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Influenza Virus. Micro401 Case Study #5 Alvaro Gomez Sheila Laqui Jensen Lau November 8, 2007. Case Study #5 - Influenza. In late December a 22 year old man suddenly experienced flu-like symptoms. Initial Symptoms Later Symptoms. Headache Myalgia Malaise Dry Cough

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influenza virus

Influenza Virus

Micro401 Case Study #5

Alvaro Gomez

Sheila Laqui

Jensen Lau

November 8, 2007

case study 5 influenza
Case Study #5 - Influenza

In late December a 22 year old man suddenly experienced flu-like symptoms.

Initial Symptoms Later Symptoms

  • Headache
  • Myalgia
  • Malaise
  • Dry Cough
  • Fever
  • Worsened Cough
  • Nausea
  • Vomiting

His family had experienced similar symptoms two weeks prior.

influenza virus background
Influenza virus Background
  • (-)ss RNA virus
  • Orthomyxoviridae family
  • Influenza A & B are Endemic - Winter,

peaks Dec - Jan

Mc Queen Nancy, micro 401, Lect 5

differential diagnosis
Differential Diagnosis

Other Flu-Like Symptoms

  • Respiratory Syncytial Virus (RSV)
  • Meningitis
  • Pneumonia
  • Adenovirus
  • Parainfluenza

www.cdc.gov

molecular lab tests
Molecular Lab Tests
  • Viral Culture
  • Immunofluorescence (IF)
  • Enzyme Immunoassay (EIA)
  • Real-Time PCR (RT-PCR)
  • Hemagglutination inhibition (HI)

Ellis, J, S. Rev, Med. Virol. Vol 12, 375-389 2002

lab tests viral culture
Lab Tests - Viral Culture

Advantages Disadvantages

  • Requires Infectious Virus
  • Highly Skilled Technicians
  • Time (3-7days)
  • Cost
  • Whole Virus Measured
  • Virus recoverable
lab tests if
Lab Tests - IF

Advantages Disadvantages

  • Time (2h-1day)
  • Requires Intact Cells
  • Highly Skilled
  • Specialized equip.
  • Cost
lab tests eia
Lab Tests - EIA

Advantages Disadvantages

  • No Virus Recoverable
  • Time (15min-1day)
  • High Throughput
  • Low-Skill
lab tests rt pcr
Lab Tests - RT-PCR

Advantages Disadvantages

  • Highly Skilled
  • Specialized Equip.
  • Cost
  • Sensitive
  • Allows Further Molecular Analysis
  • High Throughput
  • Time (1-2days)
lab tests hi
Lab Tests - HI

Advantages Disadvantages

  • Retrospective
  • Paired Samples Needed
  • High Throughput
  • Sensitive
  • Specific
  • Time (2 days)
  • Cost
tissue test
Tissue Test
  • Nasopharyngeal (Swab or Aspirate)
  • Bronchoalveolar Lavage
  • Serum (HI)
  • Chest Radiography (Pneumonia)
  • Lumbar Puncture (Meningitis)
final diagnosis
Final Diagnosis
  • Viral Culture (6 days results)
  • IF (1 day)
  • EIA (1 day)
  • Lumbar Puncture negative for Meningitis
  • X-ray scan negative for Pneumonia
  • Patient’s results came back positive for Influenza B antigens
anti influenza drugs
Amantadine

Pre-exposure prophylaxis & treatment of influenza A

Blocks M2 proton channel

Necessary for uncoating

Influenza resistance detected in 2005

Anti-Influenza Drugs

Zhuang, Xiaowei. “Zhuang Group – Cell Entry Project.” Cellular entry of viruses and non-viral gene delivery vectors. 18 October 2007. Harvard University. 6 November 2007. <http://zhuang.harvard.edu/cellentry.html>.

Bright, Rick, et. al. Adamantane Resistance Among Influenza A Viruses Isolated Early During the 2005-2006 Influenza Season in the United States. The Journal of the American Medical Association. 2006;295:(doi:10.1001/jama.295.8.joc60020). 6 November 2007. <jama.ama-assn.org/cgi/content/full/295.8.joc60020v1>.

Dimmock, N.J., et. al. Introduction to Modern Virology – 6th ed. Blackwell Publishing. Malden, MA. 2007.

anti influenza drugs14
Anti-Influenza Drugs
  • NA Inhibitors
    • Zanamivir (Relenza®) & Oseltamivir (Tamiflu®)
      • Pre-exposure prophylaxis & treatment of influenza A & B

“Flu Wiki.” Neuraminidase Inhibitors. 19 December 2006. Melanie Matson. 6 November 2007. <http://www.fluwikie.com/pmwiki.php?n=Consequences.NeuraminidaseInhibitors>.

Fiore, Anthony, et. al. “Morbidity and Mortality Weekly Report.” Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. 13 July 2007. Centers for Disease Control and Prevention. 1 November 2007. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm>.

slide15
Spread through large particle respiratory droplets & airborne transmission

Incubation period 1-4 days

Adults infectious up to 5 days after illness onset

Children infectious up to 10 days after illness onset

People at Risk

People 65 years or older

Children in general

Adults & children with chronic heart or lung diseases, diabetes, kidney disease or anemia

Immunocompromised individuals

Transmission of Influenza

Fiore, Anthony, et. al. “Morbidity and Mortality Weekly Report.” Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. 13 July 2007. Centers for Disease Control and Prevention. 1 November 2007. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm>.

genetic variability
Genetic Variability

Antigenic shift:

Major change in the influenza A virus subtypes 

HA and NA protein changes – population has little immunity for mutant virus

Two Patterns of influenza A:

  • Annual epidemics in most countries
  • Every 10-12 years-extensive pandemics
  • http://virology-online.com/viruses/Influenza.htm

Mc Queen NANCY, micro 401, Lec 5

how does the virus change
How does the virus change?

Antigenic Drift

  • Produces new virus strains not recognized by the body’s immune system
  • Occurs continuously over time
  • This “drift” creates new virus strains that the immune system does not recognize or has little or no resistance for
  • http://virology-online.com/viruses/Influenza.htm

Mc Queen Nancy, micro 401, Lect 5