DOUBLE STRANDED, NAKED, ICOSAHEDRAL LINEAR RNA VIRUS

PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT

STRUCURE
REOVIRIDAE
- with 10-11 segments - infects the cells near the tips - race and gender not a factor Signs and symptoms - enzyme immunoassay - Supportive treatment
Rotavirus - MOST COMMON CAUSE of the SI villi à impaired - asymptomatic in adults - anorexia - latex agglutination - Rotateq (6-32wks)
OF CHILDHOOD hydrolysis of CHO and excess - low grade fever - E microscopy - Rotatrix (6-24wks)
DIARRHEA fluid loss à malabsorption - vomiting - Culture
- Viral Gastroenteritis - increased motility and diarrhea - watery, bloodless diarrhea - Electrolyte levels
- abdominal cramps

PE findings
- UO is most important sign à
dehydration
- Hyperactive bowel sound
- Dry mucosa and skin
- Tachycardia
- Depressed sensorium
- Weight loss

SINGLE STRANDED, (+) SENSE, ENVELOPED, ICOSAHEDRAL RNA VIRUSES

• An ARBOVIRUS (arthropod borne)

• Life cycle involves between vertebrates and moquitos as vectors
FLAVIVIRIDAE • Vectors have lifelong infection without disease
• Transmitted during viremic stage
• Common in tropical region, urban and semi urban

PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT

STRUCURE

• 6 genotypes
• MAJOR CAUSE OF POST
TRASFUSION HEPATITIS
Hepatitis C
HCV binds to CD81 tetraspanin or - Chronic hepa C à Hepa C virus Acute Infection can 1. HCV Ab 1. Interferon – chronic
scavenger receptor B1 in lead to: – diagnosis active Hepa
Cirrhosis à Hepa Ca
hepatocytes and B lymphocytes à 1. recovery - 4 wks before it 2. Ribavirin
coat itself with LDL and VLDL and - IV abusers, tattoo recipients, 2. rapid onset cirrhosis appears so 3. Screening of blood,
transfusion and organ
use lipoprotein receptor for 3. Persistent infection cannot be used organ and tissue donors
hepatocyte uptake à resemble recipients, hemophiliac and a. Asymptomatic in acute phase 4. Blood and bodyfluid
and buds in ER à bind to TNF HIV pxs b. chronic hepatitis à liver precaution
- Affects only humans and
recpetor and protein kinase R à failure / cirrhosis / 2. HCV RNA 5. Limit alcohol drinking
chimpanzees
inhibition of apoptosis and hepatocellular Ca – diagnosis in acute
interferon phase
Immunity is not lifelong and viremia: – main use is for
protective acute infection – 4-6 mos monitoring antiviral
persistent infection - >10yrs therapy

Predominant symptom: chronic 3. HCV Antigen

fatigue - using EIA
 Dengue • 4 serotypes: DENV 1-4
• 3 structural proteins
- capsid, prM, envelope
• 7 other proteins found in
infected cell
- NS1, NS2a. NS2b, NS3,
NS4a, NS4b, NS5
Yellow Fever Severe systemic disease
with liver, kidney and heart
degeneration .
Massive Gi hemorrhage and
jaundice
TOGAVIRIDAE
Rubella - German measles or 3 day
measles
Life cycle:
Attachà fusion and diasassembly
à translation à rna replication à
assembly in ER à maturation
DHF and DSS à 3rd to 7th day
During defervescence:
- rapid plasma leakage
- altered homeostasis
- live damage
Initial viremia:
Chills, headaches, backaches,
flulike symptoms 3-7 days of infexn
à L and B interferon response to
viremia
Second viremia:
Virus-Ab complex à higher no of
mononuclear cells à release of
cytokine, procoagulants à DIC in
DHF or spread in other organs
• infection with one
serotype provides
lifelong immunity but
only temporary and
partial protection against
other serotype
§ transmission between Aedes
aegypti or Aedes albopictus
that bread in water
Dengue Classification:
Grade 1- bruising and (+)
tourniquet with fever
Grade2 – spontaneous
bleeding
Grade 3 – clinical shock
Grade 4- severe shock, bp and
pulse not detected
Transmission:
- Respiratory droplets
- Transplacental
Humans are the only host
Infection promotes lifelong
immunity
• dengue fever Initial infection – NS! With Supportive treatment
- high fever CBC IV and oral rehydration
- nausea and vomiting Acute phase – NS1 and Blood transfusion
- breakbone fever IgM Vector control
- rash – 24 hrs after fever Secondary infection – NSI No dark colored foods to
and IgG check bleeding in feces
• Dengue Hemorrhagic Fever –
high fever with hepatomegaly
• Dengue shock syndrome
Incubation 14-21 days à 3 day Presence of antirubella Live attenuated vaccine for
maculopapular rash à posterior IgM prophylaxis
LAD - Not for pregnant and
RT-PCR of viral RNA IC pxs
Immune complex polyarthritis in
adults
CONGENITAL RUBELLA
SYNDROME
- During 1st trimester
- Abnormalities:
PDA
Congenital cataracts –
bilateral leukocoria, loss of
ROR
Sensoneural deafness
Mental retardation
Bulag, bingi, bobo, butas ang
 puso, blueberry baby

RETROVIRIDAE - Presence of reverse transcriptase: ssRNA à dsDNA

- Hepa B also contain reverse transcriptase
- LAMIVUDINE for treatment of hepa and HIV

Human - Diploid - Kills helper CD4 T cells Transmission: Clinical Syndromes: Presumptive Dx 1. HAART
Immunodeficiency - Many serotypes TB – no.1 killer – Ab detection by ELISA 2 nucleoside inhibitors
Virus - Main immune response: cytotoxic Original source C. neoformans - zidovudine and
Structural genes: CD8 T cells – chimpanzees, diet – meningoencephalitis Definitive DX lamivudine
1. GAG gene Transfer of semen, presented as chronic - Western blot analysis - lactic acidosis
Stages of Infection: transplacental and perinatal headache - using gel electrophoresis protease inhibitor
P24- nucleocapsid Needlestick – more of CMV – blindness - indinavir
- Found in core Phase 0 INFECTION HEPA B Candida – esophagitis Gold Standard – PCR - Fat redistribution
- Important serologic - HIV acquired Most common means - Sex Toxoplasma – ring in CT - Detect HIV DNA in cells syndrome
marker of infexn Phase 1 WINDOW PERIOD and plasma viral RNA Immune reconstitution
P7 – nucleocapsid - Viral replication with (-) HIV test AIDS defining illnesses - For prognostication syndrome
P17 – matrix Phase 2 SEROCONVERSION 1. P. carinii pneumoni - HBV, HCV, MAC/MAI
- Peak of viral load, (+) HIV test, flu 2. Esophageal candidiasis
2. POL gene like illness 1-2wks 3. Wasting – Inc IL-12, TNF 2. General prevention
Phase 3 LATENT PERIOD 4. Kaposi sarcoma – HHV8 – responsible sex
Reverse transcriptase - Asymptomatic for 1-15yrs 5. Diss Mac
– transcribe RNA to DNA - Low CD4 3. Perinatal prevention
Protease Phase 4 EARLY SYMPTOMATIC - perinatal prophylaxis
– cleaves precursor - CD4 500-200 -Abs CI to breastfeeding
polypeptide - last 5 yrs, mucocutaneous, derma is galactosemia, HIV is
Integrase and hema illness only relative CI
– integrates viral DNA to
host cell Phase 5 AIDS 4. Post exposure therapy
- CD4<200 last 2 years, AIDS - AZT
3. ENV gene defining illnesses present

Gp120
– attachment to CD4
- Mutates rapidly à
antigenic variation
Gp 41
- Fusion with host cell

Regulatory gene:
tat – activation of
transcription
rev – transport of mRNA to
cyto
nef – dec CD4 and MHC1
vif – hypermutation
vpr – transport in nondividing
cell
vpu – virion release
 HTLV-1 - ADULT T-CELL Spread in cells after BT, sex of breast ELISA AZT and interferon alpha
LYMPHOCYTIC feeding. RT-PCR
LEUKEMIA (ATLL)

- HTLV-ASSOCIATED
MYELOPATHY
(tropical spastic
paraparesia)

SINGLE STRANDED, (+) SENSE, ENVELOPED, HELICAL RNA VIRUSES
PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT
STRUCURE
CORONAVIRIDAE
- 2 serotypes - infection in URT - reservoir: horseshoe bat Incubation: 2-10 days Chest Xray: non cavitary
Coronavirus - 2nd MOST COMMON - optimum viral growth temp of - intermediate host: civet cat ground glass infiltrates
CAUSE OF COMMON 33C to 35C - respeoratory droplet SARS à ARDS
COLDS - longer incubation of 3 days - CIVET CAT à SARS Viral RNA in respiratory
than rhino and stool by RT-PCR
- virus binds to ACE 2 receptors
à kills alveolar epithelium

SINGLE STRANDED, (+) SENSE, NAKED, ICOSAHEDRAL RNA VIRUSES

• VP1 protein with S domain (structure) and P domain (cuplike)

CALICIVIRIDAE • 5 genera: norovirus, sapovirus, vesivirus, lagovirus, nebovirus
• norovirus and sapovirus à human caliciviruses

PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL LAB DIAGNOSIS TREATMENT

STRUCURE MANIFESTATION

• main cause of
gastroenteritis outbreak
with contaminated water
Norovirus and food à SHELLFISH
• MOST COMMON CAUSE
OF NONBACTERIAL
DIARRHEA IN ADULT
HBGA on enterocyte act as host BREASTMILK Incubation: 12-60 hours, RT-PCR Bismuth subsalicylate
receptor à dec sucrose, trehalase and -inhibit transmission by persist for at least 7 days – Handling food carefully
ALP act in intestinal brush border à inhibition of binding of 2mos. Genotyping based on region
villous atrophy, epithelia norovirus D for strain differentiation
disarrangement, crypt hyperplasia, cyto Self limited nonbloody
vacuolization à malabsorption and diarrhea, nausea and EIA for stool antigen
delayed gastric emptying à vomiting vomiting nd low fever detection
and diarrhea
1-2 days in outbreak and 5-6
days in endemic cases

<1 yr old à vomiting

infant and adult à diarrhea
 Hepatits E • Resembles HAV Do not progress to chronic infection • FECAL-ORAL ROUTE • Initial à flu, arthralgia and Anti HEV IgM à acute • Clears
• Teens and young adults weakness Anti HEV IgG à recent sponatenously
Chronic Hepa E à impaired HEV are • Jaundice, uncolored stool • Interferon alpha and
specific T cell response in transplant most commonly affected and inc liver enzymes ribavirin
patient

PICORNAVIRIDAE • Rhinovirus
• Enteroviruses: poliovorus, echovirus, cosxackie virus A and B, Hepa A
• Acid stable and survive GI
• CYTOPLASMIC REPLICATION
• When cell if infected, the ER will not fuse to the CIS side of golgi
• Replication in mucosa, lymphoid tissue pf pharynx and tonsils à GI à target tissue viremia
• FECAL ORAL ROUTE

LAB Dx: IgM à acute

IgG à chronic
RT-PCR of CSF(headache and stiffneck) , blood (rash, fever, vomiting) and stool (diarrhea, fever, abdominal pain)

Poliovirus • 3 serologic types - Bind to anterior horn cell of SC and • FECAL ORAL Poliomyelitis à poliovirus + SALK vaccine
• COWDRY TYPE B muscle cells ROUTE coxsackie virus A – killed IPV
INTRANUCLEAR
INCLUSION 1. Asymptomatic Infection SABIN VACCINE
- Infexn limited to – live OPV
oropharynx and gut - Prevent dse and inc
2. Abortive poliomyelitis IG
-mild illness, fever,
headache
3. Non paralytic poliomyelitis
(aseptic meningitis)
-fever, headache, stiffneck
and pleocytosis in CSF
4. Paralytic poliomyelitis
(major illness)
- Flaccid paralysis from
LMN lesion
- Spinal paralysis à one
or more limbs
- Bulbar paralysis à CN
and medullary respi
center

Post polio syndrome – 30-40

yrs later, deterioration of
muscle

ASEPTIC MENINGITIS
WITH RASH – CoxA +
Echovirus
Cosxackie A Virus • FECAL ORAL ROUTE Herpangina
• AEROSOL - Fever, sorethroat and
vesicles in oropharynx,
pain in swallowing
- Self limited

Hand, Foot and Mouth Dse

- Vesicular lesion with
mild fever
- CoxA 16
- Lesion in hand, foot,
mouth and tongue

Acute hemorrhagic
conjunctivitis
- Enterovirus70 and Cox
A24

Cosxackie B Virus • Life threatening in • FECAL ORAL ROUTE Pleurodynia

infants • AEROSOL - Fever with severe
• Asymptomatic or mild in pleuritic chest pain
adults
Epidemic pleurodynia
- Bornholm disease /
devils grip
- Sharp paroxysmal chest
pain with fever in
adolescent and young
adult

Myocarditis and Pericarditis

- Fever, chest pain and
congestive failure

EchoVirus Enteric Cytopathic Human • FECAL ORAL ROUTE Aseptic meningitis

Orphan • AEROSOL URTI
Fever w or w/o rash
Infantile diarrhea
Hemorrhagic conjuctivitis
 Rhinovirus • Acid labile Replication in nasal mucosa and • Aerosols URTI à rhinorrhea à
• 100 serotypes conjunctiva à growth as 33C • Hand nose contact sorethroat à malaise
• MOST COMMON àinflammatory mediators such as (hand as major vector)
CAUSE OF COMMON bradykininà runny nose, sinusitis, • Person to person Infection à 3-4 days
COLDSAND URTI watery discharge contact is predominant Cough and nasal symptoms
• Same receptor with mode of spread à 7-10 days
Coxsackievrouses • Fomites
(ICAM-1) • Host limited to humans Asymptomatic Shedding
and chimpanzees
• IgA and interferon for
response to infection

Hepatitis A • Enterovirus 72 • Fecal oral route Symptoms occur 15-50 days Anti HAV IgM
• Common in after exposure (fever,
STREETFOODS and nausea, loss apetite,
SHELLFISH abdominal pain) à jaundice
• Self Limited phase (no symptom)
àrecovery

SINGLE STRANDED, (-) SENSE, ENVELOPED, HELICAL RNA VIRUSES

• Unsegmented genome
PARAMYXOVIRIDAE • RNA dependent RNA polymerase
• Hemaglutinin – attachment
• Neuraminidase
• fusion proteins – fusion of cell to multinucleated giant cell for Ab protection

PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL LAB DIAGNOSIS TREATMENT

STRUCURE MANIFESTATION

URTI à retisculoendothelial cells à • Respiratory droplet Incubation: 10-14 days VITAMIN A – reduced
depress cell mediated immunity transmission severity
Measles RUBEOLA transiently à multinucleated GC • Lifelong immunity for px Koplik spot in stensen duct
(WARTHIN FINKELDEY BODIES) à who had the dse of parotid gland à Live attenuated Vaccine
(+) hemaglutinnin and skin by hematogenous spread à maculopapular rash in face, for prevention
fusion protein vasculitis à Rash – CD8 attacking the trunk, ext, palms and soles
measles infected vascular endothelium
Complications:
1. Post infectious
Encephalitis
- Px with inactivated
vaccine and exposed
to wilder strain
2. Pneumonia
– worst
 3. SSPE
– virus persist in body
acts as slow virus but
cannot spread
-DAMSON INCLUSION
BODIES

3 Cs
Cough, Coryza,
Conjunctivitis, Koplik spot

Mumps • (+) hemaglutinnin, URT à local replication -> viremia à • Respiratory droplet • Incubation: 18-21 days Saliva, urine and CSF IgM Live attenuated Vaccine
neuraminidase and systemic infection transmission • Bilateral swelling of Ab for prevention
fusion protein 1. Parotid gland • Lifelong immunity for px parotids when drinking
2. Testes, ovaries, PNS and who had the dse citrus juice
CNS, eyes and ears • Self limited within 1 week
3. Pancreas – juvenial diabetes
Complications: orchitis and
meningitis, parotitis,
menningits, pancreatitis

Pleomorphic adenoma –
tumor in parotids

MATERNAL Ab – passes in
placenta and protection for
first 6 months of life

RSV • (+) fusion protein à Plugs in small airways of neonates Humans are natural hosts Bronchiolitis and pneumonia Wheezing in broncholitis Ribavirin
à pneumonia and bronchiolitis à fever, cough , dyspnea, - Same with hepa E
multinucleated GC à
(wheezing) à localized infection in No systemic spread cyanosis
syncytia URT
Severe disease with Febrile rhinitis and
IMMUNOLOGIC CROSS pharyngitis à children
REACTION WITH
MATERNAL AB Common cold à adults

Parainfluenza Virus • (+) hemaglutinnin, • Local disease in upper and lower Humans and animals both CROUP Croup: Steeple sign in xray Croup – racemic epi
neuraminidase and RT affected but animal strains - Inspiratory stridor, cough
fusion protein do not affect humans and hoarseness seal Thumbprint sign - epiglotittis Epiglottitis - ceftriaxone
• No viremic spread bark
• Four types - Subglottic stenosis

• Ab to H or F protein Virus 1 and 2

à less infectivity – major cause of CROUP or
laryngotracheobronchitis
- Inspiratory stridor, cough
and hoarseness seal bark
- Steeple sign in xray

Virus 3
- Most common in children
 with LRTI

Virus 4 – common codl, rare cause

ORTHOMYXOVIRIDAE • 8 segments
• interact with mucus

Influenza Virus • Majot antigens: INFLUENZA A • Respiratory droplet Incubation: 24-48 hr Oseltamivir or Zanamivir
1. hemaglutinin transmission – drug of choice
– attachment Antigenic shift àsudden major change targeting
- target of neutralizing à reassortment à new strain à • Human bites can transmit Clinical presentation neuroaminidase
Ab pandemic virus - Myalgia
2. Neuraminidase - Fever Amantidine or
- release of virus by • Influenza A - Headache rimantidine
breaking sialic acid INFLUENZA B – animal reservoir - pharyngitis – influenza A only
- degrade respi - Aquatic birds or - cough - prevents uncoating of
epithelium Antigenic drift à mutation à waterfowl – common virus – less
epidemics source Complication transmission
• Influenza A - Pigs – mixing bowl - staph pneumonia
– worldwide epidemic - Waterfowl – H1 tp - reye syndrome Yearly vaccine to
(pandemic) H16 and N1 to N9 influenza B during rainy
- Most common - Humans – H1 to H3 season
cause of RTI and N1 to N2
- 16 HA and 9 NA
• Influenza B
• Influenza B – human reservoir
– major outbreak of - Must be included in the
influenza new vaccine for
- No pandemic influenza
- No common antigen with
• Influenza C inf A
– mild RTI
- do not cuase
outbreal

SINGLE STRANDED, (-) SENSE, ENVELOPED, BULLET RNA VIRUSES

 PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT
STRUCURE
RHABDOVIRIDAE
- bullet shaped Multiply locally at animal bite à - Animal reservoir: dogs, cats, Incubation: 2-16 weeks Pre-exposure: vaccine
Rabies virus - assembly in cytoplasm sensory neuron à axonal skunks, raccoons and bats Post-exposure: vaccine
- NEGRI BODY transport to CNS - Transmission by animal Incubation period 20-80 days à and Ig
intracytoplasmic eosinophilic bites prodromal period (pain and itch
inclusion - US à skunk in bite) à acute neurologic Rabies vaccine: >4
- Philippines à dogs period (fasciculation, priapism sessions
and convulsion, furious rabies)
à coma due to respi depression Do not bring rabid animal
to ER
Symptoms:
- Confusion
- Lethargy
- Hypersalivation
- laryngospasm,
- hydrophobia (pain in attempt
to swallow h20)
- encephalitis
- aerophobia