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79 Cards in this Set

  • Front
  • Back
Paramyxovirus Genome:

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

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

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

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

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

- list the other important one
F peplomer (trimer)
- cell membrane fusion @ neutral pH

HN peplomer (tetramer)

- Segmented or Not?
- Occurs ONLY as what?

- NO segmented

- Only occurs as Nucleocapsids
List all six of the paramyxoviridae gene products.

Include the function/purpose of each.
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)
What paramyxoviridae gene products will make the fully functional polymerase complex?
L - Large Protein

P - Phosphoprotein

N - Nucleocapsid
Measles basics:

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

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

VERY contagious

Respiratory droplets

4 days before RASH onset
4 days after RASH onset

- Unexposed population
- Endemic populations w/ Inadequate medical care
Describe the spread of measles in 3 stemps

Include targets of replication and pathological appearances.
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
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.
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
Maculopapular rash:

- duration
- onset WHERE
- progresses how
- fades how
5 to 6 days

Hairline, then on Face & Neck

Downward and Outward (reaching hands & feet)

Same order as progression:
(Downwards/Outwards from hairline)
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?
Highest Fever ("Sickest")

Coincident with the
- immune response
- initiation of viral clearance

Lifetime immunity
What are the Measles associated diseases? x4

Discuss each
Gastrointestinal Disease
(diarrhea common)

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

Respiratory Dz
(Usually TOO MILD to be considered symptomatic)

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

- a person with measles is highly contagious and should take care to avoid what 2 types of people?
- Babies younger than 12-15 months

- Pregnant women
(may cause miscarriage or premature birth)
What are the complications of Measles? x6

Death is usually due to?
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)
Subacute Sclerosing Pan-Encephalitis (SSPE):

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

Degenerative disease of CNS

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

7 years after measles

- Behavior deterioration
- Intellectual deterioration
- Ataxia
- Seizures
- Death
Atypical Measles:

- due to what
- seen in what population
- symptoms x4
- average onset?
Inappropriate (atypical) MEMORY immune response to INACTIVATED VACCINE virus

Those who received measles vaccine in 1960's.

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

16 years after receiving vaccine
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?
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)
T/F - If uncertain of diagnosis, isolation of measles from Heparinized blood, Urine, Nasopharynx aspirates, and Throat swabs is recommended.

This is NOT recommended
Use Antibody testing with ELISA
Mumps disease:

- transmission
- incubation
- Progression
Respiratory droplets

18 days

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

- Nonspecific OR
- Primary Respiratory Symptoms

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

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

(25% males, possible sterility, but rare)

Symptoms alleviated in 7 days
Symptoms resolved in 10 days
In mumps, discuss the three complications types.
CNS involvement
- meningitis
(usually resolve w/o lasting damage in 3-10 days)
- encephalitis


Deafness (rare)
- Permanent
- Sudden onset

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

- Describe the Deafness seen in Mumps complications. x3
Parotitis first indications
- Earache
- Tenderness on palpation @ jaw angle

- Unilateral
- Permanent loss of hearing
- Sudden onset
What are the risk factors for CNS complications in mumps patients? x2

Males (3:1)
What lab tests are required for Mumps diagnosis?

If Serology,
- IgM reaches a peak when?

- IgG requires how many specimen?
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
MMR indications x3
- 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)
MMR dosage schedule
- First dose?
- Second dose

- Second dose is theoretically available to give any time, but what is the condition?
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)
Contraindications to MMR. x3

- Life threatening allergies to GNP
(Prior MMR dose)

- ILL @ the time of schedule shot

- Pregnant women
Check MD first if MMR is right for you if x3
- Immunosuppressive Dz
(i.e. AIDS/HIV)

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

- Cancer
(of ANY form)

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

- for 4 weeks after MMR
Is there a relationship between MMR and Autism?

- what are the MILD risks possible with MMR? x3

- Fever (1 in 6)

- Mild Rash (1 in 20)

- Swelling of glands in cheek/neck

- what are the MODERATE problem risks with MMR? x3

- 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)

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?
- Serious Allergic Reaction

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

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

- what did this epidemic lead to?
- many kids not vaccinated or only received one

- Recommendation for all kids getting 2 doses of MMR !!!!!
Parainfluenza virus has members in how many of the genera of the paramyxviridae SUBFAMILY?
3 genera
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?)
Person to person
Large Respiratory droplets

SMALL amount needed

NOT stable at all

- Croup
- Bronchiolitis
- Pneumonia

- Severe LOWER Respiratory Tract infection
(in INFANTS & Young Children)
Top 2 causes of SEVERE Lower respiratory Tract infection in infants and young children
1. RSV

2. Parainfluenza virus
Parainfluenza virus is one of the major cause of of what three respiratory conditions?
Primary infection of Parainfluenza virus occurs where?

Describe the:
- replication rate
- causes what histo findings x2
- viremia?
Upper Respiratory Tract Epithelial cells.

Rapid rate

Giant cell formation
Cell lysis

RARE viremia
Virus will typically stay where?

What are the symptoms of such?

Stay in Upper Respiratory Tract

Common cold symptoms

Resolves in 48 hours
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?
Spread to LOWER respiratory Tract

- Severe Croup

- Pneumonia in elderly
Infection with parainfluenza virus elicits what type of immunity?

What symptom type would a reinfection cause?
NOT long term.
Elicits Partial immunity

Milder symptoms
(suggests partial immunity)
What is the vaccine for Parainfluenza virus?
There is none
Respiratory Syncitial Virus is the number 1 cause of what? x3
Under the age of 1:
- Fatal Acute Respiratory Tract infection
Respiratory Syncytial Virus:

- how infectious
- common symptoms
- what population groups have severe infections? x2
HIGHLY infectious
(50-100% susceptibility)

Usually URTI that is MINOR

- immunocompromised
- elderly
Respiratory Syncytial Virus:

- transmission x2
- incubation
- route x2
- spreads along what tissue and how?
Respiratory droplets
Contaminated Fomites

3-6 days

Eye and Nose (RARELY mouth)

- spread along epithelium
- of repiratory tract
- via cell-cell spread
As the respiratory syncytial virus travels down to lower respiratory tract, what conditions can arise? x2

Can this cause viremia?

very RARE
Describe the symptoms of primary infection with Respiratory Syncytial Virus?

Describe the duration of these symptoms.

How do INFANTS usually present with RSV?
but varies from mild to severe

duration also varies

- Febrile URTI with LRT involvement over next several days
After primary infection with respiratory syncytial virus, describe the progression.
Worsening cough

-> Tachypnea + Dyspnea
In severe cases of Respiratory Syncytial Virus, what two conditions can occur?
Deficient Oxygenation of blood
(Cyanosis & Hypoxaemia)
T/F - It is clinically simple to differentiate between bronchiolitis and pneumonia.

What is one way you can observe difference?
False. Very difficult

Bronchiolitis may cause elevation of respiratory rate.
The course of Dz lasts how long?

For infants, what is the usual prognosis with RSV?
Whole course of Dz lasts several weeks

Improvement in 3 to 4 days
Lower Respiratory Tract Dz
For respiratory syncytial virus, what are the 2 complications?
- Apnea

- Lower Respiratory Dz
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?

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

PRE-mature infants
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?
Initial sign of infection

Premature infants with gestation of 8 months or less.
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
Chronic lung disease

- later in life

Recurrent lower respiratory tract WHEEZING and disease.
What are the treatment options for Respiratory Syncytial Virus? x3
(RAS for RSV)



Anti-RSV Immunoglobulins
For respiratory syncytial virus, what is Ribavirin?

Given to whom? x2
Broad spectrum antiviral

Premature infants
For respiratory syncytial virus, what is Respigam?

What does it do & NOT do?

Given to whom? x2
Anti-RSV immunoglobulin

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

Premature infants
Children under 24 months with BRONCHOPULMONARY DYSPLASIA
What is the vaccine for Respiratory Syncytial Virus?

What is included in the supportive Tx? x3
There is none

- O2
- IV fluids
- Nebulized Cold steam
Henipah viruses:

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

Hendra and Nipah virus

High genetic homology
Limited homology with others in paramyxoviridae family.
Why is Hendra and Nipah and Biosafety Level 4 agent? x2
High mortality rate in humans

Broad spectrum of hosts to infect
T/F - Antigenic cross-reactivity ability occurs with all members of the Henipah viruses.
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
- 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
Hendra virus:
- Associated zoonotic with what animal? from where?

Has killed 2 people.
- 1st one died with?
- 2nd one died with?
Horses (from Australia)

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

- Natural Host?

- Currently classified as Biosafety Level agents at what level?

- High Biosafety Agent level because of? x2
- Fruit bats

- Biosafety Level 4 agents

- High mortality rate in humans
- Ability to infect different hosts.
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?
Pigs (from Malaysia)

Severe Respiratory Illness

High Mortality
(105 out of 265)

- Outbreaks in US almost EVERY year
- Mortality approaching 75%
Newcastle Disease virus (NDV):

- affects primary what animal? to what severity?

- can it affect humans? to what severity?
Birds -> fatal

Yes humans -> only MILD
In humans, Newcastle Disease Virus (NDV) replicates best in which human cells?
Human Cancer cells
What is the problem with trying to infect CA patients with a LYTIC strain of NDV?
Patient's Ab response
What is an oncolysate?
Extracts of CA cells infected with lytic viruses

(used as anticancer vaccines)
What are three potential therapies proposed for Newcastle Disease virus due to its potential for anticancer therapy?
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.
What is the rationale behind the Newcastle Disease Virus anti-cancer VACCINES?
Tumor-specific antigens may be BETTER recognized by the immune system is they are ASSOCIATED with virus antigens.
What are the two subfamilies of paramyxoviridae?

Measles (subfamily, genus)

Mumps (subfamily, genus)
Paramyxovirinae, Morbillivirus

Paramyxovirinae, Rubulavirus
Parainfluenza virus (subfamily, genus) 2 of 3
Paramyxovirinae, Rubulavirus

Paramyxovirinae, Respirovirus
Newcastle Disease Virus
(subfamily, genus)
Paramyxovirinae, Avulavirus
Hendra virus + Nipah virus
(subfamily, genus)
Paramyxovirinae, Henipavirus
Respiratory Syncytial Virus
(subfamily, genus)
Pneumovirinae, Pneumovirus
List two genus members of the Pneumovirinae subfamily.
Pneumovirus (RSV)