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1

Gastrointestinal/Enteric Viruses 

•___virus

•___virus

•___viruses

•___virus: Virus that comes into play with outbreaks of diahhreal disease on cruise ships

____virus

•___ ___virus

•___viruses

•___viruses

•rotavirus

•adenovirus

•caliciviruses

•Norovirus

•Sapporovirus

•hepatitis E virus

•astroviruses

•polioviruses

2

Rotavirus Characteristics

•___virus family; ___,  ___ ____ capsid, ____  ___ genome; ___ segments

•___ to environmental and GI conditions

•___ groups, ____ serotypes

•most common cause of ___ ___ among ___

•virus ___ cells of the epithelium overlying the ___

Segmented genome

Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant

•reovirus family; naked, double-layered capsid, segmented RNA genome; 11 segments

•resistant to environmental and GI conditions

•five groups, seven serotypes

•most common cause of severe diarrhea among children

•virus lyses cells of the epithelium overlying the villi

Segmented genome

Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant

3

 

Rotavirus Pathogenesis

It gets into ____l cells of the GI tract.

It enter ____

Virus ____ and produces a___

It makes its own toxin which contributes to the ___ ___ ass with the virus

Virus ____ these cells and infects ___ cells

___ cells begin to ___ and the ___ exit the body

It gets into epithelial cells of the GI tract.

It enters cytoplasm

Virus multiplies and produces a toxin

It makes its own toxin which contributes to the severe diahhrea ass with the virus

Virus leaves these cells and infects healthy cells

Epith cells begin to die and the fluids exit the body

4

Rotavirus Facts and Figures

•transmitted by _____ route

•prior to vaccine, ___% infected by age 5

•may be as many as ____ viral particles/gram of stool

•some children hospitalized because of____

•infants younger than ___ ____most susceptible

•vaccination

–RotaTeq® licensed in 2006

–Rotarix® licensed in 2008

•very severe, possibly fatal infection in ____ people; may cause up to 500,000 deaths/year in ____ countries where ___ is unavailable

 

Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.

Crowding in underdeveloped world also helps to spread the infection.

Don’t need to know names of vaccines for each virus unless she REALLY emphasized it

•transmitted by fecal-oral route

•prior to vaccine, >90% infected by age 5

•may be as many as 1010 viral particles/gram of stool

•some children hospitalized because of dehydration

•infants younger than 24 months most susceptible

•vaccination

–RotaTeq® licensed in 2006

–Rotarix® licensed in 2008

•very severe, possibly fatal infection in malnourished people; may cause up to 500,000 deaths/year in underdeveloped countries where vaccine is unavailable

 

 

Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.

Crowding in underdeveloped world also helps to spread the infection.

Don’t need to know names of vaccines for each virus unless she REALLY emphasized it

5

Enteric Adenoviruses

•types __ and ___

•most common ___ ____ in infants and children since the introduction of ___ ___

As we get protection against one virus, then other viruses emerge to create the same problems

•____day incubation period

•types 40 and 41

•most common diarrheal illness in infants and children since the introduction of rotavirus vaccine

As we get protection against one virus, then other viruses emerge to create the same problems

•8-10 day incubation period

6

Noroviruses

•___viruses--small, ___, ___ stranded _NA

•named for the original strain “___ ___”; caused a gastroenteritis outbreak in ___, __in 1968

•resistant to ___, ___, ____

•highly____ (___ particles can cause infection)

•fecal-oral transmission

•symptoms--___, ___, ___

Similar to ___ virus but in a different family

•caliciviruses--small, naked, ssRNA

•named for the original strain “Norwalk virus”; caused a gastroenteritis outbreak in Norwalk, OH in 1968

•resistant to detergents, drying, acid

•highly contagious (10 particles can cause infection)

•fecal-oral transmission

•symptoms--diarrhea, nausea, vomiting

Similar to polio virus but in a different family

7

Norovirus Epidemiology

•leading cause of ___ ____ outbreaks in the U.S.

•19-21 million cases of ____/yr

•1.7-1.9 million ____visits/yr; 400,000 ___ visits/yr

•56,000-71,000 ____/yr

•outbreaks common in __ ___ facilities, especially ___ ___care facilities

•causes 90% of diarrheal disease outbreaks on ___ ___

•leading cause of ___ _____ worldwide

 

Outbreaks common on cruise ships

Graph shows a couple of times there’s been a pandemic

No ___ or ____

For most of these GI: Just make sure that there is ___ ___ so patients don’t have any other problems ass with infection

Norovirus Epidemiology

•leading cause of foodborne disease outbreaks in the U.S.

•19-21 million cases of gastroenteritis/yr

•1.7-1.9 million outpatient visits/yr; 400,000 ER visits/yr

•56,000-71,000 hospitalizations/yr

•outbreaks common in health care facilities, especially long-term care facilities

•causes 90% of diarrheal disease outbreaks on cruise ships

•leading cause of viral gastroenteritis worldwide

 

Outbreaks common on cruise ships

Graph shows a couple of times there’s been a pandemic

No trt or vaccines

For most of these GI: Just make sure that there is adequate hydration so patients don’t have any other problems ass with infection

8

Poliovirus Infections

•mainly affects ___ under 5 yrs of age

•1/___ infections leads to irreversible____

•cases have ____by 99% since 1988

•1988—350,000 cases

•2013—406 reported cases

•global effort to eradicate disease

•_____ vaccine used in U.S. since 2000; oral (____) vaccine used in many parts of the world

 

____ been eradiated in US. Last case in US was in ___. But its still out there.

Paralytic polio is not the typical presentation.

Attenuated vaccine: Given in form of a __ ___

Now we use an inactivated vaccine.

Advantages of attenuated vaccine are that you can ___ target tissue and illicit i___ ___without getting___

Poliovirus Infections

•mainly affects children under 5 yrs of age

•1/200 infections leads to irreversible paralysis

•cases have decreased by 99% since 1988

•1988—350,000 cases

•2013—406 reported cases

•global effort to eradicate disease

•inactivated vaccine used in U.S. since 2000; oral (attenuated) vaccine used in many parts of the world

Basically been eradiated in US. Last case in US was in 1980. But its still out there.

Paralytic polio is not the typical presentation.

Attenuated vaccine: Given in form of a sugar cube

Now we use an inactivated vaccine.

Advantages of attenuated vaccine are that you can infect target tissue and illicit immune response without getting disease

9

Cases of polio

Not ____eradicated

Not completely eradicated

10

Coxsackievirus and Echovirus Infections

•Coxsackie A associated with diseases with ___ ___

•Coxsackie B associated with ___ and___

•most common results of infection

–____

–mild ___ ___, __-like illness

•___(aseptic) ____-echovirus __

Vesicular lesion that occur in the _____---> Coxsackie A virus

Coxsackie B virus is associated with infection of the myocardum  and ___ of the lungs

Not ____ in kids

Named after___ ___

•Coxsackie A associated with diseases with vesicular lesions

•Coxsackie B associated with myocarditis and pleurodynia

•most common results of infection

–subclinical

–mild upper respiratory, flu-like illness

•viral (aseptic) meningitis-echovirus 11

Vesicular lesion that occur in the mouthà Coxsackie A virus

Coxsackie B virus is associated with infection of the myocardum  and lining of the lungs

Not uncommon in kids

Named after coxsackie NY

11

Hand, Foot, and Mouth Disease

•Coxsackie ___ is most common cause

•Enterovirus ___ associated with outbreaks

•vesicular lesions on ___, ___ and, in ___

AKA (____)

•mild, ____ illness

 

Coxsackie causes hand, foot and mouth disease

Serotype A16 is the most common cause

Disease is sometimes called herpangina

Febril (fever)

Hand, Foot, and Mouth Disease

•Coxsackie A16 is most common cause

•Enterovirus 71 associated with outbreaks

•vesicular lesions on hands, feet, in mouth (herpangina)

•mild, febrile illness

 

Coxsackie causes hand, foot and mouth disease

Serotype A16 is the most common cause

Disease is sometimes called herpangina

Febril (fever)

12

Respiratory Tract Viruses

•___virus 

•___virus

•_____virus

•___virus

•____ virus

•respiratory ____ virus

•enterovirus___

•___

•___

•___

•parvovirus ___

•adenovirus 

•coronavirus

•parainfluenzavirus

•rhinovirus

•influenza virus

•respiratory syncytial virus

•enterovirus 68

•measles

•mumps

•rubella

•parvovirus B19

13

Adenovirus Characteristics

___, ____, ___ viruses

•fibers at ____; ___

•___serotypes of human adenovirus

•___, ___ and ___ infections

 

Naked so Stable in the environment

They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell

This is an important mechanism of pathogenesis of this virus

__ and __ cause enteric disease. ___ cause resp disease.

They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems

•naked, icosahedral, DNA viruses

•fibers at vertices; toxic

•52 serotypes of human adenovirus

•lytic, persistent, and latent infections

Naked so Stable in the environment

They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell

This is an important mechanism of pathogenesis of this virus

40 and 41 cause enteric disease. Most cause resp disease.

They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems

14

Common Adenovirus Illnesses

•endemic, ___ ___ ___--5-10% of pediatric respiratory disease

•____

•________

•____ ___ ___

•_____--15% ofgastroenteritis in hospitalized patients

•acute ___ ____

•______

•___

 

 

Most common illnesses of adenovirus infection is acute resp disease

5-10% of pediatric resp diesease is caused by adenovirus

Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus

•gastroenteritis--15% of gastroenteritis in hospitalized patients

•Easy to spread

•acute hemorrhagic cystitis

•Bleeding from bladder

•meningoencephalitis

•hepatitis

Wide variety of clinical manifestations

Most significant ones are GI disease and resp disease

Problems in people who are __ ____

•endemic, acute respiratory disease--5-10% of pediatric respiratory disease

•pneumonia

•keratoconjunctivitis

•pharyngoconjunctival fever

•gastroenteritis--15% of
gastroenteritis in hospitalized patients

•acute hemorrhagic cystitis

•meningoencephalitis

•hepatitis

 

 

Most common illnesses of adenovirus infection is acute resp disease

5-10% of pediatric resp diesease is caused by adenovirus

Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus

•gastroenteritis--15% of gastroenteritis in hospitalized patients

•Easy to spread

•acute hemorrhagic cystitis

•Bleeding from bladder

•meningoencephalitis

•hepatitis

Wide variety of clinical manifestations

Most significant ones are GI disease and resp disease

Problems in people who are not immunocompetent

15

Adenovirus Disease Mechanisms

•transmission

•___

•__ __

•__ ___ for enteric ones

•____ of___

____ objects

•___ ____

•infection of mucoepithelial cells

•___ tract

•____l tract

•____

•____cell damage

•___ important

•___

•___

•type of disease determined by tissue___ of group and ___

 

Virus in saliva can cause infection in the eyes

Swimming in contaminated pools

Virus can infect epithelial cells of resp tract, GI, and conjuctiva

Causes direct cell damage by the fibers that she talked about

Ab is important in protecting against reinfection and resolving the disease

•transmission

•aerosol

•close contact

•fecal-oral for enteric ones

•autoinoculation of eyes

•inanimate objects

•swimming pools

•infection of mucoepithelial cells

•respiratory tract

•gastrointestinal tract

•conjunctiva

•direct cell damage

•antibody important

•protection

•resolution

•type of disease determined by tissue tropism of group and serotype

 

Virus in saliva can cause infection in the eyes

Swimming in contaminated pools

Virus can infect epithelial cells of resp tract, GI, and conjuctiva

Causes direct cell damage by the fibers that she talked about

Ab is important in protecting against reinfection and resolving the disease

16

Adenovirus Epidemiology/Treatment

•risk groups include those in ___ ___ centers, ___ ___ camps,____ clubs

•some people infected with adenoviruses can have ____ infections in their ___, ___s, and____ that __ __ ___ symptoms

•they can ___ the virus for ___ or ___

_____ infections lead to ___

•___, ___ vaccine against adenovirus types _ and _ was approved by the FDA in March 2011 for U.S. ___ personnel 17 through 50 years old

 

Can asymptomatically spread the virus

___ ____ vaccine for adenovirus

There was oral vaccine for types 4 and 7 used in military but not used for general popl.

Not worth a huge immunization program

Adenovirus Epidemiology/Treatment

•risk groups include those in day-care centers, military training camps, swimming clubs

•some people infected with adenoviruses can have ongoing infections in their tonsils, adenoids, and intestines that do not cause symptoms

•they can shed the virus for months or years

•asymptomatic infections lead to spread

•live, oral vaccine against adenovirus types 4 and 7 was approved by the FDA in March 2011 for U.S. military personnel 17 through 50 years old

 

Can asymptomatically spread the virus

No general vaccine for adenovirus

There was oral vaccine for types 4 and 7 used in military but not used for general popl.

Not worth a huge immunization program

17

Rhinovirus Characteristics

•____--__, ___, ___serotypes

•acid ____; do not replicate in ___ ___

•resistant to ___ and ___

•grow best at ____

•infection initiated by as little as __ viral particle

•peak illness ® ______ infectious virions/ml in nasal secretions

 

___ ___

Stable in the environment

100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them

Don’t replicate in GI tract.

Grow best at 33 degrees which is the temperature of our ___ ___. That’s why cold symproms localized to upper respiratory tract

Highly infectious

•picornavirus--naked, RNA, 100 serotypes

•acid labile; do not replicate in gastrointestinal tract

•resistant to drying and detergents

•grow best at 33oC

•infection initiated by as little as 1 viral particle

•peak illness ® 500-1000 infectious virions/ml in nasal secretions

 

 

Common cold

Stable in the environment

100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them

Don’t replicate in GI tract.

Grow best at 33 degrees which is the temperature of our nasal passages. That’s why cold symproms localized to upper respiratory tract

Highly infectious

18

Rhinovirus Clinical Syndrome

•___

•____ (runny nose)--due to release of____ and____; ___ at first, then ___/___ (___ ___), and then ___ (not an indication for antibiotics; __ ___ are __ __)

•nasal obstruction

•sore throat

•headache

•___

•occasionally __ and ____

 

These are the symptoms

Runny nose is clear at first and then turns white/yellow.  That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection. 

Rhinovirus Clinical Syndrome

•sneezing

•rhinorrhea (runny nose)--due to release of bradykinin and histamine; clear at first, then white/yellow (immune response), and then green (not an indication for antibiotics; normal flora are growing back)

•nasal obstruction

•sore throat

•headache

•malaise

•occasionally fever and chills

 

These are the symptoms

Runny nose is clear at first and then turns white/yellow.  That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection. 

19

Rhinovirus Epidemiology/Treatment

•cause of___ of all___ ___ ___

•immunity is ___

•transmission

____

____

___ to ___--hands (virus can be recovered from the hands of 40-90% of persons with colds)

•half of all infections are ____

•disease more common in __ ___ and____ ___

•symptomatic control

•plenty of___

•___medicines

 

Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response

___ viremia. The infection is localized. If anything there may be small ___ ___ to virus. But No ____ immunity bc of localization

Fomites: inamnimate objects

Most common way is person to person on the hands

•cause of 1/2 of all upper respiratory infections

•immunity is transient

•transmission

•aerosols

•fomites

•person-to-person--hands (virus can be recovered from the hands of 40-90% of persons with colds)

•half of all infections are subclinical

•disease more common in early fall and late spring

•symptomatic control

•plenty of liquids

•OTC medicines

 

Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response

No viremia. The infection is localized. If anything there may be small SIgA response to virus. But No systemic immunity bc of localization

Fomites: inamnimate objects

Most common way is person to person on the hands

20

Coronavirus Characteristics

•___, ___ virus

•___, ___-like appearance

•grows best at____

•infects epithelial cells of the __ ___ __

 

 

Different from rhinovirus because these are enveloped

Coronavirus Characteristics

•enveloped, RNA virus

•solar, corona-like appearance

•grows best at 33-35oC

•infects epithelial cells of the upper respiratory tract

 

 

Different from rhinovirus because these are enveloped

21

Coronavirus Epidemiology

•___ most prevalent cause of the __ __

•cause ____% of ___ ___ tract infections and ___

•spread by ___ and in __ ___

•re-infection occurs __ ___

Occasionaly cause pneumonia but that is rare

re-infection occurs despite antibodies bc its just a__ ___ response in general

Coronavirus Epidemiology

•2nd most prevalent cause of the common cold

•cause 5-10% of upper respiratory tract infections and pneumonia

•spread by aerosols and in large droplets

•re-infection occurs despite antibodies

Occasionaly cause pneumonia but that is rare

re-infection occurs despite antibodies bc its just a local immune response in general

22

Severe Acute Respiratory Syndrome-SARS

•global attention in 2/2003

•caused by ___-__

•WHO notified of 305 cases of atypical pneumonia in __ ___

•SARS declared contained in 7/2003

•>8,000 cases

•780 deaths

•29 countries

•most recent human cases of SARS-reported in ___ in April 2004 in an outbreak resulting from ___ ___ ___

 

 

It was shown that SARS is caused by a ____

This is an example of a virus that Shows up, makes a bunch of people sick and then goes away

About __% mortality

Severe Acute Respiratory Syndrome-SARS

•global attention in 2/2003

•caused by SARS-CoV

•WHO notified of 305 cases of atypical pneumonia in Guangdong Province

•SARS declared contained in 7/2003

•>8,000 cases

•780 deaths

•29 countries

•most recent human cases of SARS-reported in China in April 2004 in an outbreak resulting from laboratory-acquired infections

 

 

It was shown that SARS is caused by a Coronavirus

This is an example of a virus that Shows up, makes a bunch of people sick and then goes away

About 10% mortality

23

MERS-CoV

•first reported in___ ___ in 2012

•severe,__ ___ illness

•spread through ___ __

•___, ___, ___ of ___

•___% mortality

•likely origin is ___; transmitted by ___

•___ cases in U.S. in 2014

•outbreak in ___ in 2015

 

Another one that popped up

Middle East Resp Syndrome

This was also a Coronavirus

Came from bats, transmitted it to camels and then people in contact with camels got infected

Cases in US were in people who had traveled to the middle east

MERS-CoV

•first reported in Saudi Arabia in 2012

•severe, acute respiratory illness

•spread through close contact

•fever, cough, shortness of breath

•30% mortality

•likely origin is bats; transmitted by camels

•two cases in U.S. in 2014

•outbreak in Korea in 2015

 

Another one that popped up

Middle East Resp Syndrome

This was also a Coronavirus

Came from bats, transmitted it to camels and then people in contact with camels got infected

Cases in US were in people who had traveled to the middle east

24

Current Status of MERS Outbreak

Still some hotspots of MERs in the__ __and __

Still some hotspots of MERs in the middle east and Korea.

25

Respiratory Syncytial Virus (RSV)
Characteristics

•_____virus--___, __NA, ____ core; cause ___ ___

•causes____ infection of ___ tract

•highly ____

•causes ____, ___ in children < 1 yr

•causes ___ ___ and ____ in young kids

•causes __ ___ in older kids and adults

 

Similar to virus that causes measles and mumps

Severe in kids who are less than a year old

In young kids, it causes fever and sore throat and cold

Respiratory Syncytial Virus (RSV)
Characteristics

•paramyxovirus--enveloped, RNA, helical core; cause syncytia formation

•causes localized infection of respiratory tract

•highly contagious

•causes bronchiolitis, pneumonia in children < 1 yr

•causes febrile rhinitis and pharyngitis in young kids

•causes common cold in older kids and adults

 

Similar to virus that causes measles and mumps

Severe in kids who are less than a year old

In young kids, it causes fever and sore throat and cold

26

RSV Epidemiology

•the most common cause of severe ___ ___ tract disease among ___ and __ ___worldwide

•can be devastating in ___ ___

•infects nearly ___ by age 2

•large-droplet ____; transmitted by ___, ____, contact with ___ ___

•treatment with ___ (___ analog) ____ in only most severe cases; palivizumab(  ___ ___) for ____ infants

•outbreaks occur in communities __ ___, usually lasting __ months during the___ ____ and/or ___ months

 

We don’t think of these resp viruses very often causing pneumonia. Some of them do.

RSV can get into to lower resp tract and cause infants and young children

Treatment for children who are infected: For RSV, its ribavirin

Ribovirin also treat___  and ___

It’s a nucleoside analogà get into NA and prevents its replication

Its given as a ___ in babies and you can give an immune globin in severe cases or premature infants

RSV Epidemiology

•the most common cause of severe lower respiratory tract disease among infants and young children worldwide

•can be devastating in hospital nurseries

•infects nearly everyone by age 2

•large-droplet aerosols; transmitted by hands, fomites, contact with respiratory secretions

•treatment with ribavirin (nucleoside analog) nebulization in only most severe cases; palivizumab (immune globulin) for premature infants

•outbreaks occur in communities each year, usually lasting 4-5 months during the fall, winter, and/or spring months

 

We don’t think of these resp viruses very often causing pneumonia. Some of them do.

RSV can get into to lower resp tract and cause infants and young children

Treatment for children who are infected: For RSV, its ribavirin

Ribovirin also treats Hep B and C

It’s a nucleoside analogà get into NA and prevents its replication

Its given as a nebulizer in babies and you can give an immune globin in severe cases or premature infants

27

Parainfluenza Virus Characteristics

•____

•___ serotypes cause human disease

•infects epithelial cells of ___ respiratory tract

•___ __ ___ causes cell damage

•clinical diseases include___ , ___ and ___

 

Not influenza virus

Croup: really bad cough

Parainfluenza Virus Characteristics

•paramyxovirus

•four serotypes cause human disease

•infects epithelial cells of upper respiratory tract

•cell-mediated immunity causes cell damage

•clinical diseases include colds, bronchitis, croup

 

Not influenza virus

Croup: really bad cough

28

Parainfluenza Virus Epidemiology

•transmitted by __ ___ and inhalation of __ __ ___

•can cause outbreaks in ___ and pediatric units

•90% to 100% of children aged 5 years and older have antibodies to HPIV-_; about 75% have antibodies to HPIV-_ and -_. 

 

Very rarely cause anything serious

Parainfluenza Virus Epidemiology

•transmitted by close contact and inhalation of large-droplet aerosols

•can cause outbreaks in nurseries and pediatric units

•90% to 100% of children aged 5 years and older have antibodies to HPIV-3; about 75% have antibodies to HPIV-1 and -2. 

 

Very rarely cause anything serious

29

Metapneumovirus

•undiscovered until 2001 because it grows ___ in ___ ___

•nearly ___ ___ has been infected by age 5

___ in adults

•more ___ ___ ___ in kids

•severe __

•____

•___

•new research suggests that this virus is ___ only to ___ as a cause of severe___ respiratory infections in the young, occurring about ___ as often

 

Causes colds in adults and more severe infections in kids

Metapneumovirus

•undiscovered until 2001 because it grows poorly in cell cultures

•nearly every child has been infected by age 5

•colds in adults

•more severe respiratory infections in kids

•severe coughing

•wheezing

•congestion

•new research suggests that this virus is second only to RSV as a cause of severe lower respiratory infections in the young, occurring about 2/3 as often

 

Causes colds in adults and more severe infections in kids

30

Metapneumovirus Epidemiology

___ to ___/ ___ ___ peak

Winter to spring/early summer peak