Mendiola, Leomill O.

1/18/2017
BMLS 3-B Dr. Amelda C. Libres

RESPIRATORY VIRUSES
*Updated*1.1

1. ADENOVIRUS

CHARACTERISTICS
are medium-sized (70 to 90 nm), icosahedral, no enveloped, double-stranded, linear
DNA viruses.
SEROTYPE
Only members of the genus Mastadenovirus cause human infection.
types are divided into seven species, A through G, with species B subdivided into two
subspecies
PATHOGENESIS AND MODE OF TRANSMISSION
Aerosolized droplet and airborne. Can also be acquired thru contaminated respiratory
secretions, stool, and fomites Eye contact
Viable for weeks at variable temperature.
Lower respiratory disease in newborns may be fatal.
ability to cause severe, acute respiratory disease epidemics in military recruits,
Respiratory disease 2 to 14 days.
LABORATORY TEST
Respiratory secretion and stool in cell culture (epithelial e.g. A549, HEP-2, HeLa cell
line)
Cell culture CPE: Grapelike cluster
Confirmatory test: IFA, EIA (Gastroenteritis), Nucleic acid testing
Other test: rapid test shell vial (less sensitive)
PREVENTION AND CONTROL
Vaccine for 4-7 adenoviral serotypes.
Supportive treatment necessary.

2. BUNYAVIRUSES
MORPHOLOGY/CHARACTERISTICS
RNA virus consisting 3 single stranded RNA segments enclosed in a helical
nucleocapsid that is surrounded by a lipid envelope.
A unique feature of this family of viruses is their tripartite genome. The genomic
structure provides a mechanism for genetic reassortment
SEROTYPE
Bunyaviruses comprise a large, diverse group of viruses
(approximately 300 total members with 12 human pathogens), most of which are
transmitted by mosquitoes
PATHOGENESIS
Hantavirus Pulmonary Syndrome HPS (disease cause by Bunyaviruses) begins with
generalized symptoms that include headache, fever, and body aches typically after an
 incubation period of 11 to 32 days. Subsequently, the symptom become much more
severe, leading to hemorrhagic fever and Respiratory failure.
LABORATORY DIAGNOSTICS
Serology and antibody detection
RT-PCR
MODE OF TRANSMISSION/S
The viruses are rodent borne (rodent excreta). Rodents develop a chronic infection that
results in shedding of the virus in saliva, feces, and urine. D
disruption of these animal excreta by vacuuming, sweeping, or shaking rugs aerosolizes
infected particles
Can also be mosquito, tick borne.
No person to person contact
PREVENTION and CONTROL
Avoid contact with the virus and also the carrier of it.

3. CORONA VIRUS (REVISED)

MORPHOLOGY and its CHARACTERISTICS
Pleomorphic, roughly spherical, medium-sized, enveloped RNA viruses.
The prefix corona- results from the viral structure and the crown like surface projections
on the external surface of the virus that can be seen with electron microscopy.
CoVs cause a wide variety of disease in animals and birds.
Cause of the one of the 55% of colds including Rhinovirus and pneumonia for adults.
It is Transmitted Thru Respiratory secretions/aerosol.
o Highest concentration of viruses is in the nasal passages and infects nasal epithelial
cells.
Cause Diarrhea in infants and can be detected in stool for symptomatic patients

SEROTYPE
Novel coronavirus which causing a global outbreak known as severe acute respiratory
syndrome (SARS) in 2002 that resulted in severe respiratory distress in the human
population. It is due to the proximity of human and animals are the cause of human infection.
Originated from palm civets in Guangdong, China.
8000 Patients worldwide are affected; 700 people died
PATHOGENESIS
i. The disease was characterized by a rapid onset of high fever, followed by a dry
cough and dyspnea.
ii. The severe respiratory syndrome followed an incubation period of approximately
2 to 7 days after the appearance of the initial symptoms (fever, headache,
myalgia, and malaise). Frequently the illness would progress to severe
respiratory distress.
iii. This secondary attack (50 %) rate. It is a result of SARS being an unusual
respiratory virus. The period of maximum infectivity and highest viral loads in the
upper airways begins in the second week of illness, during the time the patients
often were severely ill. The SARS was finally isolated in July, 2003.
LABORATORY DIAGNOSTICS
No practical diagnostic methods other than electron microscopy and RT-PCR are
available
Many CoVs do not grow in routine cell culture.
 Modified cell cultures have been useful when confirmatory testing with antigen- or
nucleic acidbased methods are used.

MODE OF TRANSMISSION
Viral transmission is person to person via contaminated respiratory secretions or
aerosols.
The virus is present in the highest concentration in the nasal passages, where it infects
the nasal epithelial cells.

PREVENTION and CONTROL

Avoid contact with the virus. Also the higher proximity whose carrier on it, the more
chance to get infected.

4. ORTHOMYXOVIRUSES (INFLUENZA VIRUS) (REVISED)

MORPHOLOGY and its CHARACTERISTICS

Segmented (eight separate molecules), single-stranded, RNA genome; helical capsid
with envelope
Influenza is the most common respiratory viruses known to cause greatest number of
serious illnesses.
Only Influenza C has 7 segmented SSRNA.
HA Proteins are rod-shaped spikes, NA proteins are like Mushroom-shaped spikes
They can be distinguished based on the antigenic differences in the matrix protein (M)
and the nucleoprotein(NP).
Influenza virus A is further subdivided based on the major surface glycoproteins such as
o hemagglutinin (HA) - attachment to sialic acid containing receptor to cell.
(16 types) only 3 (H1, H2, H3) are found in humans.
o neuraminidase (NA)-facilitate release of mature virions, assist viral movement.
(also assist in budding)
influenza A naturally infects many species like bird, swine, seals, felines, and horses.
Influenza B and C are only known to infect humans.
Bacterial coinfection is common because of viral NA-induced changes in the respiratory
epithelium that allow increased bacterial adherence or decreased mucociliary
clearance.

SEROTYPE:
1. INFLUENZA A (deadliest of the three)
CHARACTERISTICS
Influenza A, B have 8-part segmented genome, Influenza C- only 7
This property results a unique ability to alter HA and NA which result to the
production of novel virus due to Antigenic drift (every year)
This phenomenon only occurs when 2 or more strain infects in the host.
1 strain came from avian and the other is from human, then the
reassortment may be takes place in intermediate host such as swine then
after reassortment, it may infect human which leads to infection from new
strain of viruses and sustain human-human transmission that causes
pandemic (worldwide spread)
SPANISH FLU H1N1
ASIAN FLU H2N2
HONG-KONG FLU H3N2
AVIAN FLU H5N1
SWINE FLU

 TRANSMISSION
Contact with respiratory secretion
1-4 DAYS incubation period

DISEASE
Influenza (fever, malaise, headache, myalgia, nonproductive cough);
primary influenza pneumonia; in children, bronchiolitis, croup, otitis media
DETECTION
Cell culture (PMK), EIA, FA stain, RT-PCR
EPIDEMIOLOGY
Viral subtypes based on hemagglutinin and neuraminidase glycoproteins
abbreviated H and N, respectively (e.g., H1N1
or H3N2); infects humans and other animals; antigenic drift, resulting in
minor antigenic change.
PREVENTION AND CONTROL
Supportive treatment
Antiviral prophylaxis and Vaccination
2. INFLUENZA B (seasonal)
TRANSMISSION
Contact with respiratory secretions
DISEASE
Similar to mild influenza
Detection Cell culture (PMK), EIA, FA stain, RT-PCR
EPIDEMIOLOGY
Antigenic drift only, resulting in local outbreaks every 1-3 years
TREATMENT
Supportive; antivirals Influenza vaccine or antiviral prophylaxis

3. INFLUENZA C (mild upper respiratory only)

TRANSMISSION
Contact with respiratory secretion
DISEASE
Mild form of influenza causing URTI
DETECTION
Testing not routinely requested, so virus is infrequently detected; only
valid test is NAAT
EPIDEMIOLOGY
Most cases occur in children; occurs sporadically or as localized
outbreaks
PREVENTION/ CONTROL
Avoid contact with virus, supportive treatment

PATHOGENESIS
The incubation period is 1 to 4 days, with rapid onset of symptoms, including fever,
nonproductive cough, sore throat, rhinitis, headache, malaise, and myalgia. The illness
usually resolves within a week, although some symptoms may persist longer.
Bacterial co-infections (S. aureus) are common with influenza, possibly because of viral
NA-induced changes in the respiratory epithelium that allow increased bacterial adherence
or decrease mucociliary clearance.
MODE OF TRANSMISSION
SEE ABOVE
LABORATORY DIAGNOSTICS
Testing for influenza can be completed by viral culture, detection of viral nucleic acid or
antigen, and serology.
 Optimal testing requires proper collection and timing of specimens. Virus is shed 3 to 5 days
after the onset of symptoms. Optimal specimens are collected from the posterior
nasopharynx. Can also be a variety of other respiratory samples, including nasal aspirates
nasal wash, throat swabs, and throat washes, may be used for viral identification.
The samples should be placed in viral transport media and may be stored at 4C for up to 5
days. If the sample must be stored longer, it should be stored in a freezer at 70C until
processed.
Cell culture is available for influenza virus using a variety of cell lines including PMK because it
demonstrated season-to-season isolation frequency of influenza virus.
o Sometimes it fails to produce CPE, hemadsorption test is the alternative using blood of
guinea pig.
RT-PCR (Gold standard)

PREVENTION AND CONTROL

SEE ABOVE

5. PARAMYOXOVIRUSES (Parainfluenza) (REVISED)

MORPHOLOGY and its CHARACTERISTICS
Single-stranded, RNA genome; Spherical, helical capsid with envelope; no segmented genome
(e.g., orthomyxoviruses)
All groups can cause disease

SEROTYPE
1. RSV VIRUS
TRANSMISSION
Contact with respiratory secretions; extremely contagious
DISEASE
Measles, atypical measles (occurs in those with waning vaccine immunity),
and subacute sclerosing panencephalitis
Cause bronchitis in children.
The most significant cause of acute lower respiratory tract infection under 5 y o.
DETECTION
Cell culture (PMK) and serology (Direct antigen detection)
virus contains a surface protein called F (fusion) protein. F protein
mediates host cell fusion into syncytial cells, which are a hallmark
of RSV infection.
RSV immune serum prevents bronchiolitis especially underdeveloped
newborn.
Can be detected using Nucleic acid detection.
TREATMENT
Supportive; immunocompromised patients can be treated with immune serum
globulin
PREVENTION
Measles vaccine
2. MUMPS VIRUS
TRANSMISSION
Person-to-person contact, presumably respiratory droplets, saliva
DISEASE
Mumps (inflamed parotid gland), rashes (Kopliks spots)- blue spot with red
halo located on the buccal or labial mucosa
DETECTION
Cell culture (PMK) and serology
Kopliks spots
TREATMENT
Supportive, Mumps vaccine, self-limiting

3. METAPNEUMOVIRUS
 CHARACTERISTCS
Closely resemble to RSV
Difficult to grow in cell culture
TRANSMISSION
Person to person
DISEASE
virus causes bronchiolitis
pneumonia in infants
lower respiratory tract disease in older adults.
In infants 6 to 12 months of age, infection with metapneumovirus is likely to
show lower airway involvement.
The virus is considered the second or third most common cause of
hospitalization for lower airway disease in pediatric patients.
DETECTION
RT-PCR
Difficult to grow in cell culture because It takes 2 weeks to have CPE.
EPIDEMIOLOGY
Winter epidemics, severity varies from year to year
TREATMENT
Prevention Avoid contact with virus
PARAINFLUENZA
Viral infection may present as either croup or other upper respiratory diseases in
children and adults.
The paramyxoviruses are second only to RSV in causing bronchiolitis and
pneumonia in infants and young children.
The parainfluenza virus has four subtypes
o Para Influenza 1 most common cause of croup
o Parainfluenza 2 infects animals
o Parainfluenza 3 2nd in prevalence to RSV; infects children 2 y.o
Common cause of fatalities
o Parainfluenza 4 infects animals
TRANSMISSION
o Fomites and aerosols and infects/inoculated to mucous membrane of
respiratory system
o Parainfluenza can live up to 10 hrs on varying surfaces
LAB IDENTICATION
o Cell culture (continuous or primary cell lines)
o Confirmation: IFA
TREATMENT
o Supportive, avoid contact with virus
6. ENTEROVIRUS - RHINOVIRUS (REVISED)
MORPHOLOGY/CHARACTERISTICS
A family of Picornaviridae. It is a Small, nonenveloped, single stranded RNA viruses. They
are among the simplest of the RNA viruses.
highly structured capsid that has limited surface elaboration.
The name derived from piccolo meaning small.

SEROTYPE
Rhinovirus (cause common cold virus) 100 serotypes
PATHOGENESIS
Rhinovirus is the cause of the common cold. Its name reflects the fact that the primary
infection and replication site is the epithelium cells in the nose.
responsible for more than 50% of viral colds and cause more upper respiratory viral
infections than any other virus.
rhinovirus infections can cause complications such as otitis media and sinusitis
 can exacerbate previously existing conditions such as asthma, chronic obstructive
pulmonary disease (COPD) and cystic fibrosis which lead to lower respiratory diseases.
It is the most common Virus whom it infects Lower Respiratory tract
Infection usually occurs through self-inoculation through the eyes or nose and also occurs
through contact with infectious aerosols.
Symptoms usually begin 2 to 3 days after exposure.
The clinical presentation includes a profuse, watery nasal discharge frequent accompanied
by symptoms of headache, malaise, sneezing, nasal congestion, sore throat, and cough.
Illness generally lasts 10 days to 2 weeks. It is self-limiting.
Having previously infected Does not confer lifelong immunity due to its different serotypes.

LABORATORY DIAGNOSTICS
Antigen detection is difficult due to its several serotypes.
Cell cultures using MRC-5; CPE 1-4 DAYS
In fibroblast cell line- Small refractile round cells.
Rhinovirus favors 30 degree Celsius below to grow
Must be resemble physiologic environment (Ph 7)
To differentiate enterovirus and RhinovirusEnterovirus favors acidic Ph because
they are acid-stable viruses but Rhinovirus favors basic ph.
Confirmation using PCR (more sensitive, specific) but not IFA (no test available)

MODE OF TRANSMISSION
Infection occurs by person-to-person transmission of infected respiratory secretions.
PREVENTION AND CONTROL
Supportive, avoid contact to the person who is actively infected. Cover your mouth when
sneezing when you have it. Rhinovirus is self-limiting.

GASTROINTESTINAL VIRUSES

1. ADENOVIRUS (see above for details)

Serotype 40 and 41

2. CALICIVIRUSES

MORPHOLOGY AND ITS CHARACTERISTICS

Caliciviruses are small (30 to 38 nm), rounded, nonenveloped, single-stranded, positive
RNA viruses
Previously recognized as animal virus
SEROTYPES
Hepatitis E virus removed from Calicivruses to Hepevirus.
Norovirus and Sapovirus are the primary cause of Gastroenteritis (HuCV).
HuCV further classified to genogroup. Norovirus (I, II, and IV) and Hepevirus (I, II, III, IV)
PATHOGENESIS
The clinical symptoms associated with norovirus infection include nausea, abdominal
cramps, vomiting, and watery diarrhea.
Symptoms usually occur after a 1- to 2- day incubation period and continue for
approximately 1 to 3 days.
Vomiting occurs more often in children than in adults. Infection with sapovirus is similar
to that with norovirus
sapoviruses more frequently cause disease in infants and toddlers than in school-age
children, whereas norovirus infections are common to all age groups.
 Maximum viral shedding in the feces occurs early, at the onset of clinical symptoms,
but viral shedding can occur for up to 2 to 3 weeks after cessation of the clinical
symptoms.
As a result, control of viral transmission is problematic, and infection does not confer
long-lasting immunity.
MODE OF TRANSMISSION
fecal-oral transmission.
Noroviruses are easily transmitted in water, person to person, or in airborne droplets of
vomitus. The virus persists in water despite treatment processes.
PREVENTION AND CONTROL
Supportive treatment
LABORATORY DIAGNOSTICS
EM, RT-PCR, EIA for noroviruses

3 CORONAVIRUS (see above)

4 ENTEROVIRUS (see above)

5 REOVIRUSES (Rotavirus)

MORPHOLOGY AND ITS CHARACTERISTICS

Segmented, double-stranded, RNA genome; icosahedral capsid with no envelope
Referred as respiratory-enteric-orphan virus.
SEROTYPES

rotavirus is further classified into seven distinct groups, A through G; groups A, B and C
cause human disease.
PATHOGENESIS
The disease is characterized by sudden onset of vomiting, followed by explosive, watery
diarrhea and moderate to high fever, often accompanied by dehydration.
MODE OF TRANMISSION
Fecal-oral; survives well on inanimate objects.
LABORATORY DIAGNOSTICS
EIA and Latex agglutination
PREVENTION AND CONTROL
Supportive fluid replacement and avoid contact with virus