MENDIOLA, LEOMIL O.

FEBRUARY 12, 2017

BMLS 3B DR. AMELDA C. LIBRES RMT
VIRUSES (Finals)
Source: Bailey and Scotts Diagnostic Microbiology

DENGUE Virus
GENERAL CHARACTERISTICS

Dengue is a aviviruses which can cause arbovirus diseases including hemorrhagic fever.
o Flaviviruses are small, single-stranded, positive sense RNA, enveloped, icosahedral viruses. It
is derived from a Latin word avus, which means yellow.
Diseases in this viral group are transmitted to humans through the bite of an infected mosquito.

EPIDEMEOLOGY

The dengue virus is the most prevalent arbovirus in the world; more than 100 million people are
infected annually.
It is the leading cause of illness and death in the tropics and subtropics. The virus is endemic in Latin
America, Puerto Rico, and Mexico.
Humans are the main reservoir for this virus, and person to-person transmission occurs through a
mosquito vector.
Dengue has (4) serotypes based on clinical manifestation, including nonlethal fever, arthritis, and rash.
Infection with one serotype confers immunity only to the infecting serotype.
Subsequent infection with one of the three remaining serotypes results in immune-enhanced disease in
the form of severe hemorrhagic fever or dengue shock syndrome.
Dengue normally affects adults and older children.

SYMPTOMS

The infection begins with a sudden onset of fever, severe headache, chills, and general myalgia. Often
a macropapular rash may be visible on the trunk of the body, which then spreads to the face and
extremities.
LABORATORY DIAGNOSIS

RT-PCR amplification for dengue genomic sequences.

Laboratory diagnosis is based on IgM antibody (4x rise)

PREVENTION

Elimination of the Aedes aegypti as a vector.

No vaccine is available

The term viral hemorrhagic fever is used to describe a severe multisystem syndrome in which multiple
organ systems are affected throughout the body. The patients vascular system becomes damaged, and the
bodys ability to regulate itself is impaired.
MARBURG VIRUS
The Filoviridae family of viruses is considered the most pathogenic of the hemorrhagic fever viruses.
The term flo means threadlike, referring to the viruss long, filamentous structural morphology seen with
electron microscopy.
The viruses are pleomorphic, enveloped, nonsegmented, single-stranded, negative sense RNA viruses.
The filamentous morphology appears in many forms under the EM, such as the 6, U, or circular.
Marburg hemorrhagic fever virus displays the characteristic shepherds hook morphology.

SYMPTOMS
Infection with the Marburg or Ebola virus, endemic in Africa, results in severe hemorrhages, vomiting,
abdominal pain, myalgia, pharyngitis, conjunctivitis, and proteinuria.
EPIDEMEOLOGY

Human case fatality rates for Ebola virus (80%); Marburg virus infection fatality (23%- 25%).
 o These diseases have no cure or established drug treatment.
The first filovirus was detected in Marburg, Germany, when a group of German laboratory workers
became ill and developed hemorrhagic fever after handling imported African green monkeys or monkey
tissue while preparing polio vaccine.
LABORATORY DIAGNOSIS (see Ebola virus)
EBOLA VIRUS
GENERAL CHARACTERISTICS

Ebola virus is the only other member of the Filovirus family.

Named after a river in Zaire (D R Congo), where it was first identified.
The genus Ebolavirus has five (5) subspecies, based on the first location where the virus was identified:
o Zaire ebolavirus,
o Sudan ebolavirus
o Cote dIvoire ebolavirus (formerly referred to as EbolaIvory Coast),
o Bundibugyo ebolavirus
o Reston ebolavirus.

EPIDEMEOLOGY

All of the Ebola subspecies cause disease in humans and nonhuman primates (i.e. Chimpanzees,
gorillas, and monkeys) except for Reston ebolavirus, which causes disease only in nonhuman primates.
o Reston ebolavirus is known to have caused infections through aerosolization of secretions.
The Ebola virus was first recognized in 1976, when a total of 602 people became ill in Zaire and Sudan.
Infections are acute, with no carrier state.
Transmission of the virus is rapid. Individuals caring for the sick who come in contact with the patients
secretions quickly develop symptoms. In fact, many of the early Ebola outbreaks were attributed to
nosocomial infections.
Fatality rate >70%.
The natural animal reservoir for the Ebola and Marburg viruses has never been determined

LABORATORY DIAGNOSIS

RT-PCR is used to identify the Ebola and Marburg viruses.

Electron microscopy is also available in some research facilities.
Cell culture is available in laboratories with BSL 4 facilities.
Antibody production occurs after an Ebola virus infection, and an antigen-capture ELISA is available to
detect IgM and IgG antibodies to Ebola virus (antibody arise even without symptoms).

MUMPS
Family: Paramyxoviridae
Mumps is an acute, self-limiting disease characterized by parotitis (inamed salivary gland)
accompanied by a high temperature (fever) and fatigue.
The mumps virus is transmitted through droplets and contact with infected saliva.
The measles virus causes an acute, generalized infection often accompanied by a characteristic rash.
The hallmark rash of measles infection is referred to as Kopliks spots, which are bluish white spots
with a red halo located on the buccal or labial mucosa.
These spot are found on the inner lip or opposite the lower molar in the mouth.
The virus is transmitted from person to person through aerosols and infects the mucosal cells of the
respiratory tract
LABORATORY DIAGNOSIS (see measles)

MEASLES VIRUS
Measles is one of six classic childhood diseases capable of causing a rash or skin eruption
(exanthem).
Atypical measles (occurs in those with waning vaccine immunity), and subacute sclerosing
panencephalitis
The other diseases that cause an exanthema are
1) Including measles
2) Scarlet fever
3) Rubella, (German measles) Referred to as atypical scarlet fever
4) Erythema infectiosum (or fifth disease, caused by parvovirus b-19)
5) And roseola (caused by hhv-6)
 LABORATORY DIAGNOSIS for Mumps and Measles

Diagnostic testing for these viruses involves serologic analysis of patient serum for IgM and IgG
antibodies
Cell culture for virus detection
o Measles specimen choice: Respiratory and Throat
o Mumps: buccal swabs (inside of the cheek)
These viruses are also shed in the urine.

PREVENTION

Vaccines for measles and mumps (a part of a trivalent vaccines including rubella)

RUBELLA VIRUS (German measles)

Rubella is a family of Togavirus which has a single-stranded RNA genome and icosahedral capsid with
envelope.
Mode of transmission

Rubella is found only in the human population and is transmitted through direct contact with
nasopharyngeal secretions
Congenital transmission. A risk associated with this disease is exposure and infection of pregnant
women.
o It occurs during the first trimester may result in low birth weight, mental retardation, deafness, congenital
heart disease, and neurologic defects. Infection that occurs later in pregnancy may result in splenomegaly
or osteomyelitis, among other birth deficiencies
Human is not an amplifier of the virus but rather a dead end host (togoviridae)

Symptoms

a benign disease characterized by fever and rash

Laboratory diagnosis

Togavirus disease is diagnosed through detection of specific serum IgG and IgM antibodies.
Virus isolation is not practical in clinical laboratories.

Prevention

For pregnant: Fetal infection can be prevented through vaccination before pregnancy.

POXVIRUS
GENERAL CHARACTERISTICS

The poxviruses are the largest and most complex of all viruses.
The virions consist of a double stranded DNA genome.
The virions appear as oval or brick-shaped structures 200 to 400 nm in length.
Due to its large size, poxvirus virions may be visualized through a light microscope.

SMALLPOX
EPIDEMEOLOGY

Smallpox is one of the most feared viruses of history.

In 1798 Edward Jenner recognized that milkmaids previously infected with cowpox were immune to
the disease of smallpox.
This discovery led to the practice of inoculating humans against smallpox by using the actual organism
(virus) responsible for the disease.
Smallpox is known to infect only humans and exists as two distinct subtypes.
1) Variola major, which caused the most severe disease (case fatality rate of 30%) mainly in Asia
2) Variola minor was associated with less severe disease and case fatality rates of 0.1%-2%.
result of an intensive vaccination campaign,
WHO declared naturally occurring variola virus eradicated in 1980 but it is feared as a possible
biologic weapon
MONKEYPOX
 The second type of infection is associated with variola virus (smallpox) and also monkeypox, and an
increased mortality rate.
Monkeypox is almost indistinguishable from smallpox infection except that it lacks the same level of
mortality and transmissibility.
It is found in the tropical rain forests of Africa, and its host reservoir is one or more rodent species.
Two clades of monkeypox exist and the Congo Basin clade has the highest fatality rate (up to 12%).

SYMPTOMS
1) symptoms of fever and headache occur first,
2) Followed by the development of a rash and lymphadenopathy.
a. The rash typically first appears on the face, beginning as macules (small, round changes in skin color)
3) Progressing to papules (slightly elevated with no uid) to vesicles (containing a bubble of uid)
and then pustules (containing purulent material consisting of necrotic inammatory cells).
illness can last 2 to 4 weeks

LABORATORY DIAGNOSIS
RT-PCR (real-time).

MOLLUSCUM CONTAGIOSUM VIRUS

MODE OF TRANSMISSION
Another member of the poxvirus family which causes single or small clusters of lesions.
Its only host is humans, and infection occurs either nonsexually, through direct contact or
fomites, or sexually, through intimate contact.
SYMPTOMS

Usually a self-limiting disease in healthy individuals, moluscum contagiosum can cause a more
severe form of disease in immunocompromised patients, resulting in large lesions, especially on
the face, neck, scalp, and upper body.
LABORATORY DIAGNOSIS

Biopsy of the lesions and histologic examination.

Molecular assays such as PCR, restriction fragment length polymorphism (RFLP), and real-
time-PCR, are still under development.
ORF
MODE OF TRANSMISSION

Another member of the poxvirus family and is transmitted from sheep to humans through human direct
contact with infected sheep.
SYMPTOMS

This virus causes single or multiple nodules, usually on the hands.

These nodules may be painful and may be accompanied by symptoms such as low-grade fever and
lymph node swelling.
The infection usually resolves in 4 to 6 weeks without further complication,
Autoinoculation of the eye can have more serious consequences.

LABORATORY DIAGNOSIS

direct examination of the nodule

Epidemiologic evidence of a recent history of contact with sheep or lambs.

RABIES
 Is a family of Rhabdoviruses which infect plants, arthropods, fish, and mammal.
The virions consists of single-stranded RNA helical Nucleocapsid surrounded by a lipid bilayer
envelope with Spike like projections approximately 10 nm long extend from the surface of the lipid
bilayer and has a bullet-shaped or conical appearance.
Rabies virus is a neurotropic virus that infects all mammals.

MODE OF TRANSMISSION
The rabies virus is transmitted through the saliva of infected animals, usually by a bite.
PATHOGENESIS
1) After inoculation, the virus may invade the peripheral nerves or nerve endings in order to go central
nervous system by moving centripetally and transneuronally known as retrograde axoplasmal flow.
2) In the CNS it proceeds from frst-order neurons to second-order neurons. The neurons are the site of
viral replication, mainly in the brain and spinal cord;
3) Then the spreads to peripheral nerves and to some non-nervous tissue, including the salivary glands.
4) After a variable incubation period, human disease usually begins with generalized symptoms of
malaise, fever, fatigue, anorexia, and headache. Frequently (and characteristically for this disease),
Symptoms include pain and sometimes tingling at the site of exposure, a first rabies-specific
symptom.
After this prodromal phase, behavioral changes may start to manifest, followed by rapidly
progressing neurologic symptoms that lead to coma and death.
After the prodromal phase of the disease, a period of increased excitation occurs, with or without
aggression. Clinical presentations of rabies often are described as furious or dumb;
o furious type is associated with heightened aggression and agitation,
o Dumb type with lethargy and paralysis.

TREATMENT

In 2004, Randy Willoughby developed a treatment protocol for rabies referred to as The Milwaukee
Protocol. This protocol requires that the patient remain in a prolonged state of generalized anesthesia,
anti-viral drugs, and supportive, life-sustaining care until individuals natural active immunity is capable
of clearing and/or fighting the infection.

LABORATORY DIAGNOSIS

Postmortem examination of brain tissue using a direct immunouorescent assay.

o Specific sections of the brain are examined for the rabies antigen using uorescent-tagged
monoclonal antibodies and a uorescent microscope.
Prompt, accurate diagnosis of rabies infections in animals is important to ensure the success of
post exposure prophylaxis for human victims of animal bites and injuries.