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Flashcards in Enteric Viruses Deck (62):
1

Roatviruses are the single most important etiologic agent of severe diarrheal illness of ________ worldwide, especially in undeveloped countries

infants and young children

2

What family does Rotavirus belong to?

Reoviridie

Reo= respiratory, enteric, orphan

3

What is the structure of Rotavirus?

non-enveloped particles consisting of 2-3 concentric icosahedral capsids 

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4

What is the genome of Rotavirus?

segmented, double-stranded RNA with high antigenic diversity:

divided into 11G (VP7) and 12P (VP4) serotypes (note that 4 G-P combinations cause 90% of disease in humans- basis of success of vaccine)

5

What is the first step of the rotavirus replication cycle?

1. Virus taken up by endocytosis and delivered to late endosome or lysosomes where 

a) Capsid proteins are proteolytically processed and lost generating infectious subviral particles

b) processing can occur either outside cells during passage through the gut or following endocytosis as above

6

What is the 2nd step of the rotavirus replication cycle?

Following penetration, enzymes within the core begin synthesizing mRNAs

a) Transcription is asymmetric (only individual (+) strand mRNAs (10-12) are made). These are extruded through the vertices of the capsid structure. mRNAs are capped, but not polyadenylated

7

What is the 3rd step of the rotavirus replication cycle?

Some of the capped mRNAs are subsequently assembled into 'assortment complexes'

a) Capped (+) strand RNAs serve as templates for synthesis of the complementary (-) strands producing each of the double-strands RNA genome segments

8

What are the 4th and 5th steps of the rotavirus replication cycle?

4th: Assembly of retovirus particles occurs entirely within the cytoplasm in viroplasms and form distinct cytoplasmis inclusion bodies

5th: Progeny virus is subsequently release by host cell lysis 

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9

What is the major cause of foodbourne epidemic acute gastroenteritis in older children and adults?

Noroviruses (Caiciviridae) (aka Norwalk or Norwalk-like viruses)

10

What is the genome of Noroviruses?

Nonenveloped, non-segmented (+) strand RNA viruses

11

Note that the replication scheme of caliciviruses has not been determined but may be similar to picornaviruses

12

Again, rotaviruses cause diarrheal disease primarily in ______

the young (responsible for 35-50% of hospitalization for severe diarrhea during the first 2 yrs of life)

13

_____ are responsible for ~50% of community-based outbreaks of nonbacterial gastroenteritis in older (school-aged) children and adults

Noroviruses (known as 'winter vomiting disease')

14

Transmission of both rota- and noroviruses is primarily by the ______ route

fecal-oral (both are very stable in the environment)

15

Norovirus outbreaks are often linked to a single source. Name some.

Contaminated food (raw or steamed shellfish, cake frosting, and salads)

Contaminated water (Cruise ship outbreaks)

16

The clinical symptoms for both rota- and norovirus infections include:

-N/V

-diarrhea

-fever

-dehydration

17

Both rota- and noroviruses initially infect villus epithelium of the _________

small intestine

a) Virus replication and cell lysis then causes loss of cells lining the small and large intestine, resulting in functional alterations in the small intestine villous epithelial cells

b) Glucose-coupled sodium transport is impaired, but adenylate cyclase and cAMP are not stimulated (thereore not like v. cholera mechanism)

18

What is most important for protection against reinfection by both rota- and noroviruses?

local (intestinal) immunity

19

Describe immunity to rotaviruses and noroviruses

AB to rotaviruses are obtained relatively early in life, but ABs to noroviruses are acquired gradually in childhood, and increase steadily over a person's lifetime

20

T or F. There are 4 major serotypes of rotaviruses that cuase most disease

T. making development of a vaccine practical even though there is potential for significant antigenic diversity through antigenic shift and drift 

21

T or F. Norovirus immunity is not long lasting

T. Antigenic diversity is generated via antigenic drift, similar to other single-stranded RNA viruses

22

What rotavirus vaccines are available?

a) RotaTeq (pentavalent bovine-human reassortant viruses (serotypes G1-G4 and P8). Live, attenuated given PO at 2,4, and 6 mos.

b) Rotarix (human-derived monovalent (G1, P8). Live, attenuated given PO in two doses starting at 6 weeks of age

**There are no approved norovirus vaccines**

23

What are the most important preventative measures for norovirus?

-hand-washing

-effective disinfection of surfaces

-proper food prep

24

What is the genome of Astroviruses?

Non-enveloped, icosahedral, single-stranded (+) sense RNA viruses with a characteristic star-like appearance on EM

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25

___ are second to rotaviruses as the most common cause of childhood diarrhea in children and infants under 1 yo

Astroviruses

26

Describe the diversity of astroviruses

There are 8 serotypes that all cause gastroenteritis, predominantly diarrhea, mainly in children under 5 yo

80% of children 5-10 have Abs to Astroviruses

27

How are astroviruses spread?

oral-fecal

28

How does astrovirus infection present?

Illness is self-limiting, of short-duration and has a peak incidence in WINTER (no vaccine available)

29

What is the genome of Enterovirsues (Picornaviridae)?

Small, icosehedral nonenveloped (+) sense RNA viruses 

30

What are the human enteroviruses?

Poliovirus (causes flaccid paralysis (poliomyelitis)

Coxsackievirus (A and B)

Echovirus

Enterovirus

31

What diseases does Caxsackievirus cause?

hand, foot, and mouth disease

meningoencephalitis

diarrhea

muscle pain

inflammation of myo- and pericardium

32

What diseases do Echo- and Enteroviruses cause?

mild gastroenteritis (Hep A is also an 'enterovirus-like' picornavirus)

33

How are enteroviruses differentiated from rhinoviruses?

a) Acid stable

b) replication at 37C

34

T or F. Humans are the only known reservoir of enteroviruses

T. Spread fecal-oral

35

Describe the replication of Enteroviruses

There is a 7-14 day incubation period followed by initial replication in lymphoid tissue of the URT and the gut. Viremua results in infection of target organs including:

-spinal cord and brain

-meninges

-myocardium

-skin

36

How do enteroviruses present?

asymptomatic infection is common

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37

Note that besides polio there are no vaccines for other enteroviruses due to the large no. of serotypes 

38

What is the genome of adenoviruses (Adenoviridae)?

large, nonenveloped, linear, dsDNA viruses

39

What serotypes of adenovirus are associated with gastroenteritis?

40 and 41

40

When does adenovirus gastroenteritis typically present?

generally in young children and infants with similar disease to rotavirus and astroviruses (most ppl have Abs by age 3)

41

How is adenovirus spread?

fecally-contaminated water (foodbourne transmission has not been documented)

42

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44

H. Adults can get rotavirus, adeno, astro, its just more common in kids. Calicivirus is more common in adults

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45

C. Kids CAN get C. diff

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46

B, D, and F

Giardia is contracted from stream-like water (not likely)

Salmonella would present with BLOODY diarrhea (not likely)

E. Coli is more like to be inflammatory to0

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47

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Better access of supportive care and better identification of disease

48

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49

Flu replicates in the nucleus and must undergo splicing

B. 

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50

Single shell

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51

E. Norovirus= diarrhea and vomiting at the same time

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52

Possible, but likely virus (Norovirus) based on timing

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53

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54

Norovirus 

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55

B.

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56

Norovirus can also be detected using a RT-PCR assay, but typically not done except for large outbreaks (like on cruise ships)

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57

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58

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59

Need to know eneterovirus D68= caused gastrointestinal disease in infants lately

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60

D. 

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61

Virus can spread lonnngggg after disease

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62

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He is certainly at risk for HSV, CMV, Giardia lamblia, Campylobacter jejuni, Shigella spp, Salmonella spp, and C. difficile.  I would also include Entamoeba histolytica, Dientamoeba fragilis, Blastocystis hominis.

Because of recent travel to Mexico, Yersinia spp, rotaviruses, and noroviruses are also in the differential. 

In addition, I would include E. coli and Vibrio parahaemolyticus.  He also could have diarrhea and wasting from HIV itself.

An exam of the stool showed many cysts of Giardia lamblia and Entamoeba histolytica. This diagnosis should be reported to the local public health department.