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Viral Disease. Slackers Facts by Mike Ori. Disclaimer. The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes.

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Viral disease

Viral Disease

Slackers Facts by Mike Ori


Disclaimer

Disclaimer

The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes.

The document can mostly be used forward and backward. I tried to mark questionable stuff with (?).

If you want it to look pretty, steal some crayons and go to town.

Finally…

If you’re a gunner, buck up and do your own work.


Viral disease

What are the three types in Orthomyxoviruses


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A, B, C


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Seasonal flu is what type?


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Type A


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Describe the genome of orthomyxovirus


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Segmented ssRNA (-)


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To what do H and N refer to


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Hemagglutinin and neuraminidase spikes on the viral surface


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In which portion of the cell orthomyxovirus replicate and why?


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In the nucleus because they cannot prime their RNA strands


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Why is the seasonal flu shot seasonal?


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A new vaccine is required each year because of antigenic drift due to polymerase errors


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Why does bacterial pneumonia often follow influenza?


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The virus causes destruction of ciliated respiratory epithelium in the upper respiratory tract. This degrades the mucociliary elevator and prevents efficient clearance of bacteria.

General immune system down regulation occurs as the influenza infection is controlled.


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What is the basis for the increased virulence seen in H1N1 of swine origin


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Antigenic shift has substantially altered the virus to reduce its antigenic similarity to previous strains and to allow it to replicate in both the upper and lower respiratory tract.


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Why are people over 50 less likely to get sick from H1N1 swine origin.


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An similar pandemic occurred within their lifetime.

They do not have as robust an immune system and cannot generate as much of a cytokine storm


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Why is avian flu H5N1 difficult to get


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Currently the strain’s H antigen interact with sialic acid alpha 2,3 gal receptors which are situated in the lower respiratory tract. Thus it take larger exposures to transmit the disease.


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What would occur if H5N1 reassorts in swine


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Why are swine important intermediates in the assortment of avian and human influenza?


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Swine upper respiratory epithelium contains sialic a2,3 gal and sialic a2,6 gal receptors thus they can be easily coninfected with both human and avian virus. This allows nature to tinker.

Idle goddesses are the devils workshop.


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What will happen if H5N1 reassorts or mutates to efficiently infect both upper and lower respiratory epithelium.


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The potential for significant mortality


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What are the requirements of a pandemic influenza


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New human type A strain

Causing serious illness

Easily spreads person to person


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What diseases are caused by paramyxovirus


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Mumps

Parainfluenza and croup

Rubeola (5 day measles)

Respiratory syncitial virus


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Describe the paramyxovirus spikes


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Combined H and N on single spike (para=next to hence H is para to N)

Fusion (F) protein on second spike


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What is a syncitia and why do they form


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A syncitia is a giant cell that forms by fusion of multiple cells. Paramyxovirus tends to form syncitia through the action of F protein deposited on cell surfaces.


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Distinguish parainfluenza from Respiratory syncitial virus


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Parainfluenza = bronchitis

RSV = bronchiolitis


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Describe RSV epidemiology


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Occurs from the late fall to the spring. Predominantly affects small children < 1 yo.


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Describe RSV immunity


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Immunity is incomplete. Repeated infections occur with lessened severity but its unclear if there is an immune basis.


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RSV diagnosis


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Immunofluorescence of nasal swabs


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RSV prophylaxis


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Injection of monoclonal antibody against factor F is indicated in high risk children


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Its flu if?


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It looks like a cold but also has

Myalgia/arthralgia

Fever


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Adenovirus structure


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Linear dsDNA


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Adenovirus disease


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URI particularly in children


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Adenovirus persistence


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DNA virus can establish latent/carrier state


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What viruses are responsible for the common cold?


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Rhinovirus

Coronavirus

Reovirus


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What is a exanthema?


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Circle the correct answer

Choose wisely grasshopper

A widespread rash

An out of date national anthem.

Last years skirt lengths


Viral disease

List the common exanthem viruses and families


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What is the basis of the vaccine for these diseases


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Combined attenuated vaccine for measles, mumps, and rubella. This avoids a rash of shots.


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Mumps time course


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16 day incubation

7 day clinical disease


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Mumps complications


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Orchitis

Meningitis

Encephalitis


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Rubeola (Measles) time course


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10 day incubation

5 days of rash

Koplik spots 1-2 days prior to exanthema


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Rubeola epidemiology


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Occurs in unimmunized people typically in childhood or teens during the winter and spring.


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What is unique about morbillivirusspikes


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Even though they are paramyxoviridae they lack N activity. Thus they have H and F spikes as opposed to H/N and F typical of other paramyxoviridae.


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What are koplik spots


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Small bluish yellow spots that appear on the oral mucosa in advance of the rubeola rash


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Rubeola complications


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Post infectious encephalitis in near term

SSPE (encephalitis) in 2-10 years


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Rubeola sx


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Progressive rash extending from head to toe.

High fever

Delirium

Photophobia

Conjunctivitis


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Rubella time course


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Incubation period 16 days

Exanthema for 3 days

Contagious -7 to +7 from rash


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Rubella epidemiology


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Occurs in unimmunized people usually in the winter and spring


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Should pregnant women receive MMR vaccine?


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No, MMR is a live vaccine and rubella is a transplacental infective agent. Reversion of rubella to a virulent form could lead to congenital rubella in the child.


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Congenital rubella sx


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Cataracts

Cardiac defects

Reticuloendothelial defects (liver, spleen, thrombocytes)

Mental retardation


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What is the mechanism of spread for MMR?


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All enter the respiratory tract to cause viremia before moving to their tropic tissue


Viral disease

What are the tropic tissues for MMR?


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Mumps – salivary glands, testes, ovary, CNS?

Measles – skin and Lymph nodes?

Rubella – skin and lymph nodes?


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What is agent for ErythemaInfectiosum?


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Parvovirus B19


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Where does the exanthema appear?


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On the face. It has a characteristic slapped face appearance.


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What is the alternative name for ErythemaInfectiosum?


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Fifth disease


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A child presents with a faint rash and convulsions. What is a likely diagnosis?


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Roseolainfantum


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Describe the structure of Enteroviruses


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They are small naked icosahedral virus with ssRNA (+) in picornaviridae

Pico = small

rna = RNA


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What is the transmission path for enterovirus


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Fecal-oral


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Describe the stability of enterovirus


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They are very stable and are resistant to acidic pH, detergents, disinfectants, and alcohol


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Describe the epidemiology of enterovirus


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Summer and fall in temperate climes. Year round in the tropics. Transmitted by direct or indirect fecal-oral contact. Vectors occasionally spread the virus.


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What are the picornaviridae genus?


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Polio

Echo

Rhino

Coxsackie

Hep A

(PERCH)


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What are the three possible outcomes of polio infection


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Abortive poliomyelitis

Aseptic meningitis

Paralytic poliomyelitis


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What is the entry point tissue for polio


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Oropharynx. Resulting viruses swallowed and infect intestines. Then infect CNS


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What vaccines are available for polio


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Salk = killed

Sabin = Attenuated


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Polio diagnostic


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Viral visualization

Ab titer


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What is the potential contagious period for polio


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Intestinal shedding can occur for weeks even in the face of effective immune response


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What is the structure of papillomavirus


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dsDNA circular. Naked icosahedral


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How many genotypes of HPV are known


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70+


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What is the transformation potential of HPV


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It’s a DNA virus and thus can be stabilized in the cell. Higher stain numbers are more oncogenic (?). Malignant strains seem to insert DNA into host genome.


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HPV Transmission Routes


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Occupational exposure (meat packers)

Sexual contact

Public showers/swimming pools (suspected)

Perinatally


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List the diseases associated with common HPV genotypes


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1,2 – common warts

7 – meat handler warts

6,11 – benign genital warts

16,18,31,45 – warty lesions with malignant potential in the nethers


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What percent of females in US are HPV positive?


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20%-60%


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Where does HPV replicate?


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Nucleus – it’s a DNA virus


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How is HPV typically diagnosed in females


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Detected by cytoplasmic vacuolization and nuclear enlargement on routine pap smear


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What is cryotherapy


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Removing HPV infected epithelium with extremely cold substances such are liquid nitrogen


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Describe PML


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Degenerative brain disease that causes focal areas of demyelination surrounded by bizarre astrocytes.


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What is the virus of PML?


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The JC Polyomavirus


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What is a likely comorbidity in PML PT?


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HIV


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A bone marrow transplant patient presents a few weeks after discharge with hemorrhagic cystitis. What is the likely agent


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BK polyomavirus


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What is the tropic tissue for BK virus?


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Kidney


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What are the general sx of arbovirus


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Encephalitis

Hemorrhagic fever


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What is the characteristic of an arbovirus?


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They are all transmitted via insect vectors such as mosquitoes or ticks.


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What is the family for arboviruses involving horses?


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Togavirus


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What commonly togavirus is commonly vaccinated for?


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Rubella


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What is the distribution of western, eastern and St Loius encephalitis


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Western – western us

Eastern – Eastern US

St Louis – central US?


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Describe a typical WEE,EEE victim


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People in association with horses where mosquitoes are present


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What is the age range for St Loius and West Nile Virus


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St Loius > 40

West Nile > 50


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What is the classic distribution for yellow fever


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Caribbean and south and central america


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What is the classic distribution of Dengue


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World wide.

Middle east, far east, Africa, Caribbean


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What is the vector for yellow fever and dengue


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Aedesaegypti


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Describe Yellow Fever SX


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Fever, chills, headache, hemorrhage, jaundice, and shock


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Describe Dengue sx


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Severe back and joint pain, fever, rash.


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What is the reservoir for west nile


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Birds


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What is the vector for west nile?


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Mosquitoes


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West nilesx


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Flu-like, Rash on torso and upper extremities


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Describe the morphology of bunyavirus


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ssRNA (-) , enveloped, spherical, segmented


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California virus family and sx


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Bunyavirus

Encephalitis with seizures

In north central mid west states


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Hantavirus family


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Bunyavirus


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Hantavirus epidemiology


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Direct exposure to rodent feces. Occurs in the southwestern US


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Hantavirus sx and mortality


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Fulminant respiratory disease with > 50% mortality.


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Reovirusarbovirus disease


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Colorado tick fever


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Arenavirus morphology


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Spherical enveloped ssRNA (+/-) segmented


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Arenavirus unique characteristics


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Ambisense (+/-) RNA

Presence of host cell ribosomes within virus


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Filovirus morphology


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Enveloped ssRNA (-)


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Filovirussx


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Hemorrhagic disease


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Famous filovirus diseases


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Marburg and ebola


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What disease is cased by a rhabdovirus


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Rabies


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Rabies virus morphology


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Bullet shaped enveloped helical ssRNA (-)


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What is the initial tx for rabies


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Injection of IgG near bite. Vaccination with killed attenuated virus.


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Describe the timecourse of rabies


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Occurs from 10 days to one year depending on inoculum size


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Classify the final stages of rabies infection


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Prodrom

Acute neurologic phase

Coma

Death


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What is the mortality of rabies


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100%

(only a few exceptions are known)


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What is the furious phase of rabies infection?


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Occurs during the acute neurologic phase. Patients are often aggressive and disoriented


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What is the dumb phase of rabies infection


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Occurs during the acute neurologic phase. Patients are lethargic and paralytic.


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Why isn’t everyone vaccinated against rabies


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The vaccine is a killed attenuated vaccine so people receiving it are double protected form conversion but the protection does not last long so repeated vaccine would be necessary. Rabies is uncommon with proper precautions


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Rotavirus family


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Reoviridae


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Rotavirus structure


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Small wheel shaped ssRNA (+). 1 segments


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What are the segmented virus


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Bunya

Orthomyxo

Arena

Reo

(BOAR)


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What is the epidemiology of rotavirus


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Infection during cooler months in children < 2 years old. Highly contagious and spreads rapidly in institutions and families


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Describe Rotavirus disease


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1-3 day incubation period followed by abrupt onset of vomiting. Subsequent diarrhea lasting 5-8 days. Virus shedding for 2-12 days


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Rotavirus prevention


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Hand washing. Vaccine in development.


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Rotavirus death factors and numbers


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Malnutrition and immunodeficient children

600K die worldwide


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Norwalkvirus family


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Calcivirus


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Calcivirus morphology


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Naked small round ssRNA (+)


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Norwalk disease


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1-2 day incubation

1-2 day vomiting and diarrhea


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Other diarrhea agents


Viral disease

Astrovirus (star shaped naked)

Adenovirus


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