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ID Week 1 > ICL 1.8: Respiratory Viruses > Flashcards

ICL 1.8: Respiratory Viruses Flashcards

1
Q

which virus family is RSV?

A

pneumoviridae = enveloped (-)ssRNA

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2
Q

how does RSV replicate?

A

like rabies

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3
Q

what is a major characteristic of RSV?

A

syncytia = giant multinucleated cell during infection

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4
Q

what are the main clinical symptoms of RSV?

A

low grade fever

wheezing

rhinorrhea

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5
Q

what is the pathogenesis of RSV?

A

in the lung, tissue damage

generalized infection, replicates in mononuclear cells, upper and lower respiratory tract, children under 2 yrs, 1-2 days of incubation

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6
Q

how do you treat RSV?

A

supportive care

Palivizumab - monoclonal antibody against F protein

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7
Q

RSV vingette

A

A 5-month-old girl was brought to the pediatric clinic of a local general hospital in February with a 2-day history of cough, respiratory difficulty with nasal discharge, and low-grade fever. She had begun attending a day care center 4 weeks before. All of her immunizations were up to date, and no one else at home was ill.

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8
Q

PIV vingette

A

A 3-year-old boy is brought to the ER by his mother who is concerned about a “barking cough,” mild fever, and hoarse voice. She reports that he had a runny nose last week that has since resolved. Physical exam reveals an inspiratory stridor.

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9
Q

what does PIV stand for?

A

parainfluenza virus

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10
Q

what virus family is PIV?

A

paramyxoviridae family

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11
Q

what are the characteristics of the PIV genome?

A

paramyxoviridae family = enveloped (-) ssRNA

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12
Q

what population is PIV most common in?

A

Kids below 5-years are victims

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13
Q

how do you treat PIV?

A

no vaccines, no treatments

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14
Q

rhinovirus vingette

A

A 66-year-old man was examined by the physician at the community center where he volunteers. He had rhinorrhea, low-grade fever, headache and cough during the last two days. He is not feeling well and worries that he may be putting other seniors at risk of becoming sick

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15
Q

which virus family is rhinovirus?

A

picornaviridae

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16
Q

what are the characteristics of the rhinovirus?

A

picornaviridae = naked, icosahedral (+) ssRNA

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17
Q

what temperature is best for rhinovirus?

A

low temperatures

adaptation to
cool environment of the nasal mucosa

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18
Q

what are the clinical features of rhinovirus?

A

2-3 day incubation

upper respiratory tract infection

nasal congestion, sneezing, sore throat, headache and cough. There may be fever

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19
Q

what population is more susceptible to rhinovirus?

A

children

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20
Q

what is the pathogenesis of rhinovirus?

A

inflammation and abundant exudation from the upper respiratory tract

cytopathology is minimal, but nose becomes engorged with blood (hyperemic) and edematous. This is likely due to the presence of bradykinin

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21
Q

how do you treat rhinovirus?

A

no prophylaxis or treatment

high degree of variation limit treatments.

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22
Q

what are complications related to rhinovirus?

A

patients with chronic bronchitis or asthma may get exacerbated

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23
Q

rhinovirus virus, pathogenesis, clinical, diagnosis, treatment, prevention

A

Virus: Picornaviridae, +ve ss RNA genome, naked virion, icosahedral capsid

Pathogenesis: Upper respiratory tract infection, 2-3 days of incubation, low optimum temp for replication (nasal mucosa)

Clinical: Nasal congestion, sneezing, sore throat, headache and cough.

Diagnosis: Not done

Treatment and Prevention: None due to high degree of variability (many serotypes)

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24
Q

coronavirus vingette

A

a 44-year-old female presented to the emergency department with complaints of fever, myalgias, and mild shortness of breath for 2 days. She also has a moderate headache and had experienced several episodes of diarrhea in the last 24 hours. She is a nurseʼs aid and had been working in a busy medical unit of a hospital. She had taken care of a patient with severe respiratory illness 4 days before feeling ill. She did not have underlying disease

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25
Q

what are the coronavirus genome characteristics?

A

enveloped (+) ssRNA

RNA is 5’-capped and 3’-polyadenylated and it is infectious

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26
Q

what does a coronavirus look like?

A

Club-shaped spike (S) protein

Transmembrane matrix protein (M)

looks like a spiky ball

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27
Q

how do coronaviruses spread?

A

spread readily by aerosol and contact

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28
Q

what are the coronavirus virus types?

A
  1. human coronaviruses
  2. SARS
  3. MERS
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29
Q

what do human coronaviruses do?

A

Can replicate exclusively in humans, causing upper respiratory tract infections. They spread readily by aerosol and contact

Causes common colds – not much to worry about

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30
Q

what do MERS do?

A

Cause atypical pneumonia

Original reservoirs of these two viruses are ‘bats’

31
Q

what are the coronavirus virus, pathogenesis, clinical, diagnosis, treatment and prevention?

A

Virus: Enveloped virion, +ve sense RNA genome (largest RNA genome), pleomorphic, human coronavirus, SARS and MERS

Pathogenesis: Upper respiratory tract infection for human coronavirus, SARS and MERS cause lower respiratory infection and extensive pneumonia

Clinical: Common cold similar to rhinovirus, unpleasant nasal discharge, malaise

Diagnosis: RT-PCR, ELISA, viral culture for SARS and MERS

Treatment and Prevention: Supportive care

32
Q

adenovirus vingette

A

A 14-year-old girl presented to the emergency department with a 2-day history of fever, sore throat, and a red left eye, which felt like there was “sand” in it. She had been at a summer camp for the past two weeks where several other children had a similar illness. Activities in the camp included swimming in a local pool. The patient has no significant past medical history and denied being sexually active. Family history was unremarkable.

33
Q

what is the adnovirus genome?

A

naked, icosahedral linear dsDNA

34
Q

how many adenovirus serotypes are there

A

51

35
Q

what are the adenovirus virus, pathogenesis, clinical, diagnosis, treatment, prevention?

A

Virus: Naked icosahedral virion, linear dsDNA genome, 51 serotypes

Pathogenesis: usually benign, persistence possible in adenoids

Clinical: Cold, keratoconjunctivitis

Diagnosis: Immunofluorescence, viral culture on human cells

Treatment and Prevention: No treatment, oral, live attenuated vaccine (serotypes 4 and 7) in military

36
Q

influenza vingette

A

In December, a 71-year-old man from a nursing home was brought to the hospital in acute respiratory distress. He had been in his usual state of health until 10 a.m. the previous day, when he suddenly developed fever, chills, muscle aches, cough, and prostration. Several other nursing home residents had developed similar illness during the previous week.
His past medical history was unremarkable, and he had not seen a physician in the past year

37
Q

which virus family is influenza?

A

orthomyxoviridae

38
Q

what are the characteristics of the influenza genome?

A

orthomyxoviridae = 8 segmented (-) ssRNA

39
Q

what are the immunogenic influenza proteins?

A

HA

NA

40
Q

how many influenza strains are there?

A

A,B,C

16 HA serotypes

9 NA serotypes

41
Q

what part of influenza replication cycle do neutralizing antibodies stop?

A

attachment

42
Q

what part of influenza replication cycle do NA inhibitors stop?

A

release

43
Q

what type of vaccine is the influenza vaccine?

A

two types of commercialized vaccines - inactivated vaccines and live attenuated vaccines

44
Q

what is the composition of the inactivated influenza vaccine?

A

Two A (H3N2 and H1N1) and one B serotypes.

appropriate strains are grown in chicken eggs, the allantoic fluids are harvested and the HA and NA are purified by ultracentrifugation.

45
Q

what is the immunization schedule for the inactivated influenza vaccine?

A

Annual dose.

for previously unvaccinated children, the first time they should receive two doses, one month apart.

46
Q

what are some adverse effects of the inactivated influenza vaccine?

A

most common: soreness at vaccination site, fever, malaise, allergy

47
Q

when should you not give someone the inactivated infleunza vaccine?

A
  1. Allergy to eggs or other vaccine components

2. Patients with acute febrile illness

48
Q

which groups of people are at risk for influenza?

A
  1. People >50 years of age
  2. People with preexisting disorders
  3. Women after the first trimester of pregnancy
  4. Health care and school workers
  5. Household contacts of groups at high risk of complications
  6. Children under 24 months of age
  7. Immunosuppressed patients
  8. Travelers
  9. People working in community services
49
Q

what is the composition of the live attenuated influenza vaccine?

A

aka flumist

live-attenuated intranasal vaccine

50
Q

what are the differences between the live attenuated vaccine and killed vaccine for influenza?

A

potentially better at producing broad mucosal and systemic immunity

51
Q

when should you not give someone the live attenuated influenza vaccine?

A
  1. Children under 5 years of age.
  2. Adults 50 years of age or older
  3. Known or suspected immune deficiency disease
  4. History of asthma or reactive airways disease
  5. With medical conditions such as chronic disorders of the lungs and heart, chronic metabolic diseases (including diabetes), kidney dysfunction, or a hemoglobinopathy such as sickle cell disease
  6. Pregnant women
  7. Due to the possible transmission of vaccine virus, FluMist recipients should avoid being in close contact with immunocompromised individuals for 3 weeks following vaccination
52
Q

what is the influenza virus, pathogenesis, clinical, diagnosis, treatment, prevention?

A

Virus: Orthomyxoviridae, -ve ss segmented RNA genome, enveloped virion, cap stealing in nucleus

Pathogenesis: Upper and lower respiratory tract infection, 2-3 days of incubation pneumonia, often causes secondary bacterial infection

Clinical: Shivering, malaise, headache, fever of about 390C, myalgia and backache and often sore throat.

Diagnosis: Based on clinical picture, but ELISA, cell culture, immunofluorescence can be done

Treatment and Prevention: Inactivated and live-attenuated vaccines, rimantadine, amantadine (target M2), oseltamivir, zanamivir (target NA)

53
Q

RSV:
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

RNA

pneumoviridae

no RT infection

3-5 day incubation

low fever

cough

sore throat

midwinter

no vaccine

54
Q

rhinovirus:
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

RNA

picomaviridae

no RT infection

2-3 day incubation

maybe fever

cough

sore throat

no seasonality

no vaccine

55
Q

coronavirus:
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

RNA

coronaviridae

no lower RT infection

3 day incubation

rarely fever

maybe cough

maybe sore throat

winter/spring seasonality

no vaccine

56
Q

SARS and MERS
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

RNA

coronaviridae

there is a lower RT infection

few days incubation

fever

cough

sore throat

no vaccine

57
Q

influenza
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

RNA

orthomyxoviridae

likely lower RT infection

2-3 incubation

high fever

cough

maybe sore throat

midwinter seasonality

vaccine available

58
Q

adenovirus
1. genome

  1. pneumo
  2. lower RT infection
  3. incubation
  4. fever
  5. cough
  6. sore throat
  7. seasonality
  8. vaccine
A

DNA

adenoviridae

variable incubation

low fever

cough

sore throat

no seasonality

limited vaccine

59
Q

what are the clinical features of coronavirus?

A

Common cold similar to that caused by rhinoviruses

Unpleasant nasal discharge and malaise

Diagnostic tests are not usually done.

SARS and MERS coronaviruses replicate in the lungs and cause extensive pneumonia

60
Q

how do you diagnose coronaviruses?

A

Diagnosis of SARS and MERS can be done by nested RT-PCR, ELISA and viral culture

61
Q

what is the pathogenesis of cornaviruses?

A

Only the upper respiratory tract supports human coronavirus replication.

Inflammation, oedema and exudation occur in the tract following days of cell destruction

62
Q

how do you prevent coronaviruses?

A

no vaccines

63
Q

how do you treat coronaviruses?

A

no antivirals to treat human coronavirus infection, treatment is limited to supportive care

SARS treatment is the same as for other serious pneumonias

Results from treatment with oseltamivir, ribavirin are unclear

64
Q

what are the clinical features of adenovirus?

A

cause colds and a wide range of other illnesses, often with involvement of the eye

65
Q

how do you diagnose adenoviruses?

A

diagnosis can be done by immunofluorescence on infected cells, by virus isolation, or by observation of cytopathic effect (cpe) on human cell lines

66
Q

what’s the pathogenesis of adenoviruses?

A

Human infections are usually benign

Persistence is possible in the adenoids.

Vigorous immune responses account for the milder disease pathogenesis – may be lethal for immunocompromised patients

67
Q

how do you prevent adenoviruses?

A

Oral, encapsulated, live attenuated vaccine (serotypes 4 & 7) used by the military

Widespread use of the vaccine may not be feasible due to the variety of circulating serotypes.

68
Q

how do you treat adenovirus?

A

No specific treatment available

69
Q

what are some of the complications of adenovirus?

A

Possible, but infrequent infection of the lower respiratory tract leading to pneumonia

70
Q

what are the clinical features of influenza?

A

symptoms set up abruptly after an incubation period of 2-3 days

shivering, malaise, headache, fever of about 39°C, myalgia (myal – muscle, gia – pain) and backache and often sore throat.

71
Q

how do you diagnose influenza?

A

Diagnosis is based on the clinical picture, but ELISA, cell culture, immunofluorescence tests can be also used

72
Q

what’s the pathogenesis of influenza?

A

Upper respiratory tract infection, but it can spread to the lower tract and cause pneumonia.

Destruction of cilia, which are important element of respiratory system.

Strong host immune response against the virus, and is mediated by interferon, IL-6 and tumor necrosis factor (TNF).

73
Q

what are some complications with influenza?

A

Secondary bacterial infections, particularly with S. aureus.

Reye’s syndrome, often fatal, is also associated with infection with influenza B in children (and aspirin)

ID Week 1 (15 decks)

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