Microbiology Block 3 Viruses

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family Respiratory Synctial Virus is in

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paramyxovirus

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envelope of RSV

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Envelopes with glycoprotein spikes:
G glycoprotein (attachment)
Fusion F glycoprotein (syncycium formation)

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epidemiology of RSV

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seasonal (midwinter to spring), global, happens ages before age of 2

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hallmark of RSV

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syncycium formation

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disease of RSV

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tropism for ciliated respiratory epithelium
necrosis of respiratory epithelium with destruction of cilia
obstruction of small airway

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clinical manifestations of RSV

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neonates and premature infants - upper respiratory symptoms may be minimal, poor, feeding, lethary, irritability, and apnea
infants and young children - upper respiratory symptoms, bronchiolitis and pneumonia
older children and adults - upper respiratory symptoms, exacerbation of asthma

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diagnosis of RSV

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nasopharyngeal specimen from washing

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treatment of RSV

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none, complicated cases are Rbavirin

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prevention of RSV

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active immunity: RSV vaccine
passive: immunoprophylaxis - RSV hyperimmunie immunoglobin or RSV monoclonal antibody

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family of influenza virus

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orthomyxovirus

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envelope of influenza virus

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lipid containing envelope: hemaglutatin and neuroaminidase surface spikes

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epidemiology of influenza virus

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annual midwinter epidemics. major antigenic shifts occur approximately every 10 years

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pathophysiology of influenza virus

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infects ciliated epithelium of respiratory tract
necrosis of ciliated epithelium
bacterial superinfection

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disease of influenza virus

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chills, nonproductive cough, headache, sore throat, vomiting, diarrhea, maylagia, dizziness

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lab diagnosis of influenza

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presumptive based on season and clinical manifestation
definitive innoculate embryonic eggs, culture, ELISA, serologic (complement fixation, hemagglutinin inhibition)

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treatment of influenza

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Type A: amantadine (prevents release of viral nucleic acid by host
Type A&B: zuamivir and oseltamivir

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prevention of influenza

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chemoprophylaxis (amantadine and ramantadine)
vaccination

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family of parainfuenza virus

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paramyxovirus

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epidemiology of parainfluenza

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type 1&2 - late summer to early fall
Type 1 - every other year
Type 3 - occur in spring/ early summer
type 2 - less severe

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disease of parainfluenza

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upper respiratory - pharyngititis, acute otitis media, laryngotrachetitis
laryngotracheobronchitits (coup)
bronchiolitis and pneumonia

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diagnosis of parainfluenza

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presumptive - based on season
definitive - tissue cell culture, IF, EIA, serological assays

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treatment of parainfluenza

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antibiotic: only if superinfection
antiviral - Ribavirin

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prevention of parainfluenza

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vaccine, infection control

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family of rhinovirus

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picornavirus

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epidemiology of rhinovirus

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acconts for 30-50% of acute respiratory illness (common cold). spring/early summer
incidence high in kids

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pathophysiology of rhnovirus

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viral replication peak in respiratory tract in 2-3 days. specific IgA antibody appear in nasal scretions in 1 week
serum antibody appears at 1 week and peak 1 month

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disease of rhinovirus

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young infants - febrile illness with upper respiratory symptoms
children and adults - afrebrile upper respiratory illness

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diagnosis of rhinovirus

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presumptive: diagnosis based on clincial presentation and season
definitive - tissue culture (impractical) and serum antibody
acid labile and gros best at 33

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treatment of rhinovirus

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symptomatic (decongestants), interferons is promising

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prevention of rhinovirus

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no vaccine, good hygiene, lack of envelope renders virus resistant to common disinfectants

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envelope of coronavirus

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large rna positive that gives soloar corona appearance with distinct spikes (peplomers)

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disease of coronavirus

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upper respiratory tract: cold and pharyngitits
lower respiratory: pneumonia or asthma
GI: watery, non-bloody diarrhea

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diagnosis of coronavirus

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tissue culture, serology is helpful

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treatment and prevention of coronavirus

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no treatment or vaccine. good hygiene

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shape of adenovirus

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large naked, ds DNA with 7 serotypes associated with illness

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pathophysiology of adenovirus

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inoculation of virus
replication in respiratory or GI epithelium
necrosis of epithelium
viremia
intranuclear inclusion bodies in lung

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diseases of adenovirus

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GI diseases: acute gastroenteritis, mesenteric adenitis, hepatitis
genitourinary disases: hemorrhagic cystitis or nephritis
ocular diseases
central nervous system disease: meningoencephalitis
cardiac disease: mycoarditis and pericarditis

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diagnosis of adenovirus

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tissue culture, ELISA

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treatment of adenovirus

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no specific therapy, high dose of immunoglobulin has been used in imunocompromised patients

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prevention of adenovirus

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infection control, commerical vaccines are not available

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envelope shape of all herpes virus

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isohedral capsid / lipid envelope

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source of transmission for herpes simplex virus

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ubiquitous, direct contact with infected secretions; asymptomatic

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pathophysiology of herpes simplex virus

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acute infection: starts in multinucleated cells (syncytia), necrosis, cell to cell spread, latent infection of glanglia of infected region. recurrence triggered by stress

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disease of herpes simplex virus I

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primarily asymptomatic, primary gingivoostromatitis (fever, irritability, painful vesicular lesions) recurrent infection
ocular lesions lead to permanent corneal scarring

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disease of herpes simplex virus II

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primary infections present as papules progressing to vesicles and postules, neonatal herpes usually due to HSV-2 acquired by passage through nfected birth canal

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lab diagnosis of herpes simplex virus

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cell culture from secretion
isoloation in culture most definitive
scraping lesions for histology and Tzanck smear

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treatment for herpes simplex virus

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acyclovir lowers severity of primary infection and suppresses recurrences
forcarnet for acyclovir-resistant

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prevention of herpes simplex virus

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avoiding contact with infected people

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source of varicella-zoster virus

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highly contagious respiratory droplets
transmitted by contact with lesions

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pathophysiology of varicella zoster virus

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synctia formation that begins in teh mucosa of the respiratory tract and spreads via blood and lymphatics
secondary viremia results in clincally apparent lesions
latent infections of dorsal root or cranial nerve ganglia

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disease of varicella-zoster virus

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chicken pox - mild, normally before 10 years old, fever and itchy maculopapolar rashdevelops after 14-21 day incubation, severe in immunocsuppressed
shingles - lesions preceded by servere pain in a dermatome, multiple attacks uncommon, progressive in immunocompromised

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laoratory diagnosis of varicella-zoster virus

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tzanck smear, antigen detection by immunological tests

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treatment for varicella-zoster virus

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acyclovir (if severe), immunoprophylaxis with VZV immunoglobulin,
vaccine now available

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source/transmission of epstein-barr virus

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transmitted in saliva, low contagious potential, limited host range and tissue tropism

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pathophysiology of epstein-barr virus

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infection of epithelial cells of the oropharynx
lytically infected cells die before becoming activated to produce IGs and antigens against
atypical lymphocytes (downey cells)

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disease of epstein-barr virus

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most asymptomatic infectious mononucleosis, fever, lymphadeopathy, sore throat, cyclical recurrent disease can occur
association with malignancies: african burkitt's lymphoma, endemic in malaria belt, B-cell lymphomas in immunosuppressed patients, primary EBV infection --> B cell proliferation and T cell immunosuppression

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lab diagnosis of epstein-barr virus

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atypical lymphocytes (downey cells)
monospot test (heterophil antibodies)

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therapy for epstein-barr disease

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supportitive therapy

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transmission of cytomegalovirus

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congenital, oral, sexual, blood transfusion, tissue transplants

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source of cytomegalovirus

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ubiquitous, isloated from urine, blood, throat, salivar, tears, milk, semen

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pathophysiology of cytomegalovirus

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latent infection, cytomegally (cell enlargement) and cytoplasmic inclusions, spreads from cell to cell in presnece of circulating antibody

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disease of cytomegalovirus

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asymptomatic, like mono but less severe and no heterophile antibody
congenital infection - microcephaly, intracerebral calcification, hepatosplenomegaly, unilateral or bilateral hearing loss and or mental retardation

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lab diagnosis of cytomegalovirus

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cytomegalic cells with intranuclear inclusions in tissues
antigen detection
serology

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treatment of cytomegalovirus

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ganciclovir
forcarnet in immunocompromised patients

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prevention of cytomegalovirus

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screan transplants and wear condoms

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source/transmission of human herpes virus 6 and 7

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replicates in lymphoid tissue and is cytopathic for T cells
can lead to rejection of transplants

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disease of human herpes virus 6

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causes exanthem subitum (roseola)

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disease for human herpes virus 7

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mononucleosis-like syndrome

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source/transmission of human herpes virus 8

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not ubiquitous
saliva transmits for kids, sex for adults

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disease of human herpes virus 8

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kaposi's sarcoma-associated herpes, tumor find in many homosexual/bisexual AIDS patients
tumors may results form IL-6 dysregulation

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treatment of human herpes virus 8

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foscarnet and ganciclovir may prevent in AIDS patients

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envelope shape of poxviruses

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large, brick shaped pox in a box.
largest and most complex virus

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replication of poxviruses

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replicates in the cytoplasm (not the nucleus)

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epidemiology of orthopoxvirus

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accidental exposure

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pathophysiology of orthopoxvirus

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inhaled and replicates in upper respiratory stract
vesicles form 4 days after flu-like symptoms
death with superinfection or viral infection

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diease of orthopoxvirus

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variola - small pox
vaccinia - small pox vaccine
monkey/cow pox - zoonotic infection

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epidemiology of parapoxvirus

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accidental exposure

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pathophysiology of parapoxvirus

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orf, cowpox, and monkeypox - nodular lesions on fingers and face that spontaneously resolve

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disease of parapoxvirus

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orf - zoonotic from sheep/goats
Milker's nodule - zoonitic infection

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pathophysiology of unclassified poxvirus

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molluscum contagiosum - dodular paintless lessions on skin.
not symptomatic
spontatniously resolved

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lab diagnosis of unclassified poxvirus

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presence of eosinophilic cytoplasmic inclusion bodies in tissue

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envelope shape of polyomaviruses

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small naked capsid viruses

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epidemiology of polyoamvirus

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ubiquitous, usually no disease

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pathophysiology and disease of polyomavirus (JC)

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progressive multifocal leukoencephalopathy (OML)
fatal CNS demyelinating disease by damage to oligodendrogial cells
found in immunosuppressed adults

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disease of polyomavirus (BK)

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found in urinary tract of immunosuppressed patients
assocaited with hemorrhagic cystitis in bone marrow transplant

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diagnosis of polyomavirus

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BK - easily isolated by routine cell cultures
JC - fetal virus requires fetal glial cells for isolation
detect by immunoassays

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envelope shape of papillomavirus

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small, naked capsid virus with cubic symmetry

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replication of papillomavirus

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HPV replication is linked to cellular differentiation of host cells
inoculate basal layer and elevate through layers to be shed at corneal layer

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clinical manifestations of papillomavirus

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mucosal form: low risk HPV 6, 11 - oral/ genital warts
high risk HPV 16, 18, 31 carcinomas of oral and genital area
cutaneous - high risk - HPV 5, 8 flat warts in people with epidermodysplasia vrruciformis - a third develop to squamous cell carcinoma

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how viral oncoproteins control cell growth and differentiation in papillomavirus

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E6 targets p53 for degradation
E7 binds pRB and histone deacetylase-1

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lab diagnosis of papillomavirus

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PAP smear see: pernuclear cytoplasmic vacuolization and nuclear enlargement (koilocytosis)
immunoassays for viral antigens

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treatment and prevention of papillomavirus

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remove lesion
interferon
antisense RNA
condomes
HPV vaccine

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definition of exanthem

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eruptive disease or eruptive fever
Rubeola (measles), Rubella, Roseola, Fifth's disease

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definition of enanthem

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eruption upon a mucous membrane
rubeola, rebella (rare), fifth's disease (rare)

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family of paramyxoviridae

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mumps, measles, parainfluenza 1,2,3 and RSV

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morphology of mumps

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hemagglutinin/ neuraminidase and fusion proteins

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pathogensis of mumps

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enter respiratory tract, multiples and spreads to CNS, kdineys, tests
viruria (virus in urine) common

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significance to public heath for childhood exanthems and mumps

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with vaccines coming out, infants and young children are now rarely getting the disease, but adolescents younger adults are getting it once the vaccine has worn of

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disease of mumps

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1/3 are asymptomatic
fever, swelling of salivary (parotid) glands, earache, facial pain
erythema/edema of stensens duct
complications - CSF pleoytosis, symptomatic meningoencephalitis

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lab diagnosis of mumps

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lemon juice increaes pain and salivation (unlike adenopathy)
viral culture serology

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layers of human tumor virus

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corneal, granular cell, spinal cell, basal, basement membrane

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morphology of measles (rubeola)

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hemaglutinin and fusion protein (no neuramindase)

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pathogenesis of measles

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enters respiratory tract and replicates in respiratory epithelium
dissemination via blod adn lymphatics
during viremia, infects WBCs

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diease of measles

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intially cough, coryza, conjunctivitis, fever
enanthem: 1-3 days later, Kplik spots (pinpoint spots with red halos in mucous membrane)
exanthem: erythematous blanching erutpion first on harline then to palms and soles
complications: otitis medial pneumonia, Subacute Sclerosing Panencephalitis

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lab diagnosis for measels

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clinical presentation + epidemiology, cultue, IF, serology

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treatment and prevention measles

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supportive care
vaccine
ribavirin
vitamin A

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family of roseola

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herpesvirus (human herpesvirus 6)

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clinical manifestations of roseola

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several days of high fever: look toxic
conincident with resolution of fever is onset of exanthem (irrecular macules, rosy pink, first on neck and trunk, spreadint to face
complications: associated with febrile seizures in infants

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disease of roseola

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STAR complex (Sore Throat, Arthritis, Rash)
caused by rbuella, parvovirus B19, HBV, adenovirus, EBV

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family of parvovirus B19

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parvoviridae

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morphology of parvovirus b19

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non-enveloped icosahedral, srrounds ssDNA

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transmission of parvovirus b19

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respiratory transmission

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pathogenesis of parvovirus b19

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replication in nucleus of immature RBCs in bone marrow

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diease for parvovirus b19

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initial mild illness with fever, malaise, headache, dcreased RBC and WBC
confluent indurated rash appears on face (slap-cheek rash)
papular prpuric glvoes and socks syndrome - immune response after onset of skin eruption
complications: infection of fetus, hydrops fetalis and death
patients with hemoglobinopathy - profound anemia, aplastic crisis

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lab diagnosis

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serology, PCR, (30-60% adults are seropositive)

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family of rubella

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togaviridae (enveloped icosahderal capsid)

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pathogenesis of rubella

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entry into respiratory tract and replicates
incubation period 2-3 weeks

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disease for rubella

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mild illness with low grade fever
exanthem: discrete pinkish-red fine maculopapular eruption which typically beings on the face
enanthem - forscheimer spots (descrete rose spots on soft palate)
complications - arthritis more common in women, major complication is results from spread of virus from pregnant women to their fetus (cardiac and eye defects, deafnes, liver and spleen enlargement, growth retardation)

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epidemiology of rubella

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highest frequency in young school aged kids that are unvaccinated