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65 Cards in this Set

  • Front
  • Back
what does corona mean in latin
crown
why is coronaviridae called crown?
spikes on the envelope of the virus
what order is coronaviridae in
nidovirales
describe corona virus appearance
enveloped, nonsegmented, + sense single strange RNA virus
who is host for corona
vertebrate hosts
what are two genera in family coronaviridae
coronavirus
torovirus
does corona virus cause dz in both humans and animals?
YES!
WHAT IS THE LARGEST RNA genome know
CORONAVIRUS
WHAT IS SHAPE AND OTHER PHYSICAL FEATURES OF THE VIRUS
SORT OF SPHERICAL, HELICAL NUCLEOCAPSID,
UNDERGOES FREQUENT RECOMBINATION
what are diseases ass with CORONAVIRUS
COMMON COLD (25% of colds)
GASTROENTERITIS
PNEUMONIA
DESCRIBE NON-SARS Coronovirus
replication in upper rep tract epithelium (effect of temperature)
Responsible for 2-10% common colds (URI)
Occur during colder months/periodic outbreaks
What is incubation for non-SARS Coronavirus
~3days
nasal discharge and malaise
small/no fever and cough and sore throat uncommon
reinfection common
Usually, NO DX
When did SARS emerge
first pandemic of century in 11/2002 in guangdong province of sothern CHINA - 26 countries on five continents.
what was demonstrated by SARS epidemic as far as new global world?
potential of air travel and globalization for dissemination of emerging infectious disease.
Describe first cases (#s deaths) and observations about sero of Sars-CoV
Hong Kong, 8098 cases/774 deaths - CFR = 9.6%
SARS-CoV had not been endemic in humans before this.
What was SARS when it emerged?
TRUE EMERGING PATHOGEN - unknown in the beginning.
what did people think SARS was when first emerged
influenza
EPI OF SARS
INCUB: 2-14 days(4-7 median)
PEAK VIRAL LOAD ~10 days
What happened to some patients during second week of illness
DETERIORATION, in spite of decreasing viral load.
WHAT IS ONE POTENTIAL PROBLEM in this DZ at this second week stage
IMMUNOPATHOLOGIC LUNG DAMAGE
WHERE WAS SARS PRIMARILY SPREAD?
IN HEALTH CARE SETTINGS FROM VERY ILL PATIENTS
Is SARS as easily spread as originally thought
less transmissible than initially thought, with average reproduction ratio of 2-4
what is a super-spreader?
significantly augments spread
what conclusions were drawn about SARS
SARS-CoV sufficiently transmissibe to cause large epidemics but not so contagious to be uncontrollable with basic PH measures.
who was affected by SARS
all ages
slight preference for female(maybe because of increased exposure of nurses).
Pg women and Immunocomp pts.
was virus just found in respiratory secretions
no, feces, urine and tissue specimens form lung biopsy also.
what is primary mode of transmission for SARS
direct or indirect contact of mucous membrane(eyes, nose or mouth) with infectious respiratory droplets or fomites.
what is thought to amplify transmission of SARS (HINT - HOSPITAL SETTINGS)
aerosol-generating procedures (trach intubation, bronchoscopy and tx with aerosolized meds)
is there evidence of transmission before disease onset?
NO
is transmission to casual contacts common in SARS
NO!
WHEN IS THE LAST POINT THAT TRANSMISSION OCCURS DURING THE CLINICAL PHASE?
none after >10 days after fever resolution.
What is the replication number for SARS
Ro ~ 2
is F/O transmission important in SARS
Could be - not known for sure. watery diarrhea common, shed in stool in large quantity. no trans btw children.
is there any food/waterborne or vertical/perinatal transmission known?
NO
talk about super-spreaders in SARS
most super spreaders do not become super spreaders. Undetected hosp cases and aerosol generating procedures.
Role of other biologic and host behavioral factors?
What factors are thought to be associated with super spreaders of SARS
lots of contacts (social)
HIV/immunocomp - Biologic
Can SARS survive for days in environment?
yes, in feces and dried on surfaces in alkaline pH
Much more stable than other human resp viruses(more so than RSV)

yes
talk about Amoy Gardens Outbreak
> 300 cases in aptment complex in HK- leading hypothesis is that droplets with virus entered bathrooms from contaminated sewage in bad U-trap plumbing.
what is ground zero?
direct transmission
was there something significant about viruses form guangdong province?
more genetically diverse
Were there variations of virus
yes, genetic lineages distinct form index case in HK
describe disease progression of sars
1/3 - rapid defervescence & resolution of radiographic changes.
2/3 persisten fever, worsened resp status, diarrhea
key sign in the mediastinum?
pneumomediastinum w/o preceding +pressure ventilation or intubation.
what % of SARS pts require ICU tx
20-30%, most requiring mechanical ventilation.
what were common terminal events?
resp failure, Mult organ failure, sepsis, inter-current medical illness such as acute myo infarction.(out of the blue, heart attack)
what were best diagnostics
early RT-PCR on resp and fecal spec - some + > 30 days after illness, rarely isolated virus after 3rd wk of dz.
what were late diagnostics
>1 week - serology via ELISA or IFA
what was SARS Pathogenesis
Viral RNA byRT-PCR - hi copies in lung, bowel, liver, spleen, lymph nodes and kidney
AGN in lung:
Alveolar epith cells
mphages and bronchial epithelial cells.
lab finds
hi lymphs
leukopenia
thrombocytopenia
anemia
inc LDH
incALT
was there anything early on to identify SARS
NO, not particularly. key point.
Pathogenesis of SARS
Viral RNA by RT-PCR in lung, bowel, lymphn odes, spleen, liver and kidney
Viral AGN in lung - epith cells/Mphages and bronchial epith cells
what was key factor in controlling pandemic in SARS
lab techs were great and had great diagnostix
What is associated with poor prog in SARS
age - old - >50% over 65/kids not so bad
co-existing dz - diabetes and heart
INC LACTATE DEHYDRO - indicates hemolysis, can mean MI
INC NEUTROPHIL COUNT
LOW CD4 AND CD8 COUNTS
WHAT IS TX FOR SARS
SUPPORTIVE
BROAD SPEC ABIOTIX
WHAT IS NOT INDICATED FOR SARS
don't know about:
ribavirin, thymic peptides, recomb thymus proteins, iv igg,
IgM enriched Igg, convalescent plasma
trad CHinese herbs
what are possible drug strategies for SARS
IN VITRO: susc to Interferon alpha, Interferon beta, Glcyrrhizin(licorice root extract)
IN VIVO: Pegylated interferon alpha in macaque model reduced viral load both pre post exposure
CORTICOSTEROID - NO NEGATVE EFFECT, NO PROVEN
What is SARS chronic sequelae
6-20% some degree of respiratory impairment
- residual lung fibrosis
-mm weakness
-systemic effects of viral illness
PTSD
DEPRESSION
BREATHE BY NEG P - BARIO TRAUMA IS POS P ON VENTILATOR
Describe Public Health resonse
-early case detection
-triage and isolation
-public ed
-contact tracing and QUARANTINE
-Surveillance @ border xings (forms and fever detection)
-enhanced hospital inf-cont practices(aerosol precautions and resp droplet precautions)
-Vaccine research
who was wrongly blamed initially in the SARS outbreak?
CIVET CATS
RESERVOIR FOR SARS
BATS(horseshoe bat)
Civet catsRaccoon dog
ferrets
wild animal trade
challenges from SARS
New disease - source, mode spread, dx methods, tx, and case fatality all unknown
other SARS challenges
-Transmission often inhospital
-successful prevention measures require vig and $$$
-Multinat'l outbreak
language, cultural diff
complicated politics
implications for
travel/economix
what was good about SARS epi
-rapid mobilization of global expertise
-overall good int'l collab
-tech comng thru
etiologic agent identified fast
lab diagnostix under dev
What needed work in confronting SARS
-not all countries forthcoming with info
-exposed poor surveillance in some countries
-global network coordination still challenging
what happened in Hanoi SARS cases
higher fatal rate - 10.9%
all cases linked to same hospital
nosocomial, 2nd and 3rd transmissions observed.