VIRAL INFECTIONS OF THE

RESPIRATORY TRACT
 VIRAL INFECTIONS OF THE
RESPIRATORY TRACT

• Influenza virus • Parainfluenza viruses

• Rhinovirus • Respiratory Syncytial
• Coronavirus viruses
• Adenovirus
• Coxsackievirus
INFLUENZA VIRUSES
 INFLUENZA VIRUSES
Orthomyxovirus: myxo (viruses interact with mucin (glycoproteins))

ORTHOMYXOVIRUS PARAMYXOVIRUS

RNA genome Segmented Single piece

diameter Smaller (80-120 nm) Larger (150 nm)

Hemagglutinin (H) and

On different spikes On the same one
neuraminidase (N)

Giant cell formation No Yes

 DISEASE
• Influenza A virus cause
– worldwide epidemics (pandemic)
– major outbreaks of influenza
• occurs virtually every year.

• Influenza B virus cause

– major outbreaks of influenza
 VIRUS
• Segmented (8 segments in types A & B, 7 in type C) ssRNA
genome

• Helical nucleocapsid

• Outer lipoprotein envelope

– The envelope is covered with two different types of spikes,
hemagglutinin and a neuraminidase.
– Hemagglutinin binds cell surface receptor, to initiate infection.
– Neuraminidase releases progeny virus from infected cells.

• The internal ribonucleoprotein is the group specific antigen that

distinguishes influenza A, B and C.
 ORTHOMYXOVIRUSES
HA - hemagglutinin

NA - neuraminidase

helical nucleocapsid (RNA plus

NP protein)

lipid bilayer membrane

polymerase complex

M1 protein

Type A, B, C : NP, M1 protein

Sub-types: HA or NA protein
 ANTIGENIC CHANGES
• Influenza viruses especially type A show changes in
antigenicity of hemagglutinin (H) and neuraminidase (N)
proteins.

• Antigenic shifts:
– major changes based on the reassortment of RNA
segments. It occurs only with influenza A.
– Other theories of antigenic shift includes:
• Recirculation of existing subtypes
• Gradual adaptation of animal viruses to human transmission

• Antigenic drifts:
– minor changes based on mutations in the RNA genome.
• Animal viruses (aquatic birds, chicken,
swine) are the source of RNA segments
that encode antigenic shift variants.

• Because influenza B virus is only a human

virus, there is no animal source of new
RNA segments. Influenza B virus shows
only antigenic drift, but not shift.
 Reassortment

A
v
ia
nH
3 H
u
ma
nH
2

H
u
ma
nH
3
 A / PHILIPPINES / 82 (H3N2)

• A group antigen of influenza A

• Philippines / 82 location and year the virus isolated

• H3N2 Hemagglutinin and Neuraminidase types

• H1N1 and H3N2 strains of influenza A are the most common

types at this time and are the strains included in the current
vaccine.
 Past Antigenic Shifts

1918 H1N1 “Spanish Influenza” 20-40 million

deaths
1957 H2N2 “Asian Flu” 1-2 million deaths
1968 H3N2 “Hong Kong Flu” 700,000 deaths
1977 H1N1 Re-emergence No
pandemic

 At least 15 HA subtypes and 9 NA subtypes occur in

nature. Up until 1997, only viruses of H1, H2, and H3
are known to infect and cause disease in humans.
 • TRANSMISSION
– Airborne respiratory droplets

• EPIDEMIOLOGY
– Winter months
 CLINICAL FINDINGS

• Incubation period 24 – 48 hours

• Fever, myalgias, headache, dry cough,

photophobia, shivering

• Resolve spontaneously in 4 – 7 days. Influenza B

is similar to A, but influenza C is usually
subclinical or milder in nature.
 COMPLICATIONS
• Tracheobronchitis and bronchiolitis
• Primary viral pneumonia
• Secondary bacterial pneumonia
– usually occurs late in the course of disease, after a period of
improvement has been observed for the acute disease. S. aureus
is most commonly involved although S. pneumoniae and H.
influenzae may be found.
• Myositis and myoglobinuria
• Reye's syndrome
– Reye's syndrome is characterized by encephalopathy and fatty
liver degeneration. It occurs in children with viral infection and are
taken aspirin to reduce fever. The disease had been associated
with several viruses; such as influenza A and B, Coxsackie B5,
echovirus, HSV, VZV, CMV and adenovirus.
 LABORATORY DIAGNOSIS
• Virus Isolation
– Throat swabs, NPA and nasal washings may be used for virus
isolation. It is reported that nasal washings are the best
specimens for virus isolation. Influenza viruses isolated from
embryonated eggs or tissue culture can be identified by
serological or molecular methods.

• Rapid Diagnosis by Immunoflurescence

– cells from pathological specimens may be examined for the
presence of influenza A and B antigens by indirect
immunofluorescence.

• Serology
– Demonstration of a rise in serum antibody to the infecting virus
 TREATMENT
• Amantidine
• The only effective against influenza A.
• Act at the level of virus uncoating.
• Both therapeutic and prophylactic effects.
• Significantly reduces the duration of fever (51
hours as opposed to 74 hours) and illness.
• 70% protection against influenza A when given
prophylactically.
• Rimantadine is an amantadine derivative but not
as effective as amantadine and less toxic.
 PREVENTION
• Vaccine
• killed influenza A (HINI and H3N2 isolates) and B viruses
• Protection lasts only 6 months
• Yearly boosters are recommended
• Should be given to people
– Older than 65 years
– With chronic respiratory diseases
– With chronic cardiovascular diseases.
• Immunity to Influenza
– Antibody against hemagglutinin (H) is the most important
component in the protection against influenza viruses.
 AVIAN INFLUENZA

• Avian influenza A viruses usually do not infect humans

• Rare cases of human infection with avian influenza viruses have

been reported since 1997 with avian influenza A (H5N1)
H5N1 viruses

• All strains of the infecting virus were totally avian in origin and there
was no evidence of reassortment.

• Infection in humans are thought to have resulted from direct

contact with infected poultry or contaminated surfaces.

• To date, human infections with avian influenza A viruses have not

resulted in sustained human-to-human transmission.
PICORNAVIRUSES
 PICORNAVIRUSES
• Small (20 – 30 nm) non–enveloped viruses, with icosahedral
nucleocapsid and ssRNA genome with positive polarity.
• Includes two groups:
• Enteroviruses
– Enteroviruses include poliovirus, coxsackieviruses, echovirus
and hepatitis A virus.
– replicate optimally at 37 ºC
– Enteroviruses are stable under acid conditions (pH 3 – 5)
• Rhinoviruses
– Rhinoviruses grow better at 33 ºC in accordance with the lower
temperature of the nose.
– Rhinoviruses are acid – labile.
RHINOVIRUSES
 RHINOVIRUSES
• Common cold accounts for 1/3 to 1/2 of all acute
respiratory infections in humans.
• Rhinoviruses are responsible for 50% of common
colds, coronaviruses for 10%, adenoviruses,
enteroviruses, RSV, influenza, parainfluenza can
also cause common cold symptoms
indistinguishable form those caused by
rhinoviruses and coronaviruses.
• Common cold is a self-limited illness.
• More than 100 serologic types of rhinoviruses (No
vaccine)
 TRANSMISSION
• Directly from person to person via respiratory
droplets
• Indirectly in which droplets are deposited on the
hands or on a surface such as table and then
transported by fingers to the nose or eyes.
• An individual may suffer 2 to 5 episodes of colds
per year. The primary site of rhinovirus infection
is in the nasal epithelium. Rhinoviruses rarely
cause lower respiratory infection.
CLINICAL FINDINGS
• Incubation period: 2 – 4 days

• Sneezing
• Nasal discharge
• Nasal obstruction
• Sore throat
• Cough
• Headache
• Lasts for 1 week
 COMPLICATIONS
• Acute bacterial sinusitis
– The major causes are Pneumococcus, Hemophilus
influenza, Moraxella, and Staphylococci.

• Acute bacterial otitis media

– mainly a problem in children

• Asthma attacks in children

• Exacerbation of chronic bronchitis

 LABORATORY DIAGNOSIS

• Usually, common cold does not require

laboratory investigation

• Cell culture isolation from nasal secretion

 TREATMENT

• Cold treatments recommended include the

following:
– Antihistamines
– Nonsteroidal antinflammatory drugs
– Decongestants (vasoconstrictors)
– Cough suppressants (narcotics)
CORONAVIRUSES
 CORONAVIRUSES
• The group was so named because of the
crown-like projections on its surface.

• At present, at least 10 species are

recognized, of which human coronavirus is
one. The other viruses are found in
animals.
 PROPERTIES
• ssRNA enveloped viruses of pleomorphic
morphology
• 60 to 220nm in diameter.
• Positive stranded RNA; helical symmetry
• Three antigenic molecules are found in the virions
i.e. nucleocapsid, surface projection and
transmembrane proteins. The main antigenic
determinants reside on the surface projections.
• Human coronavirus strains fall into serological
groups, which are named OC43, and 229E.
 EPIDEMIOLOGY
• Human coronavirus infections occur during
the winter and early spring.
• High infection rates during the year are
caused by either 229E or OC43 group
viruses. This pattern is observed
throughout the world.
• Human coronaviruses are responsible for
10 - 30% of all common colds.
DIAGNOSIS AND TREATMENT
• Laboratory diagnosis is not attempted.

• Coronaviruses have fastidious growth

requirement in cell culture.

• No antiviral drugs against coronaviruses

are available.
 OTHER CAUSES OF COMMON
COLD SYNDROME
• Coxsackievirus
– Herpangina (severe sore throat with vesiculoulcerative
lesions)
– Pleurisy
– common cold syndrome
• Adenovirus
– Pharyngitis
– common cold syndrome
– Bronchitis
– pneumonia (types 3, 4, 7 and 21)
• Influenza C