Viral infections

LEILANI O. ESTACIO
 VIRAL GASTROENTERITIS
• Viral gastroenteritis is an inflammation, swelling, and
irritation of the inside lining of your gastrointestinal tract. Signs and symptoms:
•Watery, usually non bloody diarrhea —
bloody diarrhea usually means you have
Viruses can be found in the vomit and the diarrhea of infected a different, more severe infection
people. It can live for a long time outside the body. People who •Nausea, vomiting or both
are infected can spread the virus to objects they touch, •Stomach cramps and pain
especially if they don’t wash their hands after using the •Occasional muscle aches or headache
bathroom. Food workers with the infection can spread it to •Low-grade fever
others through food and beverages. Sewage that gets into the
water supply can also spread the illness. Although viral CHILDREN and INFANT:
gastroenteritis is sometimes called "stomach flu," the seasonal • Fever
influenza (flu) virus does not cause it. • Irritable
• Bloody diarrhea
Mode of Transmission: • Dehydration
Contact with an infected person or by
consuming contaminated food or
water
Norovirus. This virus is the most common cause of adult
infections, and it’s usually responsible for outbreaks on cruise
ships. Symptoms last from 1 to 3 days and can occur any time
of the year.
  virus from contaminated food or water
 spread between people who are in close contact or who
share food
 touching a surface that's been contaminated with norovirus
and then touching your mouth.

Rotavirus. Worldwide, this is the most common cause of

viral gastroenteritis.  Commonly infects infants age 3 to 15
months. The illness lasts for 3 to 7 days and is most common in
fall and winter.
 fingers or other objects contaminated with the virus into
their mouths
 through contaminated food.
The infection is most severe in infants and young
children.
Risk Factors
• Young children. Children in child care centers or elementary schools may be
especially vulnerable because it takes time for a child's immune system to
mature.
• Older adults. Adult immune systems tend to become less efficient later in
life. Older adults in nursing homes are vulnerable because their immune
systems weaken. They also live in close contact with others who may pass
along germs.
• Schoolchildren or dormitory residents. Anywhere that groups of people
come together in close quarters can be an environment for an intestinal
infection to get passed.
• Anyone with a weakened immune system. If your resistance to infection is
low — for instance, if your immune system is compromised by HIV/AIDS,
chemotherapy or another medical condition — you may be especially at risk.
PREVENTIONS:
• Wash your hands thoroughly.
• Use separate personal items
around your home. 
• Prepare food safely. Keep your
distance. 
• Disinfect hard surfaces. 
• Avoid touching laundry that may
have been exposed to a virus.

Take precautions when traveling

•Drink only well-sealed bottled or carbonated water.
•Avoid ice cubes because they may be made from
contaminated water.
•Use bottled water to brush your teeth.
•Avoid raw food — including peeled fruits, raw vegetables
and salads — that has been touched by human hands.
•Avoid undercooked meat and fish.
24 HOUR FLU
•  commonly associated Gastroenteritis is an inflammation of the lining of the stomach
with the rotavirus in and intestines, which leads to symptoms such as vomiting and
children and either diarrhea.
the norovirus
 or Campylobacter bac
teria in adults
MOT:
 having close contact with a person who has the
•Diarrhea
infection.
•nausea or vomiting
 Coming into contact with a surface or object that’s
•abdominal cramps or pain
been contaminated. Examples include things like
•loss of appetite
•low-grade fever
doorknobs, faucets, or eating utensils. self-Limiting
 Consuming contaminated food or water.
•body aches and pains
•headache
sickness lasting
•feeling tired or fatigue
24 to 48
 CORONA VIRUS ADENO VIRUS

PARAMYXO VIRUS
Influenza
 INFLUENZA A INFLUENZA B INFLUENZA C

Responsible of most cases Mainly the one that cause Milder than either type
of Epidemics and A or B. People
Epidemics and Pandemics Infections and is generally do not
- Also cause of restricted to HUMANS become very ill from
influenza in birds only the influenza type C
Known as AVIIAN FLU viruses. Type C flu
viruses do not cause
epidemics.

SUBTYPE LINEAGES
A (H1N1) B(VICTORIA)
A (H3N2) B(YAMAGATA)
 2 TYPES OF ANTIGENIC
CHANGES
1.HEMAGGLUTININ (HA) 2. NEURAMINIDASE
- Minor change arising by the accumulation of - major change that involves
Mutations in the virus genes that code the virus rearrangement of the gene
That host antibody recognize segments involving the H ag and
N ag resulting in the development
of new strain

Shifting can result in a new

Influenza A subtypes in human

No immunity against new

virus
 Avian Influenza (Bird Flu)

• Commonly referred to as bird flu, primarily

a disease of birds, but can cause human

• The virus causes a respiratory infection

in humans, with symptoms ranging
from influenza-like
symptoms (fever, cough, sore throat,
and muscle aches) to eye infections,
pneumonia, acute and
severe respiratory distress, and other
severe and life-threatening
complications.
• Pathogen of avian influenza virus
type A causes bird flu; three
prominent subtypes of the virus
are H5, H7, and H9.
• H5N1 is the most virulent strain
SARS
• Severe acute respiratory syndrome (SARS) is a viral respiratory disease caused
by a SARS-associated coronavirus. It was first identified at the end of February
2003 during an outbreak that emerged in China and spread to 4 other
countries.
Mode of Transmission: • high fever (measured temperature greater than 100.4°F
 Airborne virus and can spread through [>38.0°C]). The fever is sometimes associated with chills
or other symptoms, including headache, general feeling
small droplets of saliva in a similar way to of discomfort, and body aches.
the cold and influenza.  • mild respiratory symptoms at the outset.
  indirectly via surfaces that have been • Diarrhea is seen in approximately 10 percent to 20
percent of patients.
touched by someone who is infected with • After 2 to 7 days, SARS patients may develop a dry,
the virus. nonproductive cough that might be accompanied by or
progress to a condition in which the oxygen levels in the
blood are low (hypoxia).
• In 10 percent to 20 percent of cases, patients require
mechanical ventilation. Most patients develop
pneumonia.
 Who are at RISK?
1. Sexually active individual with multiple partners
2. IV drug users – sharing of needles
3. Patients receiving blood and post transfusion
4. NB of HIV positive mothers
IP: Lasts from less than a year to about 10 years wherein the
patient is asymptomatic
1 month from exposure : flu-like symptoms, symptoms of chronic
diarrhea, lymphadenopathy

Symptoms will then subside followed by a long period of latency

(approx. 8 years)

LABORATORY DIAGNOSIS: patient will present with evidences of opportunistic

infections and malignancies
1.ELISA – Enzyme linked immunosorbent assay - SCREENING - CD4 + T cells very low (NORMAL 500-1200 cells)
2. WESTERN BLOT - CONFIRMATORY - wasting syndrome ( diarrhea and weight loss)
- leukoplakia (lesions in tongue and mouth)
- Kaposi’s sarcoma – soft tissue cancer
- MYCOBACTERIUM Avium-intracellulare
- cytomegalovirus
Secondary infections caused by viruses (e.g., cytomegalovirus,
herpes simplex), protozoa (e.g., Cryptosporidium, Toxoplasma),
bacteria (e.g., mycobacteria), DEATH
and/or fungi (e.g., Candida, Cryptococcus, Pneumocystis)
become systemic
TREATMEN
T
• - Involves the use of reverse
transcriptase inhibitors
• AZT – Azidothymidine and
• ddC – dideoxycytidine
• Which can be used in combination
with protease inhibitor like INDINAVIR
and SAQUINAVIR
HAART – highly active anti-retroviral
tx
• Combination of several drugs to
prevent the development of drug
resistance
PREVENTION
1. Education of the public regarding its mode of transmission
and control measures to prevent the spread of infection
2. Screening of blood donors
3. Monogamous relationship, use of condoms
4. PPE
5. Avoidance of sharing of needles
6. Disinfection of contaminated surfaces and laundry
NO VACCINE
- Virus undergoes constant mutation due to antigenic drift of its
gp120
 MUMPS
• Mumps is a contagious disease that is caused by a virus.
It typically starts with a few days of fever, headache,
muscle aches, tiredness, and loss of appetite. Then
most people will have swelling of their salivary glands
(often referred to as parotitis when the parotid gland,
located in front and below the ear, swells). This is what
causes the puffy cheeks and a tender, swollen jaw.
complications can include:
•inflammation of the testicles (orchitis); this may
lead to a decrease in testicular size (testicular
atrophy)
•inflammation of the ovaries (oophoritis) and/or
breast tissue (mastitis)
•inflammation in the pancreas (pancreatitis)
•inflammation of the brain (encephalitis)
•inflammation of the tissue covering the brain and
spinal cord (meningitis)
•deafness
PREVENTION
1. MMR VACCINE
 POLIOMYELITIS
o Polio, or poliomyelitis, is a disabling and life-threatening SIGNS and SYMPTOMS These symptoms
disease caused by the poliovirus. 1. Sore throat
o The virus spreads from person to person and can infect a usually last 2 to 5
2. Fever
person’s spinal cord, causing paralysis (can’t move parts of 3. Tiredness days, then go away
the body). 4. Nausea on their own
5. Headache
PICORNAVIRUS 6. Stomach pain
• Classified under the family of picornavirus
• Single stranded RNA A smaller proportion of people with poliovirus infection will
• Naked virus , no envelope develop other, more serious symptoms that affect the brain and
• Resistant to adverse environmental conditions spinal cord:

Paresthesia (feeling of pins and needles in the legs)

Meningitis (infection of the covering of the spinal cord and/or
brain) occurs in about 1 out of 25 people with poliovirus
infection
Paralysis (can’t move parts of the body) or weakness in the
arms, legs, or both, occurs in about 1 out of 200 people with
poliovirus infection
CLINICAL FINDINGS:

INAPPARENT, ASYMPTOMATIC INFECTIONS – accounts 90% of polio cases

The infection is confined to the oropharynx and GI Tract

ABORTIVE POLIOMYELITIS –referred as minor illness. Present with febrile illness manifesting as headache, sore throat, N/V

NON-PARALYTIC POLIOMYELITIS – referred as minor illness then manifest with back pains and stiff neck

PARALYTIC POLIOMYELITIS – referred as major illness. FLACCID PARALYSIS w/o sensory loss. Due to involvement of the
motor neurons of the anterior horn cells of the spinal cord. BULBAR POLIOMYELITIS involvement of the medullary
respiratory center. It involves the muscle of the vocal cords, pharynx, respiratory muscle resulting the death of the patient.

POST-POLIOMYELITIS SYNDROME – occurs years after the initial polio infection and involves the previously affected muscle,
showing the marked deterioration of the residual function of the muscle.

3 polio virus types:

Type 1 – most common cause of poliomyelitis
Type 2- declared eradicated in September 2015, with the last virus detected in India in 1999
Type 3- declared eradicated in October 2019. It was last detected in November 2012
Transmission Prevention & Treatment
• Poliovirus is very contagious and spreads through person-to- There are two types of vaccine that can prevent polio:
person contact.
• It lives in an infected person’s throat and intestines.  Inactivated poliovirus vaccine (IPV) given as an injection
• Poliovirus only infects people. in the leg or arm, depending on the patient’s age. Only
It enters the body through the mouth and spreads through: IPV has been used in the United States since 2000.
 Oral poliovirus vaccine (OPV) is still used throughout
• Contact with the feces (poop) of an infected person. much of the world.
• Droplets from a sneeze or cough of an infected person (less Polio vaccine protects children by preparing their bodies to
common). fight the poliovirus. Almost all children (99 children out of
100) who get all the recommended doses of the inactivated
You can get infected with poliovirus if: polio vaccine will be protected from polio.

• You have feces on your hands, and you touch your mouth.
• You put in your mouth objects like toys that are
contaminated with feces.
• An infected person may spread the virus to others
immediately before and up to 2 weeks after symptoms
appear.

The virus can live in an infected person’s feces for many weeks.
It can contaminate food and water in unsanitary conditions.
People who don’t have symptoms can still pass the virus to
others and make them sick.
 The Rabies Virus (Rhabdovirus)
 Rabies virus belongs to the order Mononegavirales,
viruses with a nonsegmented, negative-stranded

RABI
RNA genomes.
 Within this group, viruses with a distinct “bullet”
shape are classified in the Rhabdoviridae family,
which includes at least three genera of animal

ES
Rabies is a deadly virus spread to people from
the saliva of infected animals. The rabies virus
viruses,
Vesiculovirus.
Lyssavirus, Ephemerovirus, and

 The genus Lyssavirus includes rabies virus, Lagos

bat, Mokola virus, Duvenhage virus, European bat
is usually transmitted through a bite.
virus 1 & 2 and Australian bat virus.
Infects the Central Nervous system

MODE of TRANSMISSION:
Rabies virus is transmitted through direct
contact (such as through broken skin or
mucous membranes in the eyes, nose, or
mouth) with saliva or brain/nervous system
tissue from an infected animal.
affects only mammals. Mammals are warm-
blooded animals with fur. 

• bats, raccoons, skunks, and foxes

• Dogs, cats, rodents, rabbits
INCUBATION PERIOD:
last for weeks to months. 
The incubation period may vary based on:
1. the location of the exposure site (how far away
it is from the brain),
2. the type of rabies virus, and
3.any existing immunity.

 S/sx:
1.fever with pain and
2. unusual or unexplained tingling, pricking, or
burning sensation (paraesthesia) at the wound
site.
Furious rabies results in signs of
1.hyperactivity, excitable behavior,
2.hydrophobia (fear of water) and sometimes
3. aerophobia (fear of drafts or of fresh air). Death occurs
after a few days due to cardio-respiratory arrest.
4. Delirium
The acute period of disease typically ends after 2 to 10
days. Once clinical signs of rabies appear, the disease is
nearly always fatal, and treatment is typically supportive.
Less than 20 cases of human survival from clinical rabies
have been documented. Only a few survivors had no
history of pre- or postexposure prophylaxis.

Paralytic rabies accounts for about 20% of the

total number of human cases. This form of rabies runs a
less dramatic and usually longer course than the furious
form. Muscles gradually become paralysed, starting at the
site of the bite or scratch. A coma slowly develops, and
eventually death occurs. The paralytic form of rabies is
often misdiagnosed, contributing to the under-reporting of
the disease.
What happened to the Animals?
 How can you prevent rabies in animals?

1. Vaccination for pets (up to date)

2. maintain control of your pets by
keeping cats and ferrets indoors and
keeping dogs under direct
supervision.

Positive DFA Negative DFA

One important factor in deciding if you

should receive rabies vaccination (
post exposure prophylaxis) will be if the
animal you were exposed to can be found
and tested for rabies or 
held for observation.

Negri Bodies
 Pstexposure Prophylaxis for Non-immunized Individuals
Treatment Regimen
Postexposure Prophylaxis for Previously Immunized
Wound cleansing All postexposure prophylaxis should begin Individuals
with immediate thorough cleansing of all
wounds with soap and water. If available,
a virucidal agent such as povidine-iodine Treatment Regimen
solution should be used to irrigate the
wounds. Wound cleansing All postexposure
prophylaxis should begin
with immediate thorough
RIG If possible, the full dose should be
cleansing of all wounds with
infiltrated around any wound(s) and any soap and water. If available,
remaining volume should be administered a virucidal agent such as
IM at an anatomical site distant from
vaccine administration. Also, RIG should povidine-iodine solution
not be administered in the same syringe should be used to irrigate
as vaccine. Because RIG might partially the wounds.
suppress active production of antibody,
no more than the recommended dose
should be given.
RIG RIG should not be
administered.
Vaccine HDCV or PCECV 1.0 mL, IM
(deltoid area), one each on
days 0 and 3.

Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area ),

one each on days 0 , 3, 7, and 14
 ENCEPHALITIS
Encephalitis often causes only mild flu-like signs and Primary encephalitis. This condition occurs when a virus or
symptoms — such as a fever or headache — or no other agent directly infects the brain. The infection may be
symptoms at all. Sometimes the flu-like symptoms are concentrated in one area or widespread. A primary infection
more severe. Encephalitis can also cause confused may be a reactivation of a virus that had been inactive after a
thinking, seizures, or problems with movement or with previous illness.
senses such as sight or hearing.
Secondary encephalitis. This condition results from a faulty
immune system reaction to an infection elsewhere in the body.
CA: ENTEROVIRUSES – Poliovirus and Coxsackie virus
Instead of attacking only the cells causing the infection, the
Others : Mumps virus, Herpes simplex virus, Epstein-Barr virus
immune system also mistakenly attacks healthy cells in the
Arbovirus
brain. Also known as post-infection encephalitis, secondary
Mosquito-borne viruses. These viruses can cause infections
encephalitis often occurs two to three weeks after the initial
such as West Nile, La Crosse, St. Louis, western equine and
infection
eastern equine encephalitis. Symptoms of an infection might
appear within a few days to a couple of weeks after exposure RISK:
to a mosquito-borne virus. 1. AGE – young, children
Tick-borne viruses. The Powassan virus is carried by ticks and 2. GEOGRAPHICAL AREAS- mosquito borne , southeast Asian
causes encephalitis in the Midwestern United States. 3. SEASON OF THE YEAR - summer
Symptoms usually appear about a week after a bite from an 4. WEAKENED IMMUNE STATE
infected tick.

Prevention
The best way to prevent viral encephalitis is to take
precautions to avoid exposure to viruses that can
cause the disease. Try to:
1. Practice good hygiene. Wash hands frequently and
thoroughly with soap and water, particularly after
using the toilet and before and after meals.
2. Don't share utensils. Don't share tableware and
beverages.
3. Teach your children good habits. Make sure they
practice good hygiene and avoid sharing utensils at
home and school.
4. Get vaccinations. Keep your own and your children's
vaccinations current. Before traveling, talk to your
doctor about recommended vaccinations for different
destinations.
Diagnosis
1.Brain imaging. MRI or CT images can reveal any swelling of
the brain or another condition that might be causing your
symptoms, such as a tumor.
2.Spinal tap (lumbar puncture). A needle inserted into your
lower back removes a small amount of cerebrospinal fluid
(CSF), the protective fluid that surrounds the brain and
spinal column. Changes in this fluid can indicate infection
and inflammation in the brain. Sometimes samples of CSF
can be tested to identify the virus or other infectious agent.
3.Other lab tests. Samples of blood, urine or excretions from
the back of the throat can be tested for viruses or other
infectious agents.
4.Electroencephalogram (EEG). Electrodes affixed to your
scalp record the brain's electrical activity. Certain abnormal
patterns may indicate a diagnosis of encephalitis.
5. Brain biopsy. Rarely, a small sample of brain tissue might
be removed for testing. A brain biopsy is usually done only if
symptoms are worsening and treatments are having no
effect.
Treatment Supportive care
Treatment for mild encephalitis usually consists of: People who are hospitalized with severe encephalitis might
need:
1. Bed rest
1.Breathing assistance, as well as careful monitoring of
2. Plenty of fluids breathing and heart function
3. Anti-inflammatory drugs — such as acetaminophen 2.Intravenous fluids to ensure proper hydration and levels of
(Tylenol, others), ibuprofen (Advil, Motrin IB, others) and essential minerals
naproxen sodium (Aleve) — to relieve headaches and 3.Anti-inflammatory drugs, such as corticosteroids, to reduce
fevers swelling and pressure within the skull
4. Anticonvulsant medications, such as phenytoin (Dilantin), to
Antiviral drugs stop or prevent seizures
Encephalitis caused by certain viruses usually requires antiviral
treatment.

Antiviral medications commonly used to treat encephalitis

include:

1. Acyclovir (Zovirax)
2.Ganciclovir (Cytovene)
3. Foscarnet (Foscavir)