Viral Respiratory Tract Viral Respiratory Tract Infection-Part 2Infection-Part 2

Prof. Dr Asem ShehabiProf. Dr Asem Shehabi

Faculty of Medicine, University of Faculty of Medicine, University of JordanJordan

RhinovirusesRhinoviruses

Rhinoviruses part Rhinoviruses part Picorna virus GroupPicorna virus Group.. have positive- .. have positive- sense single stranded RNA genomes..surrounded by sense single stranded RNA genomes..surrounded by protein capsid composed 4 viral protein protein capsid composed 4 viral protein (VP1-4)..(VP1-4)..

IcosahedronIcosahedron structure without Envelop. structure without Envelop. A & B Rhinovirus major group ..A & B Rhinovirus major group .. Over 100 serotypes.. Over 100 serotypes.. Susceptible to stomach acidity, infect nasal Susceptible to stomach acidity, infect nasal mucosa..Common incidence all year seasons.. Few mucosa..Common incidence all year seasons.. Few common serotypes are common serotypes are highly human communicable highly human communicable .. .. droplet infection.. Upper Respiratory Tract.. Caused droplet infection.. Upper Respiratory Tract.. Caused about about 10-20% of common cold 10-20% of common cold infectionsinfections/mild Flu-like /mild Flu-like symptoms.. Epidemic Outbreaks in crowded meeting symptoms.. Epidemic Outbreaks in crowded meeting & areas. & areas.

22//

Incub. 2-3 daysIncub. 2-3 days.. Mild /Severe .. Acute .. Mild /Severe .. Acute Inflammation Nasal & Throat mucosa.. Mild Inflammation Nasal & Throat mucosa.. Mild sore throat, watery nasal discharge, cough.. sore throat, watery nasal discharge, cough.. Children often develop Children often develop sinusitis, otitis mediasinusitis, otitis media.. .. Serotype–specific Immunity for short time.. Re-Serotype–specific Immunity for short time.. Re-infection is common.. infection is common.. Rare Lower RT infectionRare Lower RT infection. . Complications: Complications: Bacterial infections.. Sinusitis, Bacterial infections.. Sinusitis, Pneumonia (Pneumonia (Pneumococcus, H.influenzae, Pneumococcus, H.influenzae, S.aureusS.aureus)..antibiotic treatment. No vaccine)..antibiotic treatment. No vaccine

Corona Respiratory VirusesCorona Respiratory VirusesVirus structure:Virus structure: have positive- sense single stranded have positive- sense single stranded RNA genomes, Lipoprotein envelop associated with RNA genomes, Lipoprotein envelop associated with characteristic ring of small characteristic ring of small protein structuresprotein structures (spikes) spikes) covers covers nucleocapsid.... Crown-like structures.Crown-like structures..Multiply .Multiply within cell cytoplasm..causing within cell cytoplasm..causing cell lysis & syncytiacell lysis & syncytia rapidly. Causing up rapidly. Causing up 30% of human common cold30% of human common cold. . Attached to Ciliary epithelium Trachea, Nasal Attached to Ciliary epithelium Trachea, Nasal mucosa.. Mostly mild URT Infections. Both mucosa.. Mostly mild URT Infections. Both symptomatic or asymptomatic.. Winter-Spring.. Major symptomatic or asymptomatic.. Winter-Spring.. Major symptoms symptoms Nasal dischargeNasal discharge.. less .. less pharyngitis, Fever or pharyngitis, Fever or CoughCough.. Affect All Ages. Re-infections is common.. .. Affect All Ages. Re-infections is common.. Mostly Sporadic Cases..less outbreaks.. In animals-Mostly Sporadic Cases..less outbreaks.. In animals-birds (chicken) infect both birds (chicken) infect both Gut & RTGut & RT.. May affects liver .. May affects liver and CNS. and CNS.

Coronavirus

SARS-CoronavirusSARS-CoronavirusSARSSARS ( ( Severe Acute Respiratory Syndrome)Severe Acute Respiratory Syndrome) is is caused by caused by Corona related virusCorona related virus. . First detected First detected 20032003 in Chinain China.. Later spread worldwide .. Later spread worldwide (2003-4) within weeks first in Asian..later numerous (2003-4) within weeks first in Asian..later numerous countries caused countries caused thousands cases & hundred Deaths.thousands cases & hundred Deaths. In 2012-14 New In 2012-14 New SARS-Like CoronavirusSARS-Like Coronavirus strain caused strain caused Middle East Respiratory Syndrome.Middle East Respiratory Syndrome.. More fatal cases, . More fatal cases, Saudi-Arabia, Jordan , other countries Saudi-Arabia, Jordan , other countries CoronavirusesCoronaviruses affect the upper respiratory & gastrointestinal affect the upper respiratory & gastrointestinal tract human ,animal & birds. tract human ,animal & birds. Clinical Infection cause suddenly severe mixed Clinical Infection cause suddenly severe mixed viral & bacterial viral & bacterial pneumoniapneumonia.. Symptoms include high fever, dry cough, dyspnea, .. Symptoms include high fever, dry cough, dyspnea, headache, hypoxemia, high mortality ..more severe in middle headache, hypoxemia, high mortality ..more severe in middle ages & elderly persons.. progressive ages & elderly persons.. progressive respiratory failure & liver respiratory failure & liver damage.damage..few days..No vaccine or specific antiviral therapy. .few days..No vaccine or specific antiviral therapy.

Rubellavirus-1Rubellavirus-1 Rubivirus:Rubivirus: Rubella/ German measles..Rubella/ German measles..positive-ss RNA, Envelope ..carries only positive-ss RNA, Envelope ..carries only Haemaggultinins (Haemaggultinins (2 glycoproteins, E1, E22 glycoproteins, E1, E2), only one ), only one virus antigenic type.. Part of virus antigenic type.. Part of Togavirus /ArovirrusTogavirus /ArovirrusRubella is a highly contagious viral disease, spread Rubella is a highly contagious viral disease, spread through contact with droplet discharges nose, throat, through contact with droplet discharges nose, throat, rarely by skin contact.. Susceptible ultraviolet light, low rarely by skin contact.. Susceptible ultraviolet light, low pH, heat. The virus may also be present during active pH, heat. The virus may also be present during active disease in the disease in the urine, feces, skin urine, feces, skin   Rubella virus incubation 2 weeks Rubella virus incubation 2 weeks in Respiratory tract in Respiratory tract mucosa.. Saliva, Lymphadenopathy, Viremia, Mild mucosa.. Saliva, Lymphadenopathy, Viremia, Mild fever, later fever, later macular fine skin rash macular fine skin rash .. develops on face, .. develops on face, neck.. then the trunk and extremities.. neck.. then the trunk and extremities.. MostlyMostly subclinical infection.. subclinical infection.. Not recognizedNot recognized.. .. more in more in Children than Adults.. Results Rubella antibodies & Children than Adults.. Results Rubella antibodies & immunity.immunity.

Rubella RashRubella Rash

Rubellavirus-2Rubellavirus-2Rubella may have symptoms similar to those of flu.. Rubella may have symptoms similar to those of flu.. LymphadenopathyLymphadenopathy begins 3 days prior to the skin begins 3 days prior to the skin rash and lasts until 3 days after disappear of rash.. rash and lasts until 3 days after disappear of rash.. Infected person remain for 2 weeks highly Infectious to Infected person remain for 2 weeks highly Infectious to susceptible persons of all ages. susceptible persons of all ages. Humans are the only known reservoir for disease.. Humans are the only known reservoir for disease.. RT, RT, Intestine, Urinary tract.Intestine, Urinary tract.Rubella infection spread all the year.. But more in late Rubella infection spread all the year.. But more in late winter and spring months.winter and spring months.Rubella Rubella is mostly is mostly endemic endemic in countries who have less in countries who have less than 90% immunization.than 90% immunization.Infection during pregnancy:Infection during pregnancy: Lack of Rubella Lack of Rubella antibodies.. Virus reach placenta & fetus via blood.. antibodies.. Virus reach placenta & fetus via blood.. multiply in fetal organ and cause multiply in fetal organ and cause severe damage, severe damage, stillbirth, abortionstillbirth, abortion during the 1-trimester (3-4 months) during the 1-trimester (3-4 months)

Rubellavirus -3Rubellavirus -3• Risk of birth defects drops after the first trimester/20- Risk of birth defects drops after the first trimester/20-

week pregnancy.. rarely any complications in fetus.week pregnancy.. rarely any complications in fetus.Rubella Intra-uterine infection during pregnancy: Rubella Intra-uterine infection during pregnancy: Detected by presence virus Detected by presence virus IgMIgM antibodies in fetus antibodies in fetus blood.. Mother should abort her fetus.blood.. Mother should abort her fetus.Congenital rubella syndrome:Congenital rubella syndrome: Affects the eyes of new Affects the eyes of new born babies (cataracts), Blindness, congenital heart born babies (cataracts), Blindness, congenital heart defects, Brain & CNS abnormalities, Mental defects, Brain & CNS abnormalities, Mental retardation, Deafness, Hepatitis.retardation, Deafness, Hepatitis.Virus may persist in the infected new born baby Virus may persist in the infected new born baby tissues for 3-4 years and can infect others up to one tissues for 3-4 years and can infect others up to one year after birth.year after birth. Rubella infection Rubella infection acquiredacquired later in life of young later in life of young women may be associated with Arthralgia / Arthritis. women may be associated with Arthralgia / Arthritis.

Rubella immunity-4Rubella immunity-4• Rubella Humoral antibodies Rubella Humoral antibodies develop soon after develop soon after

infection/vaccination (IgM, IgG).. Rubella IgG alone infection/vaccination (IgM, IgG).. Rubella IgG alone indicates immunity .. The lack of both antibodies or indicates immunity .. The lack of both antibodies or IgG IgG indicates susceptible to Rubella. indicates susceptible to Rubella. Passive prophylaxis: Passive prophylaxis: SusceptibleSusceptible pregnant women pregnant women after contact with infected Rubella case should given after contact with infected Rubella case should given Rubella human immunoglobulin.Rubella human immunoglobulin.LaboratoryLaboratory testtest : : A 4-fold increase in Rubella serum A 4-fold increase in Rubella serum antibodies titer antibodies titer IgMIgM or both or both IgG & IgM IgG & IgM is diagnostic for is diagnostic for recent infection.recent infection. A live attenuated vaccine is given in A live attenuated vaccine is given in combination with measles and mumps combination with measles and mumps (MMR) (MMR) to any to any woman lacks enough woman lacks enough Rubella AntibodiesRubella Antibodies.. 2-.. 2-3 months 3 months prior to becoming pregnant.prior to becoming pregnant.

Adenoviruses GroupAdenoviruses GroupVirus structureVirus structure: : linear ds-DNA, non-envelopedlinear ds-DNA, non-enveloped, , enclosed in a cubical capsid shell with projected enclosed in a cubical capsid shell with projected surface fiberssurface fibers act as specific receptors.. human & act as specific receptors.. human & Avian specific virus groups.. Wide distribution nature.Avian specific virus groups.. Wide distribution nature.Human Adenovirus:Human Adenovirus: 47 serotypes..common few types47 serotypes..common few types

Pathogensis: Pathogensis: Attachment to mucosal surfaces of respiratory Attachment to mucosal surfaces of respiratory tract, GI tract, and conjunctiva.. Produces severe tract, GI tract, and conjunctiva.. Produces severe cytopathic cytopathic effect effect (CPE) in infected tissues. (CPE) in infected tissues. Transmission:Transmission: Respiratory droplets, Saliva, Blood., Fecal-oral, Respiratory droplets, Saliva, Blood., Fecal-oral, Urine..close contacts.. common asymptomatic infections in Urine..close contacts.. common asymptomatic infections in medical professionals, Common healthy carriers.. children & medical professionals, Common healthy carriers.. children & Adults can transmitted the virus. Adults can transmitted the virus. Virus persist in Virus persist in Tonsils+ AdenoidsTonsils+ Adenoids, Intestine & Urinary tract , , Intestine & Urinary tract , in lymphoid tissues including in lymphoid tissues including Peyer's PatchesPeyer's Patches.. For short/ long .. For short/ long live time.. may be reactivated by immunosuppression condition.live time.. may be reactivated by immunosuppression condition.

Adenoviruses (ds-DNA).. non-enveloped, Adenoviruses (ds-DNA).. non-enveloped, The capsid is built up 252 capsomers with The capsid is built up 252 capsomers with

apical Surface Fibersapical Surface Fibers

Adenovirus-2Adenovirus-2Clinical ManifestationClinical Manifestation: : Almost all humans acquire Almost all humans acquire Adenovirus infection early in life.. Adenovirus infection early in life.. Only a few percentage Only a few percentage (1- 5%) develop mild clinical disease.. Serious disease in (1- 5%) develop mild clinical disease.. Serious disease in Immunocompromised personsImmunocompromised persons, , Common associated with Common associated with kidney transplant. kidney transplant. Common Clinical Diseases:Common Clinical Diseases:1-Acute Respiratory Infections: 1-Acute Respiratory Infections: Few serotypes.. Common in Few serotypes.. Common in crowded schools, military & refuge camps .. crowded schools, military & refuge camps .. Acute febrile Acute febrile pharyngitis, pharyngitis, fever, runny nose, mild cough.. Rarely pneumonia/ fever, runny nose, mild cough.. Rarely pneumonia/ Pharyngo-conjunctivitis.Pharyngo-conjunctivitis.2-Conjunctivitis: 2-Conjunctivitis: Epidemic keratoconjunctivitis with no systemic Epidemic keratoconjunctivitis with no systemic symptoms, very painful, Sporadic & Outbreaks cases.symptoms, very painful, Sporadic & Outbreaks cases.3-Acute Gastroenteritis: 3-Acute Gastroenteritis: Few serotypes.. common infants.. Less Few serotypes.. common infants.. Less other children/Adults.. Mesenteric Adenitis.. Mild-acute other children/Adults.. Mesenteric Adenitis.. Mild-acute Diarrhea.. Diarrhea.. chronic diarrhea chronic diarrhea in patient with AIDS or in patient with AIDS or immunosuppressed conditions. immunosuppressed conditions.

Adenovirus-3Adenovirus-34-Acute Hemorrhagic Cystitis: 4-Acute Hemorrhagic Cystitis: Children & Young Children & Young

Males/Females.. Infection genital tract cause Males/Females.. Infection genital tract cause Cervicitis , Urethritis , Haemorrhagic cystitis, Cervicitis , Urethritis , Haemorrhagic cystitis, Hepatitis, Pneumonitis..Fatal immunosuppressant. Hepatitis, Pneumonitis..Fatal immunosuppressant.

Immunity: Immunity: Specific humoral antibodies against one Specific humoral antibodies against one or few serotype..Last long time and protect against or few serotype..Last long time and protect against re-infection.. Each country has endemic specific re-infection.. Each country has endemic specific Adenovirus type infections. Adenovirus type infections.

Diagnosis: Diagnosis: Detection a rise in specific antibodies by Detection a rise in specific antibodies by ELASA.. Viral antigen Detection DNA PCR . ELASA.. Viral antigen Detection DNA PCR .

Treatment: Treatment: Antiviral drugs for eye infection & other Antiviral drugs for eye infection & other patients .. patients .. Cidofovir, RibavirinCidofovir, Ribavirin.. No Vaccine. .. No Vaccine.