Emerging & Re-emerging

Viral Diseases

Dr. Nazmin Jahan Sultana

SHMC
Emerging infections
An emerging infectious disease is a one that is caused by
a newly discovered infectious agent.

Re-emerging infections

A re-emerging infectious disease is a one which was

previously controlled but once again has risen to be a
significant health problem.
Some emerging viruses
• SARS-CoV-2
• MERS-CoV
• SARS-CoV
• H1N1 Virus (Swine flu)
• H5NI Virus (Bird flu)
• Hendra Virus
• HIV
• HCV
 Some re-emerging viruses
• Monkeypox • Murberg Virus
• Dengue Virus • Influenza Virus
• Zika Virus • Yellow fever Virus
• Chikungunia Virus • West Nile Virus
• Nipah Virus • Measles Virus
• Ebola Virus
Dengue virus
(breakbone fever)
Structure
Important properties
Arbovirus, enveloped, RNA virus.
Family: Flaviviridae, flavus means yellow.
Occurs in rainy season.
most common insect-borne viral disease in the world.
About 20 million people are infected each year
worldwide.
• RNA components- Internal structure 10 genes (3 structural and 7 non-
structural)
• 3 structural protein genes encoding the nucleocapsid of core protein, a
membrane associated protein(M), an envelope protein(E) and 7 non-structural
(NS) proteins- NS1, NS2A, NS2B, NS3, NS4A, NS4B and NS5.
• NS1- Only NS protein which is soluble and can be detected in circulation and
also shown to interact with the host immune system
• In dengue infection, patients have measurable levels of NS1 protein in the
blood, which are utilized as a diagnostic marker of the infection.
4 serological types( DEN 1, DEN 2, DEN 3, DEN 4).
Cytoplasmic replication.
Tropism: Monocyte, Lymphocyte.
Human are the reservoir, but the jungle cycle involve
monkey.
Ades Aegypti mosquito
Peculiarities of A.aegypti
Day biting mosquito when normally coils, repellents, nets
etc are not used.
Breads in fresh water, lays eggs preferentially in water jars,
discarded containers, coconut shells, old tires etc.
Can transmit the infection vertically.
Tropics and sub-tropics are its favorite zones.
It is an urban vector.
Life cycle
Dengue serotypes
Immunologically distinct but related viruses.
Infection with a particular serotype provokes long
lasting homotypic immunity.
Heterotypic immunity lasted for 2-12 months, after
that patients susceptible to another serotype.
Dengue serotypes
Infection with another serotype increases the chances
of DHF.
Each of the four serotypes is individually found to be
responsible for dengue epidemics and associated with
more severe dengue.
DEN-3 is much more virulent than others.
Importance of serotyping
Important in epidemiological and pathological studies.
A molecular epidemiology of virus serotypes is
important for assessing the relative risk of hemorrhagic
complications in the inhabitants of any given region.
It helps to give early warning about an outbreak/
epidemic.
Pathogenesis of Dengue hemorrhagic fever
(DHF)/Dengue shock syndrome (DSS)

Primary infection with one of the four

serotypes, e.g.- DENV-1

Production of antibody against DENV-1

Reinfection by another serotype, e.g.- DENV-2

Production of large amounts of cross-reacting

antibody against the first serotype (DENV-1)
Two hypothesis
1. The immune complex composed of virus and antibody
activate complements.
2. The antibodies increase the entry of virus into
monocytes and macrophages, with the consequent
liberation of a large amount of cytokines.

Increased vascular permeability Thrombocytopenia

Plasma leakage Disseminate Intravascular

Coagulation (DIC)
Hypovolemia Excessive haemorrhage

Shock

Death
 Clinical course

 Incubation period(3-7 days)

 Febrile phase (2-7 days)
 Critical phase (1-3 days)
marked by defervescence,
leukopenia and
thrombocytopenia.
 Recovery phase(or severe dengue)
May have bradycardia
(Important to avoid fluid overload)
Manifestations of dengue virus infection
Symptoms of dengue/breakbone fever
Laboratory diagnosis
Detection of Dengue Antigen: NS1 antigen (Non-
Structural protein 1)
Detection of Antibody: Dengue IgM /IgG test ( ELISA
or Rapid ICT )
Dengue Virus Isolation: Cell culture
Nucleic Acid Detection: PCR, LAMP, etc
• 3. Hematological: -
• TC – either  or slightly 
• DC – lymphocytes, monocytosis.
• platelet count - <1,00,000
• Haematocrit
• Liver enzyme (ALT)
• Serum billirubin slightly  but not >2
• Serum protein level - 
TOURNIQUET TEST

• Inflate the blood pressure cuff on the upper arm to a point midway
between the systolic and diastolic pressures for 5 minutes.
• A positive test is when 20 or more petechiae per 2.5 cm (1 inch)
square are observed.
• The tourniquet test may be helpful in the early febrile phase (less
than three days) in differentiating dengue from other febrile illness.
CONT….

Detection of Dengue virus antigen

• Dengue NS1 antigen, a highly conserved glycoprotein which is produced

in both membrane-associated and secretion forms, is abundant in the
serum of patients during the early stages of DENV infection.
• It is useful for the diagnosis of acute dengue infections
• NS1 enables detection of the cases early, i.e. in the viremic stage.
CONT….

Detection of Dengue specific IgG, IgM

Primary Infection
IgM antibodies
• Detectable in days 3-5
IgG antibodies
• Low titers at the end of 1st week
• Detectable after several months, and probably even for life
 Interpretation of serological reports
IgM IgG Interpretation

Negative Negative Early stage of infection/not dengue

Negative Positive (low titre) Past dengue infection

Negative Positive (high titre) Secondery dengue infection

Positive Negative Primary dengue infection

Positive Positive (low titre) Recent primary dengue infection

Positive Positive (high titre) Secondery dengue infection

Dengue infection management strategy

Problems in diagnosis.
Poor understanding of its pathogenesis.
Absence of prediction rule for outcome determination.
Lack of affective antiviral drugs and vaccine.
Inefficient vector control.
Problem in prevention
Vaccine
• No animal models
• Pre-existing heterotypic dengue antibody
• Auto antibody production
Vector control
• Reduction in herd immunity
Update on Dengue vaccine (Dengvaxia)
Live, attenuated tetravalent recombinant vaccine.
Should be used only in those who have a laboratory
documented prior infection by dengue virus.
9-45 years in endemic areas.
3 doses (0,6,12).
Experimental infection of mosquitoes with Wolbachia.
MANAGEMENT

DF
• Symptomatic & supportive treatment
• Avoidence of antipyretics/ aspirin (only Paracetamol)
• For vomiting and sweating oral fluids and electrolytes
• Monitoring of patient (PC & HCT)

DHF/DSS
• Early volume replacement by isotonic saline
• Close monitoring for shock.
Prevention
THANK YOU
Corona virus
Properties
Enveloped RNA virus
Crown shaped
7 Coronaviruses cause human diseases
HCoV-229E, HCoV-NL63, HCoV-OC43 and HCoV-HKU1
cause mild respiratory illnesses (e.g., common cold)
Other 3 may cause severe illness, as well as epidemics (and
probably pandemics)
SARS-CoV
MERS-CoV
SARS-CoV-2
Name of the species- SARS-CoV-2
Name of the disease- COVID-19
Natural reservoir- Bat
Intermediate host- Pangolin and other wild animals
Human to human transmission
Respiratory droplet
Fomites
Pathogenesis- Upper/lower RTI
Diagnosis- RT-PCR, Rapid antigen test
Short notes on-
Nipah virus
Ebola virus
Bird flu
Swine flu