M2-C3-L83 --> Paramyxoviridae - Measles Mumps

Front 1

Paramyxovirus Genome:

- structure?
- envelope?
- # of encoded gene products
- GP structure?

- Defined by?
- Infects?
- Genome
- Replication locale?
- Capsid type?

Back 1

SEES FINCH

- Spherical
- Enveloped
- Encodes 6 -10 gene products
- Spikes of GP

- F protein
- Infects vertebrates
- Negative stranded RNA
- Cytoplasmic replication
- Helical capsid

Front 2

PARAMYXOVIRIDAE

- Defined by what structure?
- what is its function?

- list the other important one

Back 2

F peplomer (trimer)
- cell membrane fusion @ neutral pH

HN peplomer (tetramer)

Front 3

PARAMYXOVIRIDAE
GENOME

- Segmented or Not?
- Occurs ONLY as what?

Back 3

NO ON

- NO segmented

- Only occurs as Nucleocapsids

Front 4

List all six of the paramyxoviridae gene products.

Include the function/purpose of each.

Back 4

F - Fusion
(pH independent fusion)

HN - Hemagluttinin-Neuraminidase
(cell attachment)
(HA binds to sialic acid)
(NA cleaves sialic acid)

M - Matrix
(viral architecture/budding)

L - Large Protein
(RNA polymerization, capping, and polyadenylation)

P - Phosphoprotein
(RNA replication/encapsidation)

N - Nucleocapsid
(coats genome forming the Helical Nucleocapsid TEMPLATE)

Front 5

What paramyxoviridae gene products will make the fully functional polymerase complex?

Back 5

L - Large Protein

P - Phosphoprotein

N - Nucleocapsid

Front 6

Measles basics:

- Primary population affected
- how contagious
- transmission
- infectious period

What Population groups are susceptible to serious measles outbreaks with High mortality? x2

Back 6

Childhood disease

VERY contagious

Respiratory droplets

4 days before RASH onset
and
4 days after RASH onset

- Unexposed population
- Endemic populations w/ Inadequate medical care

Front 7

Describe the spread of measles in 3 stemps

Include targets of replication and pathological appearances.

Back 7

Primary Infection: RESPIRATORY TRACT
(replication in trachial/bronchial epithelial cells)
(replication in pulmonary macrophages)

Dissemination to LOCAL LYMPH NODES
(appearance of giant cells -syncytia)
(replication here results VIREMIA)

Dissemination to MULTIPLE ORGANS

Front 8

Measles Progression:

- duration of latent period
- duration of prodrome period
- symptoms of prodrome x5
- what follows prodrome and lasts how long?
- this post-prodrome phase coinsides with what 2 physiological events.

Back 8

10 to 14 days

2 to 3 days
- Fever, Head Cold, Cough
- Conjunctivitis - (Pink eye)
- Koplik's spots

Maculopapular rash
(5 to 6 days)

Rash coincides with
- Immune response
- Initiation of viral clearance

Front 9

Maculopapular rash:

- duration
- onset WHERE
- progresses how
- fades how

Back 9

5 to 6 days

Hairline, then on Face & Neck

Downward and Outward (reaching hands & feet)

Same order as progression:
(Downwards/Outwards from hairline)

Front 10

In measles, when the maculopapular rash first appears, this is associated with what:

- clinical manifestation
- physiological manifestation x2

Once the rash goes away, what type of immunity do you have?

Back 10

Highest Fever ("Sickest")

Coincident with the
- immune response
- initiation of viral clearance

Lifetime immunity

Front 11

What are the Measles associated diseases? x4

Discuss each

Back 11

Gastrointestinal Disease
(diarrhea common)

Eye Disease
(Major concern for corneal lesions AND childhood blindness)

Respiratory Dz
(Pneumonitis)
(Usually TOO MILD to be considered symptomatic)

Myocardial disease
(Asymptomatic, but ~25% have ECG abnormalities)

Front 12

MEASLES
TRANSMISSION

- a person with measles is highly contagious and should take care to avoid what 2 types of people?

Back 12

- Babies younger than 12-15 months
(non-vaccinated)

- Pregnant women
(may cause miscarriage or premature birth)

Front 13

What are the complications of Measles? x6

Death is usually due to?

Back 13

Pregnant Women
(Premature birth, miscarriage)

Otitis (1 in 10)

Pneumonia (1 in 20)

Encephalitis (1 in 1000)

Death (1-2 in 1000)
(usually due by pneumonia)

Front 14

Subacute Sclerosing Pan-Encephalitis (SSPE):

- prevalence
- what is it
- due to what
- average onset
- symptoms x5

Back 14

Rare

Degenerative disease of CNS

Persistent measles infection of brain
(unknown how virus enters CNS)

7 years after measles

BIAS'D
- Behavior deterioration
- Intellectual deterioration
- Ataxia
- Seizures
- Death

Front 15

Atypical Measles:

- due to what
- seen in what population
- symptoms x4
- average onset?

Back 15

Inappropriate (atypical) MEMORY immune response to INACTIVATED VACCINE virus

Those who received measles vaccine in 1960's.

PUSH
- Prolonged & Higher Fever
- Unusual skin lesions
- Severe pneumonitis
- Hemorrhage with skin lesions

16 years after receiving vaccine

Front 16

What lab test is necessary to establish diagnosis of measles?

What different lab tests is NOT recommended

What lab test can be used?
- what requires 1 specimen and when detected?
- what requires 2 specimen and when obtained?

Back 16

NONE - Very characteristic disease so unneeded for diagnosis. Just good HPI.

Isolation of virus (not recommended)

ELISA antibody testing
- For 1 specimen when rash is present, IgM can be found
- For 2 specimen
(1st drawn with rash onset)
(2nd drawn 10-30 days later)
(Test for IgG Ab for EACH specimen at the SAME TIME)
(4 fold increase seen)

Front 17

T/F - If uncertain of diagnosis, isolation of measles from Heparinized blood, Urine, Nasopharynx aspirates, and Throat swabs is recommended.

Back 17

False

This is NOT recommended
Use Antibody testing with ELISA

Front 18

Mumps disease:

- transmission
- incubation
- Progression

Back 18

Respiratory droplets

18 days

Similar to measles
- Upper respiratory tract Mucosa
-> Local lymph nodes
-> Dissemination via viremia to virtually all organ/tissue.

Front 19

Mumps symptoms:

- 33% have what symptoms
- 40-50% have what symptoms? x2

- Prodromal symptoms are usually?
- Prodromal symptoms can include? x5

- Most common (@ 95%) symptom
(any accompanying symptoms?)
(usually unilateral or bilateral)

- What other symptom occurs in 25% of MALES?
(What is a complication of this?)

Symptom Alleviates after?
Symptoms Resolve after?

Back 19

- Asymptomatic

- Nonspecific OR
- Primary Respiratory Symptoms

- Nonspecific Prodrome
(+/- FHM, Myalgia, or Anorexia)

Parotitis (salivary gland swelling)
- Fever usually accompanies
- Bilateral

Orchitis
(25% males, possible sterility, but rare)

Symptoms alleviated in 7 days
Symptoms resolved in 10 days

Front 20

In mumps, discuss the three complications types.

Back 20

CNS involvement
- meningitis
(usually resolve w/o lasting damage in 3-10 days)
- encephalitis
(rare)

Pancreatitis
(rare)

Deafness (rare)
- UNILATERAL
- Permanent
- Sudden onset

Front 21

MUMPS

- Parotitis in Mumps may FIRST be noted as what? x2

- Describe the Deafness seen in Mumps complications. x3

Back 21

Parotitis first indications
- Earache
- Tenderness on palpation @ jaw angle

UPS
- Unilateral
- Permanent loss of hearing
- Sudden onset
-

Front 22

What are the risk factors for CNS complications in mumps patients? x2

Back 22

Adults

Males (3:1)

Front 23

What lab tests are required for Mumps diagnosis?

If Serology,
- IgM reaches a peak when?

- IgG requires how many specimen?

Back 23

None required b/c mumps is very characteristic

Can use SEROLOGY tho:
- Peak @ 1 week after onset
- 2 specimens taken, 4 fold increase is positive

Front 24

MMR indications x3

Back 24

- Susceptible adults/kids WITHOUT documented evidence of immunity

- All infants younger than 12 months old

- Traveling outside the US kids from 6 months to 11 months old
(if a single antigen measles vaccine is NOT available)

Front 25

MMR dosage schedule
- First dose?
- Second dose

- Second dose is theoretically available to give any time, but what is the condition?

Back 25

First at 12 to 15 months

Second at 4 to 6 years old

(Second can be given anytime as long as 28 days after the first dose)

Front 26

Contraindications to MMR. x3

Back 26

LIP

- Life threatening allergies to GNP
(Gelatin)
(Neomycin)
(Prior MMR dose)

- ILL @ the time of schedule shot

- Pregnant women

Front 27

Check MD first if MMR is right for you if x3

Back 27

- Immunosuppressive Dz
(i.e. AIDS/HIV)

- Immunosuppressive Drugs taken
(i.e. - steroids)

- Cancer
(of ANY form)

Front 28

MMR VACCINE

- hot chicks who get MMR should avoid what & for how long?

Back 28

- Avoid pregnancy

- for 4 weeks after MMR

Front 29

Is there a relationship between MMR and Autism?

Back 29

NO

Front 30

MMR VACCINE

- what are the MILD risks possible with MMR? x3

Back 30

FaMouS

- Fever (1 in 6)

- Mild Rash (1 in 20)

- Swelling of glands in cheek/neck
(rare)

Front 31

MMR VACCINE

- what are the MODERATE problem risks with MMR? x3

Back 31

JeTS

- Joint pain & swelling which is Transient
(1 out of 4)
(mostly in teens or adult women)

- Transient Thrombocytopenia
(1 in 30,000)

- Seizure
(1 in 3000)

Front 32

MMR VACCINE

SEVERE problems associated with MMR risks
- which is 1 in a million?
- which are extremely rare & unexplainable
- which one is extremely rare, unexplainable & long term? x3
- which one is extremely rare, unexplainable & permanent?

Back 32

- Serious Allergic Reaction

- Deafness
- Long term Seizure, Coma, Lowered Consciousness
- Permanent Brain damage

Front 33

MMR VACCINE

- why did Measles Epidemic strike the US in 1989-1991?

- what did this epidemic lead to?

Back 33

- many kids not vaccinated or only received one

- Recommendation for all kids getting 2 doses of MMR !!!!!

Front 34

Parainfluenza virus has members in how many of the genera of the paramyxviridae SUBFAMILY?

Back 34

3 genera

Front 35

Parainfluenze virus:

- transmission x2
- infectious dose
- stability
- Major causes of what 3 Dz?
- Second only to RSV in the cause of?
(in what 2 population groups?)

Back 35

Person to person
Large Respiratory droplets

SMALL amount needed

NOT stable at all

CRB
- Croup
- Bronchiolitis
- Pneumonia

- Severe LOWER Respiratory Tract infection
(in INFANTS & Young Children)

Front 36

Top 2 causes of SEVERE Lower respiratory Tract infection in infants and young children

Back 36

1. RSV

2. Parainfluenza virus

Front 37

Parainfluenza virus is one of the major cause of of what three respiratory conditions?

Back 37

Pneumonia
Bronchiolitis
Croup

Front 38

Primary infection of Parainfluenza virus occurs where?

Describe the:
- replication rate
- causes what histo findings x2
- viremia?

Back 38

Upper Respiratory Tract Epithelial cells.

Rapid rate

Giant cell formation
Cell lysis

RARE viremia

Front 39

Virus will typically stay where?

What are the symptoms of such?

Prognosis?

Back 39

Stay in Upper Respiratory Tract

Common cold symptoms

Resolves in 48 hours

Front 40

What does the virus migrate to in the 25% of reported cases?

- what severe symptom may result as such (in 2-3% of cases)

- what about in the elderly?

Back 40

Spread to LOWER respiratory Tract

- Severe Croup

- Pneumonia in elderly

Front 41

Infection with parainfluenza virus elicits what type of immunity?

What symptom type would a reinfection cause?

Back 41

NOT long term.
Elicits Partial immunity

Milder symptoms
(suggests partial immunity)

Front 42

What is the vaccine for Parainfluenza virus?

Back 42

There is none

Front 43

Respiratory Syncitial Virus is the number 1 cause of what? x3

Back 43

Under the age of 1:
- BronchIOLITIS
- PNEUMONIA
- Fatal Acute Respiratory Tract infection

Front 44

Respiratory Syncytial Virus:

- how infectious
- common symptoms
- what population groups have severe infections? x2

Back 44

HIGHLY infectious
(50-100% susceptibility)

Usually URTI that is MINOR

- immunocompromised
- elderly

Front 45

Respiratory Syncytial Virus:

- transmission x2
- incubation
- route x2
- spreads along what tissue and how?

Back 45

Respiratory droplets
Contaminated Fomites

3-6 days

Eye and Nose (RARELY mouth)

- spread along epithelium
- of repiratory tract
- via cell-cell spread

Front 46

As the respiratory syncytial virus travels down to lower respiratory tract, what conditions can arise? x2

Can this cause viremia?

Back 46

bronchiOLitis
pneumonia

very RARE

Front 47

Describe the symptoms of primary infection with Respiratory Syncytial Virus?

Describe the duration of these symptoms.

How do INFANTS usually present with RSV?

Back 47

SYMPTOMATIC
but varies from mild to severe

duration also varies

- Febrile URTI with LRT involvement over next several days

Front 48

After primary infection with respiratory syncytial virus, describe the progression.

Back 48

Worsening cough

-> Tachypnea + Dyspnea

Front 49

In severe cases of Respiratory Syncytial Virus, what two conditions can occur?

Back 49

Deficient Oxygenation of blood
(Cyanosis & Hypoxaemia)

Front 50

T/F - It is clinically simple to differentiate between bronchiolitis and pneumonia.

What is one way you can observe difference?

Back 50

False. Very difficult

Bronchiolitis may cause elevation of respiratory rate.

Front 51

The course of Dz lasts how long?

For infants, what is the usual prognosis with RSV?

Back 51

Whole course of Dz lasts several weeks

Improvement in 3 to 4 days
AFTER
onset
of
Lower Respiratory Tract Dz

Front 52

For respiratory syncytial virus, what are the 2 complications?

Back 52

- Apnea

- Lower Respiratory Dz

Front 53

For Respiratory Syncytial Virus, APNEA complications tends to be __________.

This complication may occur when?

RSV complication of Apnea is most likely to occur with what population group?

Back 53

Non-obstructive

at the onset, thus may be the initial sign of infection

PRE-mature infants

Front 54

Complications of apnea associated with Respiratory Syncitial virus may be the sign of what?

To what population group would this complication most likely occur in?

Back 54

Initial sign of infection

Premature infants with gestation of 8 months or less.

Front 55

Respiratory Syncytial Virus Complication of Lower Respiratory Tract Dz may lead to another complication of what Dz

when would this secondary complication Dz occur?

These children may present with what? x2

Back 55

Chronic lung disease

- later in life

Recurrent lower respiratory tract WHEEZING and disease.

Front 56

What are the treatment options for Respiratory Syncytial Virus? x3

Back 56

(RAS for RSV)

Supporative

Ribavirin

Anti-RSV Immunoglobulins
(Respigam)

Front 57

For respiratory syncytial virus, what is Ribavirin?

Given to whom? x2

Back 57

Broad spectrum antiviral

Premature infants
Immnuocompromised

Front 58

For respiratory syncytial virus, what is Respigam?

What does it do & NOT do?

Given to whom? x2

Back 58

Anti-RSV immunoglobulin

Does NOT PREVENT RSV infection, but PROTECTS from the consequence of RSV.

Premature infants
Children under 24 months with BRONCHOPULMONARY DYSPLASIA

Front 59

What is the vaccine for Respiratory Syncytial Virus?

What is included in the supportive Tx? x3

Back 59

There is none

- O2
- IV fluids
- Nebulized Cold steam

Front 60

Henipah viruses:

- Natural Host
- Virus names
- genetic homology with each other and other paramyxoviridae

Back 60

Fruit Bats

Hendra and Nipah virus

High genetic homology
Limited homology with others in paramyxoviridae family.

Front 61

Why is Hendra and Nipah and Biosafety Level 4 agent? x2

Back 61

High mortality rate in humans

Broad spectrum of hosts to infect

Front 62

T/F - Antigenic cross-reactivity ability occurs with all members of the Henipah viruses.

Back 62

True

Front 63

What are some unique characters of henipah viruses that separate it from the rest of the paramyxoviridae family, thus allowing them their own Genus? x3

Genetic homology
- with each other?
- with other viruses of Paramyxoviridae

Back 63

BAG
- Broad host range
- Antigenic Cross reactivity to each other
- Genomic features that are unique

- High genetic homology w/ each other
- Limited identity with other Paramyxoviridae members

Front 64

Hendra virus:
- Associated zoonotic with what animal? from where?

Has killed 2 people.
- 1st one died with?
- 2nd one died with?

Back 64

Horses (from Australia)

- Severe Respiratory Illness
- Viral encephalitis
(2nd dude assisted in necropsy of 2 horses that died in initial outbreak)

Front 65

HENDRA & NIPAH VIRUSES

- Natural Host?

- Currently classified as Biosafety Level agents at what level?

- High Biosafety Agent level because of? x2

Back 65

- Fruit bats

- Biosafety Level 4 agents

- High mortality rate in humans
- Ability to infect different hosts.

Front 66

Nipah virus:
- Associated zoonotic with what animal? from where?
- What Dz in humans? x2

- Describe mortality rate

- Has outbreaks occured in US?
- What is the mortality rate in US with Nipah?

Back 66

Pigs (from Malaysia)

Severe Respiratory Illness
Encephalitis

High Mortality
(105 out of 265)

- Outbreaks in US almost EVERY year
- Mortality approaching 75%

Front 67

Newcastle Disease virus (NDV):

- affects primary what animal? to what severity?

- can it affect humans? to what severity?

Back 67

Birds -> fatal

Yes humans -> only MILD

Front 68

In humans, Newcastle Disease Virus (NDV) replicates best in which human cells?

Back 68

Human Cancer cells

Front 69

What is the problem with trying to infect CA patients with a LYTIC strain of NDV?

Back 69

Patient's Ab response

Front 70

What is an oncolysate?

Back 70

Extracts of CA cells infected with lytic viruses

(used as anticancer vaccines)

Front 71

What are three potential therapies proposed for Newcastle Disease virus due to its potential for anticancer therapy?

Back 71

1. Infect patients with lytic NDV strain

2. Oncolysates - Use fragments of cancer cells infected with lytic NDV viruses as a vaccine

3. Use intact cancer cells infected with a NONlytic strain of NDV as a anticancer WHOLE-CELL vaccine.

Front 72

What is the rationale behind the Newcastle Disease Virus anti-cancer VACCINES?

Back 72

Tumor-specific antigens may be BETTER recognized by the immune system is they are ASSOCIATED with virus antigens.

Front 73

What are the two subfamilies of paramyxoviridae?

Back 73

Paramyxovirinae

Pneumovirinae

Front 74

Measles (subfamily, genus)

Mumps (subfamily, genus)

Back 74

Paramyxovirinae, Morbillivirus

Paramyxovirinae, Rubulavirus

Front 75

Parainfluenza virus (subfamily, genus) 2 of 3

Back 75

Paramyxovirinae, Rubulavirus

Paramyxovirinae, Respirovirus

Front 76

Newcastle Disease Virus
(subfamily, genus)

Back 76

Paramyxovirinae, Avulavirus

Front 77

Hendra virus + Nipah virus
(subfamily, genus)

Back 77

Paramyxovirinae, Henipavirus

Front 78

Respiratory Syncytial Virus
(subfamily, genus)

Back 78

Pneumovirinae, Pneumovirus

Front 79

List two genus members of the Pneumovirinae subfamily.

Back 79

Pneumovirus (RSV)
Metapneumovirus