitization
of nerve tissue → post-vaccinial
encephalitis
3. Duck Embryo vaccine (DEV)

= prepared from developing chick embryo


and
inactivated by beta-propiolactone

= given for 14 days (Subcutanous injection)

4. Herperimmune serum
Family Orthomyxoviridae

Orthomyxovirus
(Influenza viruses)

= has special affinity for glycoprotein

Characteristic:
= segmented, single- stranded RNA virus
= helical nucleocapsid
= provided w/ envelope contg 2 glycoprotein
spikes
Hemagglutinin (H antigen)
Neuraminidase (N antigen)
= size 80–120 nm
= genetic ressortment common
= replicate in the host nucleus
Major antigenic types producing human infection

Influenza Type A
= undergo major and minor antigenic changes
often
exhibit antigenic shifting and drifting
↓ ↓
caused by reassortment due to
mutation
of the RNA genome in the
genome
= assoc. with epidemic outbreak of influenza
= 13 serotypes (hemaglutinatin H1-13)
(neuraminidase N1-N9)
Influenza Type B
= undergo only antigenic drifting, no antigenic
shifting
Influenza Type C
Disease: Influenza/Flu/La Grippe
= self-limiting disease lasting for 3-7 days
= charac. by URT manif.: cough, fever, sore
throat, chill,
myalgia, arthralgia
= highly contagious and spread by person to
person
contact or by aerosol
= incubation period 24 – 48 hours
= site of predilection – ciliated respiratory
epithelium of
the respiratory tract

Complication:
Reye’s syndrome
(Post influenza B encephalitis & fatty degeneration
Lab. Diagnosis:
throat swab
1. Virological – specimen
nasopharyngeal
washing

A. MKC – + hemadsorption
B. Yolk Sac Chick Embryo -
+hemagglutinatin
C. Madin Darby Canine Kidney (M D C K)
+ hemadsorption

2. Serological
C F test (C F antibody first to be formed)
HI
Treatment:
Symptomatic/Supportive
Amantadine – effective for type A infection
(Symmetril)

Prevention: Influenza vaccine (inactivated influenza


virus)
= given by I. M.
= against influenza type A & B
Family Paramyxoviridae

Paramyxoviruses

= ss rna virus, non-segmented


= helical nucleocapsid
= enveloped with 1 glycoprotein spike containing
neuraminidase and hemagglutinin
= 150-300 NM
= sensitive to ether
= has special affinity for mucin
= members of this family can cause wide spectrum
of disease in human
= replicate in the cytoplasm
3 Genera:

1. Genus Paramyxovirus
= Parainfluenza virus
= Mumps virus

2. Genus Morbillivirus
= Rubeola/Measle virus

3. Genus Pneumovirus
= Respiratory Syncitial Virus (RSV)
A. Genus Paramyxoviruses

Parainfluenza virus

Properties:
= second leading cause of lower respiratory tract
infection in young children
= 4 serologic types affecting human

a) Type 1 & 2 parainfluenza virus


= assoc. with laryngotracheo-bronchitis
(croup) infants and children (6 months
–3yrs. old)
= charac. stridor (high pitched noisy
respiration
signalling resp. obstruction) and
barking
b) type 3 parainfluenza virus
= assoc. with bronchiolitis and pneumonia
= common in infants less than 1 year old

c) type 4 parainfluenza virus


= less common
= occur- adult
= assoc. with mild URT manif.
(pharyngitis & common cold
syndrome)

Pathogenesis:
= infection confined resp. epith. without systemic
spread of virus
= all 4 types of infection occurs year round
= acquired by inhalation of infectious particles
(resp. secretion)
Lab. Diagnosis.
1) Isolation of virus
Cell culture- MKC-+ hemadsorption
2. Serological
HI – demonst. four- fold rise AB titer bet.
acute and convalescent sera.
3. Flourescence staining of exfoliated epithelial
cell
to demonstrate virus

Treatment: Symptomatic & Supportive

Prevention: - No Vaccine available


= avoid contact with the virus
Differentiating Influenza Parainfluenza
points

1. Size 80-120 NM. dia. 150 – 300 NM.


dia.

2. Genome Single stranded Single stranded


segmented non-
segmented

3. Spikes Hemagglutinin and


Hemagglutinin
neuraminidase in &
neuraminidase
separate spikes in one spikes

4. Fusion (F) absent present


Mumps virus

= enveloped containing 2 types of glycoprotein


spikes< HN
= 1 serotype
= human (natural host)

Disease: Mumps/Epidemic Parotitis


= worldwide
= prevalent -children 5-14 years old
= MOT- respiratory droplet or inhalation/person to
person
contact
= inc. pd. 18-21 days
= initial site of infection → URT
= mild self-limiting disease associated with:
fever, malaise, anorexia, tenderness &
= disease benign and self-limiting
= resolves 10-15 days
= 30% children –asymptomatic

Complications:
1. Orchitis - infection of testicles
- postpubertal male
- usually unilateral involvement
2. Sterility - rare complication
3. Aseptic meningitis

- self limiting and has no sequelae


Lab. Diagnosis:
1. Physical appearance of the patient
2. Virological - (saliva, blood, urine, CSF)
MKC + hemadsorption
Yolk sac developing chick embryo
+ hemagglutination
Treatment: = Symptomatic
= No antiviral drug available

Prevention:
= vaccine contg.-live attenuated mump virus
given in
combination with measle and rubella (MMR)

= hyperimmune - gamma globulin

Immunity – recovery is associated with lifetime


immunity
Genus Morbillivirus

Rubeola/Measle virus
= only 1 serotype
= sensitive to ether
Disease: Measle/Rubeola
MOT- contact with respiratory droplet or
secretion/inhalation
= inc. pd. 7-14 days
= initial site of infection mucosa
URT

multiply (disseminate)

LN

bloodstream (viremia)

Prodromal manif:
= fever, rhinitis, conjunctivitis, photopobia and
cough
= maculo- papular skin rashes usually appears
during
fever face → neck → trunk → extremities
= presence of koplik’s spots buccal mucosa
(diagnostic)
= period of communicability 4 days before and 4
days
after the appearance of rashes

Complications:
1. Bronchopneumonia
2. Encephalitis
3. Subacute sclerosing Panencephalitis
(rare and late complication)
Lab. Diagnosis:
1. Virological- isolation virus clinical material
(nasopharyngeal and conjunctival secretions)
MKC/Human Embryonic Kidney
+ CPE – syncithium formation
= presence of Warthin-Fenkeldy cell
(diagnostic)

2. Serological- det. rise AB titer


CF, HI, NT, Elisa
Treatment: Supportive & Symptomatic
= Immune serum globulin for immunocompromised
patient

Prevention: MMR vaccine


= live attenuated measle virus vaccine
= given IM
= 100% protection
Genus Pneumovirus

Respiratory Syncitial Virus (RSV)

= enveloped and contain 1 type of fusion protein


spikes
which causes cell to fuse forming a
multinucleated
syncitial which gives rise to the name of virus
(charac. of RSV only)
= possess no hemagglutinin or neuraminidase
activity
= human only natural host RSV
= 1 antigenic type
Diseases: Bronchiolitis, Pneumonia and Croup
(infants)
Upper Resp. tract infection (children &
adult)

= self-limiting disease of the URT charac. by


profuse
rhinorrhea, nasal congestion, pharyngitis,
cough
and fever accompanied with labored and
rapid
respiration with prolonged expiration
= primarily a resp. tract pathogen involving both
the
upper and lower respiratory tract
= acquired by respiratory droplets
= inc. pd. 1-4 days
Lab. Diagnosis:
1. Isolation of virus from nasal & pharyngeal
secretion
→ tissue culture
+ presence of multinucleated giant cells

2. Detection of RSviral antigen from exfoliated


cells of
resp. tract by immunofluorescence test

3. Serological - ELISA

Treatment: Symptomatic & Supportive


Aerosolized Ribavirine → infants

Prevention: = No vaccine available


= recovery from infection does not induce
immunity
Family Filoviridae

“filament” – describe the filamentous
shape of the virus

Filoviruses: Marburg virus


Ebola virus
Properties:
= ss non-segmented rna viruses
= helical nucleocapsid
= envelope
= size 80nm dia. X 800nm L
= pleomorphic form (circular, branched or U-shaped)
= endemic in African countries (Uganda, Kenya, Sudan &
Zaire)
= no known reservoir host
= natural host are probably monkey (african green
monkeys)
Disease: Acute Viral Hemorrhagic Fever

= a disease affecting human which is thought to


originate
from monkeys
= mechanism of transmission is via the skin and
mucous
membrane through:
1) direct contact of virus infected body fluids
(blood, vomitus, feces, semen)
2) nosocomial infection from contaminated
materials
(medical/surgical instrument)
3) preparation of body for burial
= not transmitted by aerosol
= incubation period 1 – 2 weeks accompanied with
S & Sx
of: fever, headache, myalgia, weakness,
= mortality rate high (80 – 90%)
= death is due to multiorgan failure
= autopsy of the patient shows hemorrhagic
diasthesis
and necrosis of the liver

Diagnosis: PCR, ELISA

Treatment: Symptomatic and Supportive


= no known effective antiviral drugs available

Prevention:
= avoid contact with bodyfluid coming from
infected
body fluids
= proper disposal of corpses
= any material used must be incinerated and
Family Retroviridae

Retroviruses

= diploid, single-stranded RNA genome


= icosahedral nucleocapsid
= spherical envelope virus
= presence of reverse transcriptase enzyme
which
converts genome RNA to DNA and 2 copies
of its
genome so it is a diploid virus
= can cause cancer or immune deficiency
disease in
human
1. Human T – cell leukemia virus (HTLV)
= assoc. with T – cell malignancies (Leukemia &
Lymphomas)
= transmission similar to HIV
Disease: T-cell Leukemia/Lymphoma

2. Human immunodeficiency virus (HIV-1, HIV-2)


Disease: Acquired immunodeficiency syndrome (AIDS)
= result from suppression of the immune system
= charac. by opportunistic infection and unusual
malignancies
= most disease in human is cause in HIV -1
= infected cell include CD4 helper T-lymphocytes,
monocytes and some cells of the CNS
= MOT: 1. Sexual contact
2. Blood product exposure
3. Perinatal
= site of latency: CD4 T-lymphocytes
Epidemiology:
Those at risk of infection:
1. Homosexual and Bisexual male
2. Intravenous drug users
3. Sexual contact of HIV infected individual
4. Infant of infected mother

Lab. Diagnosis:
1. Clinical sign and symptoms
2. Serologic assay: Elisa/Western Blot

Treatment: AZT
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