Dr F Noordeen Department of Microbiology Faculty of Medicine Peradeniya May 2013

Learning outcomes
Modes of transmission and the pathogenesis of respiratory viral infections in humans Clinical features of respiratory viral infections Principles of diagnosis, management and prevention of respiratory viral infections

Aim: Make students aware pathogenesis and

clinical significance of respiratory viruses

Objectives:
1. to diagnose respiratory virus infections (aetiological diagnosis in the lab) 2. to prevent/control them in Sri Lanka

ORTHOMYXOVIRUSES
Influenza virus - A, B and C
Influenza Epidemics Outbreaks Pandemic
- Specific clinical syndrome - Since ancient times - Significant morbidity + mortality - 1918-1919 (20 million deaths) H1N1 - 1997 Asia (Hong Kong) H5N1 - 2009 Americas (Mexico) H1N1 - 2010 and Asia - 2011 H1N1 - 2012 Sri Lanka H5N1 (Avian virus in a poultry farm in Bingiriya)

INFLUENZA VIRUS
80-120 nm, Segmented RNA genome Helical capsid symmetry and very pleomorphic

Classification

Groups - (matrix and NP) Subtypes on N and H

Important surface antigens

Haemagglutinin (H) (surface polypeptide) Neuraminidase (N) (enzyme glycoprotein)

INFLUENZA VIRUS on EM

PATHOGENESIS OF INFLUENZA
Antigenic drift and shift
Non immune population

Destruction of mucous glycoprotein

Neuraminidase mediated

Attachment to respiratory cells

Haemagglutinin mediated

Damaged mucosa and altered clearing

mechanisms
Secondary bacterial infections

INFLUENZA
CLINICAL SYNDROMES

Brief pro-drome of malaise and headache Fever (abrupt onset), severe myalgia Non productive cough Lasts 3 days and full recovery

COMPLICATIONS
Respiratory CNS

- Pneumonia (viral /bacterial) (S pneumoniae, S aureus) - Acute encephalopathy - Post viral encephalitis - Reyes syndrome

LABORATORY DIAGNOSIS
Individual diagnosis - clinical NPA Immunofluorescence (IF) stain Cell culture Sentinel surveillance Laboratories established throughout the world Detect influenza activity Look for changes in N and H Predict outbreaks Prepare stocks of appropriate vaccine

PREVENTION
IMMUNIZATION
KILLED OR SUBUNIT VACCINE and GIVEN ANNUALLY RISK GROUPS Elderly Institutionalised persons Cardiac and respiratory compromised

PARAMYXOVIRUS
RNA virus
156-300 nm helical nucleocapsid surface glycoproteins (H, N, F) and membrane protein

3 Genera
Morbillivirus - Measles virus Paramyxovirus - Parainfluenza virus Pneumovirus - Respiratory Syncitial Virus (RSV)

MEASLES VIRUS
Common childhood exanthem
High fever and characteristic rash Cough, coryza and conjunctivitis

Significant morbidity and mortality Complications

Pneumonia (60% mortality) CNS - Encephalitis (15% mortality)

- Subacute sclerosing panencephalitis (SSPE)

Appreciable drop in incidence since immunisation

MEASLES
DIAGNOSIS 1. Clinical - typical rash with fever 2. Laboratory a. Direct (NPA) - IF or EIA b. Serology - Rise in antibody - Measles specific IgM

Kopliks spots

PREVENTION
Live attenuated vaccine Introduced in 1963 Major impact on incidence of disease Given at 9 months of age Discussion - need for booster

PARAINFLUENZA VIRUSES
4 serologic types Older children & adults - mild to moderate URT

infection -cold infants & children < 5 years

Lower respiratory tract infections Laryngotracheobronchitis CROUP

IP 2- 6 days Hoarseness Seal bark cough Tachypnoea

Re-infections common - Only short Laboratory diagnosis

Cell culture, IFA on NPA

Tachycardia

term immunity Suprasternal

retraction

RESPIRATORY SYNCYTIAL VIRUS (RSV)

First recovered in 1936 Most frequent cause of fatal acute respiratory infection in

infants and young children

Re-infections occur Pathogenesis
Localised infection Bronchiolitis and Pneumonia Vaccination increases severity of disease

Nosocomial transmission common

IMMUNOFLUOROSCENCE OF NASOPHARYNGEAL ASPIRATE FOR RSV

MUMPS VIRUS
Cause of acute benign viral parotitis Epidemiology - world wide and endemic
Spread - direct -person to person Virus present in respiratory secretions 7 days

before clinical illness

Clinical syndromes
Parotitis - usually bilateral Orchitis - usaully unilateral Oopheritis Pancreatitis CNS - Aseptic meningitis (50%)

- Encephalitis

Papilla of parotid gland in mumps

CORONAVIRUS
Strains from human and animals Enveloped RNA virus Optimum temperature 33-35C Upper respiratory pathogen 5-15% of common cold Also a GI pathogen

The novel CORONAVIRUS

Aetiology - Quickly suspected to be a virus March 2003 - 3 groups associated CORONAVIRUS with SARS Recovered this new virus from E 6 cells Finding which surprised the scientists
There were no other respiratory pathogen including human metapneumovirus

Association with the novel coronavirus + SARS agreed

RNA viruses include

1. Herpes Simplex 1 2. Epstein Barr virus 3. Hepatitis B virus 4. Measles virus 5. Respiratory Syncytial Virus (RSV)

Which of the diagnostic method is appropriate for the stated infection

1. RSV 2. Hepatitis A 3. Hepatitis B 4. Chicken pox 5. Measles - IF staining of NP secretions - isolation of virus from faeces - HBsAg detection in the serum - EM examination of vesicle fluid - Rise in mumps antibody titre