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PE findings
- UO is most important sign
dehydration
- Hyperactive bowel sound
- Dry mucosa and skin
- Tachycardia
- Depressed sensorium
- Weight loss
SINGLE STRANDED, (+) SENSE, ENVELOPED, ICOSAHEDRAL RNA VIRUSES
6 genotypes HCV binds to CD81 tetraspanin or - Chronic hepa C Hepa C virus Acute Infection can 1. HCV Ab 1. Interferon chronic
MAJOR CAUSE OF POST scavenger receptor B1 in lead to: diagnosis active Hepa
Cirrhosis Hepa Ca
TRASFUSION HEPATITIS hepatocytes and B lymphocytes 1. recovery - 4 wks before it 2. Ribavirin
coat itself with LDL and VLDL and - IV abusers, tattoo recipients, 2. rapid onset cirrhosis appears so 3. Screening of blood,
Hepatitis C transfusion and organ
use lipoprotein receptor for 3. Persistent infection cannot be used organ and tissue donors
hepatocyte uptake resemble recipients, hemophiliac and a. Asymptomatic in acute phase 4. Blood and bodyfluid
and buds in ER bind to TNF HIV pxs b. chronic hepatitis liver precaution
- Affects only humans and
recpetor and protein kinase R failure / cirrhosis / 2. HCV RNA 5. Limit alcohol drinking
chimpanzees
inhibition of apoptosis and hepatocellular Ca diagnosis in acute
interferon phase
Immunity is not lifelong and viremia: main use is for
protective acute infection 4-6 mos monitoring antiviral
persistent infection - >10yrs therapy
TOGAVIRIDAE Transmission: Incubation 14-21 days 3 day Presence of antirubella Live attenuated vaccine for
- Respiratory droplets maculopapular rash posterior IgM prophylaxis
- Transplacental LAD - Not for pregnant and
Rubella - German measles or 3 day RT-PCR of viral RNA IC pxs
measles Humans are the only host Immune complex polyarthritis in
adults
Infection promotes lifelong
immunity
CONGENITAL RUBELLA
SYNDROME
- During 1st trimester
- Abnormalities:
PDA
Congenital cataracts
bilateral leukocoria, loss of
ROR
Sensoneural deafness
Mental retardation
Bulag, bingi, bobo, butas ang
puso, blueberry baby
Human - Diploid - Kills helper CD4 T cells Transmission: Clinical Syndromes: Presumptive Dx 1. HAART
Immunodeficiency - Many serotypes TB no.1 killer Ab detection by ELISA 2 nucleoside inhibitors
Virus - Main immune response: cytotoxic Original source C. neoformans - zidovudine and
Structural genes: CD8 T cells chimpanzees, diet meningoencephalitis Definitive DX lamivudine
1. GAG gene Transfer of semen, presented as chronic - Western blot analysis - lactic acidosis
Stages of Infection: transplacental and perinatal headache - using gel electrophoresis protease inhibitor
P24- nucleocapsid Needlestick more of CMV blindness - indinavir
- Found in core Phase 0 INFECTION HEPA B Candida esophagitis Gold Standard PCR - Fat redistribution
- Important serologic - HIV acquired Most common means - Sex Toxoplasma ring in CT - Detect HIV DNA in cells syndrome
marker of infexn Phase 1 WINDOW PERIOD and plasma viral RNA Immune reconstitution
P7 nucleocapsid - Viral replication with (-) HIV test AIDS defining illnesses - For prognostication syndrome
P17 matrix Phase 2 SEROCONVERSION 1. P. carinii pneumoni - HBV, HCV, MAC/MAI
- Peak of viral load, (+) HIV test, flu 2. Esophageal candidiasis
2. POL gene like illness 1-2wks 3. Wasting Inc IL-12, TNF 2. General prevention
Phase 3 LATENT PERIOD 4. Kaposi sarcoma HHV8 responsible sex
Reverse transcriptase - Asymptomatic for 1-15yrs 5. Diss Mac
transcribe RNA to DNA - Low CD4 3. Perinatal prevention
Protease Phase 4 EARLY SYMPTOMATIC - perinatal prophylaxis
cleaves precursor - CD4 500-200 -Abs CI to breastfeeding
polypeptide - last 5 yrs, mucocutaneous, derma is galactosemia, HIV is
Integrase and hema illness only relative CI
integrates viral DNA to
host cell Phase 5 AIDS 4. Post exposure therapy
- CD4<200 last 2 years, AIDS - AZT
3. ENV gene defining illnesses present
Gp120
attachment to CD4
- Mutates rapidly
antigenic variation
Gp 41
- Fusion with host cell
Regulatory gene:
tat activation of
transcription
rev transport of mRNA to
cyto
nef dec CD4 and MHC1
vif hypermutation
vpr transport in nondividing
cell
vpu virion release
HTLV-1 - ADULT T-CELL Spread in cells after BT, sex of breast ELISA AZT and interferon alpha
LYMPHOCYTIC feeding. RT-PCR
LEUKEMIA (ATLL)
- HTLV-ASSOCIATED
MYELOPATHY
(tropical spastic
paraparesia)
SINGLE STRANDED, (+) SENSE, ENVELOPED, HELICAL RNA VIRUSES
PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT
STRUCURE
CORONAVIRIDAE
- 2 serotypes - infection in URT - reservoir: horseshoe bat Incubation: 2-10 days Chest Xray: non cavitary
Coronavirus - 2nd MOST COMMON - optimum viral growth temp of - intermediate host: civet cat ground glass infiltrates
CAUSE OF COMMON 33C to 35C - respeoratory droplet SARS ARDS
COLDS - longer incubation of 3 days - CIVET CAT SARS Viral RNA in respiratory
than rhino and stool by RT-PCR
- virus binds to ACE 2 receptors
kills alveolar epithelium
SINGLE STRANDED, (+) SENSE, NAKED, ICOSAHEDRAL RNA VIRUSES
main cause of HBGA on enterocyte act as host BREASTMILK Incubation: 12-60 hours, RT-PCR Bismuth subsalicylate
gastroenteritis outbreak receptor dec sucrose, trehalase and -inhibit transmission by persist for at least 7 days Handling food carefully
with contaminated water ALP act in intestinal brush border inhibition of binding of 2mos. Genotyping based on region
Norovirus and food SHELLFISH villous atrophy, epithelia norovirus D for strain differentiation
MOST COMMON CAUSE disarrangement, crypt hyperplasia, cyto Self limited nonbloody
OF NONBACTERIAL vacuolization malabsorption and diarrhea, nausea and EIA for stool antigen
DIARRHEA IN ADULT delayed gastric emptying vomiting vomiting nd low fever detection
and diarrhea
1-2 days in outbreak and 5-6
days in endemic cases
PICORNAVIRIDAE Rhinovirus
Enteroviruses: poliovorus, echovirus, cosxackie virus A and B, Hepa A
Acid stable and survive GI
CYTOPLASMIC REPLICATION
When cell if infected, the ER will not fuse to the CIS side of golgi
Replication in mucosa, lymphoid tissue pf pharynx and tonsils GI target tissue viremia
FECAL ORAL ROUTE
Poliovirus 3 serologic types - Bind to anterior horn cell of SC and FECAL ORAL Poliomyelitis poliovirus + SALK vaccine
COWDRY TYPE B muscle cells ROUTE coxsackie virus A killed IPV
INTRANUCLEAR
INCLUSION 1. Asymptomatic Infection SABIN VACCINE
- Infexn limited to live OPV
oropharynx and gut - Prevent dse and inc
2. Abortive poliomyelitis IG
-mild illness, fever,
headache
3. Non paralytic poliomyelitis
(aseptic meningitis)
-fever, headache, stiffneck
and pleocytosis in CSF
4. Paralytic poliomyelitis
(major illness)
- Flaccid paralysis from
LMN lesion
- Spinal paralysis one
or more limbs
- Bulbar paralysis CN
and medullary respi
center
ASEPTIC MENINGITIS
WITH RASH CoxA +
Echovirus
Cosxackie A Virus FECAL ORAL ROUTE Herpangina
AEROSOL - Fever, sorethroat and
vesicles in oropharynx,
pain in swallowing
- Self limited
Acute hemorrhagic
conjunctivitis
- Enterovirus70 and Cox
A24
Hepatitis A Enterovirus 72 Fecal oral route Symptoms occur 15-50 days Anti HAV IgM
Common in after exposure (fever,
STREETFOODS and nausea, loss apetite,
SHELLFISH abdominal pain) jaundice
Self Limited phase (no symptom)
recovery
SINGLE STRANDED, (-) SENSE, ENVELOPED, HELICAL RNA VIRUSES
Unsegmented genome
PARAMYXOVIRIDAE RNA dependent RNA polymerase
Hemaglutinin attachment
Neuraminidase
fusion proteins fusion of cell to multinucleated giant cell for Ab protection
URTI retisculoendothelial cells Respiratory droplet Incubation: 10-14 days VITAMIN A reduced
depress cell mediated immunity transmission severity
Measles RUBEOLA transiently multinucleated GC Lifelong immunity for px Koplik spot in stensen duct
(WARTHIN FINKELDEY BODIES) who had the dse of parotid gland Live attenuated Vaccine
(+) hemaglutinnin and skin by hematogenous spread maculopapular rash in face, for prevention
fusion protein vasculitis Rash CD8 attacking the trunk, ext, palms and soles
measles infected vascular endothelium
Complications:
1. Post infectious
Encephalitis
- Px with inactivated
vaccine and exposed
to wilder strain
2. Pneumonia
worst
3. SSPE
virus persist in body
acts as slow virus but
cannot spread
-DAMSON INCLUSION
BODIES
3 Cs
Cough, Coryza,
Conjunctivitis, Koplik spot
Mumps (+) hemaglutinnin, URT local replication -> viremia Respiratory droplet Incubation: 18-21 days Saliva, urine and CSF IgM Live attenuated Vaccine
neuraminidase and systemic infection transmission Bilateral swelling of Ab for prevention
fusion protein 1. Parotid gland Lifelong immunity for px parotids when drinking
2. Testes, ovaries, PNS and who had the dse citrus juice
CNS, eyes and ears Self limited within 1 week
3. Pancreas juvenial diabetes
Complications: orchitis and
meningitis, parotitis,
menningits, pancreatitis
Pleomorphic adenoma
tumor in parotids
MATERNAL Ab passes in
placenta and protection for
first 6 months of life
RSV (+) fusion protein Plugs in small airways of neonates Humans are natural hosts Bronchiolitis and pneumonia Wheezing in broncholitis Ribavirin
pneumonia and bronchiolitis fever, cough , dyspnea, - Same with hepa E
multinucleated GC
(wheezing) localized infection in No systemic spread cyanosis
syncytia URT
Severe disease with Febrile rhinitis and
IMMUNOLOGIC CROSS pharyngitis children
REACTION WITH
MATERNAL AB Common cold adults
Parainfluenza Virus (+) hemaglutinnin, Local disease in upper and lower Humans and animals both CROUP Croup: Steeple sign in xray Croup racemic epi
neuraminidase and RT affected but animal strains - Inspiratory stridor, cough
fusion protein do not affect humans and hoarseness seal Thumbprint sign - epiglotittis Epiglottitis - ceftriaxone
No viremic spread bark
Four types - Subglottic stenosis
Virus 3
- Most common in children
with LRTI
ORTHOMYXOVIRIDAE 8 segments
interact with mucus
Influenza Virus Majot antigens: INFLUENZA A Respiratory droplet Incubation: 24-48 hr Oseltamivir or Zanamivir
1. hemaglutinin transmission drug of choice
attachment Antigenic shift sudden major change targeting
- target of neutralizing reassortment new strain Human bites can transmit Clinical presentation neuroaminidase
Ab pandemic virus - Myalgia
2. Neuraminidase - Fever Amantidine or
- release of virus by Influenza A - Headache rimantidine
breaking sialic acid INFLUENZA B animal reservoir - pharyngitis influenza A only
- degrade respi - Aquatic birds or - cough - prevents uncoating of
epithelium Antigenic drift mutation waterfowl common virus less
epidemics source Complication transmission
Influenza A - Pigs mixing bowl - staph pneumonia
worldwide epidemic - Waterfowl H1 tp - reye syndrome Yearly vaccine to
(pandemic) H16 and N1 to N9 influenza B during rainy
- Most common - Humans H1 to H3 season
cause of RTI and N1 to N2
- 16 HA and 9 NA
Influenza B
Influenza B human reservoir
major outbreak of - Must be included in the
influenza new vaccine for
- No pandemic influenza
- No common antigen with
Influenza C inf A
mild RTI
- do not cuase
outbreal
PHYSIOLOGY AND PATHOGENESIS EPIDEMIOLOGY CLINICAL MANIFESTATION LAB DIAGNOSIS TREATMENT
STRUCURE
RHABDOVIRIDAE
- bullet shaped Multiply locally at animal bite - Animal reservoir: dogs, cats, Incubation: 2-16 weeks Pre-exposure: vaccine
Rabies virus - assembly in cytoplasm sensory neuron axonal skunks, raccoons and bats Post-exposure: vaccine
- NEGRI BODY transport to CNS - Transmission by animal Incubation period 20-80 days and Ig
intracytoplasmic eosinophilic bites prodromal period (pain and itch
inclusion - US skunk in bite) acute neurologic Rabies vaccine: >4
- Philippines dogs period (fasciculation, priapism sessions
and convulsion, furious rabies)
coma due to respi depression Do not bring rabid animal
to ER
Symptoms:
- Confusion
- Lethargy
- Hypersalivation
- laryngospasm,
- hydrophobia (pain in attempt
to swallow h20)
- encephalitis
- aerophobia