Micro Winter 2 Enterovirus

Front 1

what is encephalitis

what is meningioencephalitis

Back 1

sx indicating extensive brain involvemnet- seizure, visual change, paralysis

combination of findings

Front 2

what was the history of poliomylitis

Back 2

infantile paralysis was rare until 20th century

**b4 water was dirty adn ppl got polio as infants and it was NBG, now with clean water ppl got it later in life and it was a worse outcome

Front 3

what is the problem that comes with the enterovirus polioviurs

Back 3

poliomyelitis- destruction of motor neurons in spinal cord. feared but RARE

*flaccid paralysis
**disease of "civilization" - clean the water onset of disease is delayed and sx are worse

Front 4

whats the dx for poliomylitis

Back 4

fever
asymmetric flaccid paralysis
serology
isolate virus in the poo
PREVENTION is key

**civilization disease

Front 5

whats the structure of poliovirus

whats it like in acid

Back 5

picorna virus, ssrRNA, NO envelope- no lipids

Acid STABLE

similar to rhivivirus- picovir (pleconaril) can be used

3 AG types that cross react

Front 6

wht feature of polio has allowed us to nearly erradicate it

how is it transmitted

Back 6

it ONLY affects humals (sole natural host)
wont live in environment for a long time (?? thought it lived in milk water and food)
vaccination is life long protection


**3 AG types, need immunization against all 3 types
**fecal oral spread or respiratory

Front 7

what is the seasonality of poliovirus

Back 7

summer sutum in temperate zone (swimming pool use)

no peak in tropical regions

**recall this is the one that is structurally (ssRNA, small) similar to rhinivirus and picovir is used

Front 8

why is polioviris persistent

what is the incubation period

what is the infectious period

Back 8

tough! lasts a long time in milk, food, water

1-2 week incubation

most infectious at first week of illness

Front 9

what is the pathogenesis of poliovirus

Back 9

enters GI via M cells, multiplies in pharynx and sm intestine, viremia spread to draining LN

seeds to CNS- infection of ant horn of brain stem--> respiratory paralysis (bulbar form) and motor cortex (rare)

Front 10

where in the CNS does poliovirus do

Back 10

1. Bulbar Form: ant horn of spinal cord, brain stem- respiratory paralysis

2. Motor cortex- rare (paralysis, via dead nerve not destruction of sk mm tissue)

Front 11

T or F

paralysis in polio is due to infection and subsequent death of mm fibers

Back 11

FALSE! its death of neural cells

**virus enters from blood or retrograde axonal flow

**paralysis is asymmetric flaccid
**2-3 days, maximal paralysis with rebound up to 6 weeks

Front 12

what does the bulbar form of polio affect

Back 12

involuntary respiratory mm

Front 13

what is "infantile paralysis" of polio

Back 13

misnomer! infants who get polio do really well! its the older kids who were just using their mm heavily (ie swimming) that get the worse paralysis

**paralysis is maximal 2-3 days, then you recover until 6 weeks. at 6 weeks revocery is maximal

Front 14

what is the genome of poliovirus

Back 14

ssRNA
+ sense (no reverse transcription needed, serves as mRNA directly)

IRES- internal ribosome entry site. mimics mRNA and will cleave ALL other mRNA's so they are not recognized

Front 15

what is IRES

Back 15

its the internal ribosome entry site in poliovirus

**it acts as mRNA and blocks ALL other mRNA from being translated into protein

Front 16

tell me about polio polypeptide processing

Back 16

processed by viral protease to make caspid units

RNA dependent RNA polymerase and additional viral RNA replication accessory proteins that will make new +sense RNA genome

**new RNA is linked to the viral protein VPg- this is needed to initiate viral RNA replication

Front 17

what are the clinical syndromes of poliovirus

Back 17

1. MOST- not clinically evident
2. Abortive illness- general fever, maliage, HA, nausea/vomit. most recover spontaneously
3. Non paralytic poliomylitis: fever, HA, maliase, N/V, STIFF NECK/BACK. 2-10 day with spontaneously recovery

4. PARALYTIC POLIOMYLITIS- rare but feared. asymmetric flaccid paralysis (LMN damage) damages nerves. get max paralysis 2-3 days and max recovery at 6 weeks

5. post polio syndrome: mm atrophy years after infection bc of overuse of compensating nerves

Front 18

ok so when we think polio we all think paralysis but that is not common at all, what is MUCH more liekly

Back 18

1. inapparent infection
2. abortive illness
3. non paralytic
4. post polio

Front 19

whats bulbar paralysis, what is it associated with

Back 19

polio

**CN nerve involvemnet- speech, swallow, facial mm movement
**repsiratory center- life threatening

**now can live in iron lung to help breath

Front 20

martha mason

Back 20

the gal with bulbar poliovirus that lived for a really long time in the iron lung

Front 21

whats post polio syndrome

Back 21

years and years after initial infection the mm being to atrophy (initial infection WAS Paralytic)

its NOT a latent infection, its atrophy after compensation of overused nerves

**gradual clinical course

Front 22

what is a long term complication of paralytic polio

Back 22

post polio syndrome

the compensating nerves get worne out from overuse syndrome

**gradual clinical course

Front 23

how can we prevent polio since that is such a good way to treat it!

Back 23

recall 3 AG variants (serologic types) exist and ALL must be vaccinated against!

3 vaccines

1. IPV (inactivated polio virus) not as effective as OPV, 4 shots over 1-2 years

2. eIPV- enhanced inactivated polio. ensures all 3 strains get good immune response

3. OPV- oral, live. can get back mutations that cause paralytic polio so NOT sued in US

Front 24

what are the 3 polio vaccines

Back 24

1. inactivated- 4 shots over 1-2 years

2. e inactivated polio vaccine- ensures good immune response to all 3 strains

3. Oral- live! not used, can back mutated and cause paralytic disease

Front 25

is travel and polio a concern

Back 25

you bet! there have bern 24 countries where polio was brought into previously polio free areas

CONTINUE VACCINATION

2005 in MN, 4 kids with PV vaccine strain even though vaccination hadnt been given in 5 years!

Front 26

what do we need to consider when given OPV vaccine

Back 26

the LIVE oral vaccine- better to use in countries that have some immunity already

can get poliovirus VACCINE strains

Front 27

whats the deal with polio vaccine and SV40

Back 27

SV40 was transmitted along with the polio vaccine

the polio virus vaccine was make in monkey and the monkey has the SV 40 virus

SV 40 can cause cancer but IT NEVER HAPPENED IN THE PTS who got the SV40/polio vaccine

**there were some problems with the babe if a preggo mom took them

Front 28

ok so SV40 and polio vaccine is not really an issue, what might be

Back 28

PML- progressive multifocal leukoencephalopathy

opprotunistic demyelinating infection due to JC virus induced lysis of oligodendrites that form spreading leisions

88disease of old immunosuppressed

Front 29

did OPV intorduce AIDS to humans

Back 29

nope

Front 30

whats the break down if picorna virus

Back 30

Enterivirus- infect via gut

Rhinovirus

**entero typically associated with intestinal infection but there is lots of tissue tropism, so rhino is exclusive to airway

Front 31

is CNS infection with enterovirus common in us

Back 31

yes, even through polio is controlled for the most part

**newborns and immunocomprimised are at greatest risk

Front 32

describe the non oplio enterovirus. what are they

Back 32

ssRNA, small, + sense (same as polio),

still picornavirus but are very different from polio

1. ECHO
2. Coxsackie
3. Enterovirus 70

Front 33

tell em about ECHO virus

Back 33

non- polio enterovirus

**accidently discovered in poop, can have virus buthave no disease

Front 34

tell me about coxsackie

Back 34

similiar structure to polio but different RNA

A- myotitis with acute inflammation/necrosis of coluntary mm fibers

B- degeneration of BRAIN adn voluntary sk mm

Front 35

how will a newborn present with ECHO or Coxsackie

what about an older kid or adult

Back 35

NEWBORN
sudden fever, vomit, anorexia, rash, meningeal inflammation, bulging ant fontanelle, Live failure in ECHO, Myocarditis in Cosackie

OLDER:
fever, HA, nuchal rigidity

Front 36

ok so a newborn with the non polio enterovirus ECHO or Coxsackie will both have sudden fever, vomit, anorexia, rash, bulging ant fontanelle etc. how can you tell them apart

Back 36

ECHO- liver failure

Coxsackie- myocarditis

**commonly cause meningitis, not severe unless in the newborn

Front 37

encephalitis is most commonly caused by what 3 things

Back 37

1. HSV
2. arbovirus
3. enterovirus

Front 38

how are coxsackie and ECHO dx

Back 38

*hard to culture, cox A wont grow in culture (throat or fecal)

*can have non sx shedding of virus, and 30% of + will show -

**CSF samples take a long time to be +

*serology might help or reverse transcriptase PCR

Front 39

whats the dif btwn coxsackie A and B

Back 39

A- voluntary mm involvement

B- brain adn voluntary mm involvement

Front 40

what does it mean when you can isolate coxsaxie or ECHO from...
Poo

Nasopharynx

CSF/Blood

how do you treat

Back 40

Poo- most sensitive but least disease specific

Nasopharynx- better to link the disease

CSF-Blood: not usually here so when you find it its an invasive disease

Tx is supportive, no antivirals. Perhaps picovir bc its like a rhinovirus

Front 41

are there antivirals for both polio enterovirus AND non polio

Back 41

just polio

IPV
eIPV
OPV

Front 42

who gets non polio enterovirus like ECHO and Coxsackie

Back 42

young kids in the summer/fall

**young kids get REALLY sick, unlike polio where it was better to get it as an infant

*fecal oral

Front 43

what enterovirus is BAD for inants

Back 43

non polios

**summer/fall, fecal oral,

Front 44

what other disease is like the flu in that each season there are just a few viral serotypes that predominate, what is the season

Back 44

non polio enterovirus

summer fall

Front 45

how are enterovirus cleared from us, what implication does this have on infants who get it (non polio- coxsackie/echo)

Back 45

with AB, so the more AB your mom has hte better the infant does :)

Front 46

what is the best way to treat non polio enterovirus

Back 46

prevention!! NOT likely to get a vaccin

wash your hands you yucky kids!! its fecal oral

bc they are similar to rhinovirus they are thinking of pleconaril (picovir)

Front 47

what is Enterovirus 70

Back 47

non polio, acute hemmoragic conjunctivitis

super contagious, rapid onset of pain and swelling and bleeding

Front 48

what are some controversial enterovirus associated diseases

Back 48

1. Juvenile onset DM- coxsaxkie B
2. Inflammatory myositis- rheumatological disease
3. Chronic Fatigue- XMRV, not the case!

Front 49

what is lymphocytic choriomeningitis (LCM)

structure, genome, etc

Back 49

areanvirus
ambisense ssRNA
enveloped (all others in this lecture were NON enveloped)

HUGE, this virus has chromosomes and can replicate in cytoplasm

causes preventable meningitis

Front 50

who is infected with LCM

Back 50

rodents, human zoonoses
*infection rates are low

Front 51

how do arenavirus replicate (ie LCM)

Back 51

ambisence (the polio and non polios- coxsaxkie, echo, entero 70 are + sence enveloped)

Front 52

what are hte clinical manifestations of LCM

Back 52

MENINGITIS is UNCOMMON!
encephalitis is RARE

**flue like illness
**risk to baby if mom is preggo
**also a problem if a transplant is infected nad host is immunocomprimised

Front 53

what happened with petsmart

Back 53

sued after a kid with a liver transplant got sick after playing with his LCM + hamster

**animal can be certified LCM free but then can pick up up from anything! NEVER have RODENTS! bc its really super dangerous to have flu like sx (meningitis nad encephalitis is RARE) ;) paranoia!

Front 54

if you have aseptic meningitis what might be the culprit

Back 54

aseptic- no pathogen is isolated (recall CSF will get pathogen with cox and ECHO but it takes a week or longer)

LCM- with history of rodent exposure

**PREVENT LCM with rodent control

Front 55

who gets LCM

Back 55

any age group who plays with rodents in autumn- winter

**the others were more common in summer